Publications

OBJECTIVES: To analyze the intercontinental differences and inequities in the management of hepatocellular carcinoma (HCC), including surveillance, diagnosis, and treatment, through the survey responses from the participants of the Global Abdominal Imaging Forum on HCC, organized by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR).

MATERIALS AND METHODS: An online anonymous survey was distributed to the attendees of the Global Abdominal Imaging Forum on HCC. The survey consisted of 14 multiple-choice questions, covering demographic, epidemiological and occupational data, and information on the management of HCC. Global differences and differences between European and non-European countries were analyzed.

RESULTS: Of 1963 attendees from 110 countries, 408 (20.8%) from 67 countries responded to the survey. Multidisciplinary HCC meetings were reported with the highest frequency in North America (83.3%) and the lowest in Africa (41.2%). The most commonly reported tools for HCC surveillance were ultrasound (86.8%) and serum alpha-fetoprotein (79.4%). Global inequities were reported for contrast-enhanced ultrasound (p < 0.001, lowest access in South America, Africa, and Asia), MRI (p < 0.001, lowest access in Africa) and PET/CT (p < 0.001, lowest access in Africa). LI-RADS was the most common algorithm used for HCC diagnosis (83.6%), with the highest use reported in North America (94.4%). Heterogeneity in treatment availability was observed, with respondents from Africa reporting limited availability of surgery (41.2%), locoregional treatments (23.5%), liver transplantation (0%), and immunotherapy (17.6%).

CONCLUSION: Although the surveillance strategy for HCC is similar at a global level, disparities exist in access to CEUS, MRI, PET/CT, and treatments for HCC.

KEY POINTS: Question What are the global disparities in hepatocellular carcinoma surveillance, diagnosis, and treatment reported by doctors working in different continents? Findings The survey from the Global Abdominal Imaging Forum on HCC revealed significant global variability with disparities regarding access to advanced imaging modalities and treatments, particularly affecting Africa. Clinical relevance Global efforts should focus on improving access to advanced imaging techniques (including MRI and PET/CT) and treatments (including transplantation and immunotherapy). Guidelines for the management of HCC should consider the existing regional disparities in healthcare infrastructure and resource availability to ensure more equitable HCC care worldwide.

Few studies have published on the existing models of cancer multidisciplinary clinics (MDCs) and no studies have conclusively compared the implications of different MDC models. We aimed to characterize MDC structural elements and reported quality measures through a narrative review of cancer MDCs in the United States. Forty-one unique MDCs were examined (8 breast, 13 gastrointestinal [GI], 8 genitourinary [GU], 4 head and neck [HN], 3 lung, 5 other cancers). MDCs were most commonly weekly (19/41) and evaluated new patients (9/41). All breast and most GU (5/8) and lung (2/3) MDCs were asynchronous whereas all HN MDCs were synchronous. Interdisciplinary discussions most frequently preceded provider visits, except for HN and other cancer MDCs. Medical, radiation, and surgical oncology were almost always included across all MDCs. The 41 unique institutional MDCs were reported across 54 studies (10 breast, 17 GI, 13 GU, 4 HN, 4 lung, 6 other cancers). Outcome measures were investigated by 38/54 (70%) studies, of which 13 reported overall survival and 6 (46%) noted a statistically significant improvement with MDCs. All lung and approximately half of GI (7/17), breast (5/10), and HN (2/4) MDCs examined a process measure. Structure and balance measures were not as widely reported. Current understanding of MDCs is based on disparate reports with significant heterogeneity in MDC structures and reported outcomes. Further investigation is needed to better elucidate the impact of MDCs in cancer care outcomes across different cancer diagnoses.

BACKGROUND: Meningiomas are typically managed with surgery or radiotherapy, but recurrent or surgically inaccessible tumors present a persistent therapeutic gap, particularly for progressive higher grade disease. Intra-arterial yttrium-90 (90Y) transarterial radioembolization (TARE) is well established for hepatocellular carcinoma to deliver high dose, short range β-brachytherapy in the form of 20-60µm radioactive microspheres. This technology could plausibly be adapted to meningiomas, exploiting their dominant dural arterial supply.

METHODS: We performed systematic searches of PubMed and Google Scholar for literature directly addressing intracranial TARE planning or delivery, supplemented by a scoping review of adjacent fields: meningioma radionuclide therapy, peptide receptor radionuclide therapy (PRRT), hepatic TARE, bland meningioma embolization, and the radiobiology relevant to meningioma vascular behavior, dosimetry, hypoxia, and imaging.

RESULTS: Five studies and one ongoing clinical trial directly addressed intracranial TARE or its planning. Seventy-four supporting studies informed synthesis across meningioma embolization, vascular anatomy, hepatic TARE dosimetry and device characteristics, and foundational radiobiology. Currently two TARE platforms exist (glass and resin), with differences in dose-per sphere and physical density which may impact deliverability. The compartmentalized dural arterial supply of most meningiomas supports catheter-based access and may permit single-compartment dosimetry modeling, with generally low-to-moderate arterial shunting risk. The established but incomplete efficacy of radioligand therapies provides a biologic rationale for TARE, while underscoring the need for higher tumor radiation delivery, which early dosimetry work suggests may be achievable with TARE.

CONCLUSIONS: TARE is a plausible treatment for recurrent and inoperable meningiomas due to their compartmentalized vascular supply. Four considerations should anchor early phase trial design: (1) microsphere platform selection between glass and resin spheres, with their differing embolic burden and dosimetric profiles; (2) whether to limit treatment to external carotid artery territories or include internal carotid artery supplied tumor; (3) compartmental dosimetric planning calibrated to meningioma angiosomes; and (4) a structured safety framework non-target deposition, peri-procedural risks, and delayed radiation necrosis.

BACKGROUND: Conventional clinical scoring systems and contrast-enhanced computed tomography (CECT) interpretation provide limited accuracy in predicting adverse outcomes in early acute pancreatitis (AP). This leads to suboptimal patient management and underscores the need for improved triage methods. To address this, we developed a multimodal artificial intelligence (AI) framework that integrates clinical parameters, radiomics, and deep learning (DL) models to predict adverse clinical outcomes in early AP.

METHODS: In this retrospective tertiary-care, imaging-enriched cohort study, patients with AP who underwent CECT within 72 h of hospital admission were included. Adverse clinical outcomes were defined as mortality, intensive care unit (ICU) admission, or the need for invasive intervention within 30 days. Radiomics (using both pancreatic and peripancreatic features) and DL models were developed using CECT images to predict adverse outcomes. Multimodal models were constructed by integrating imaging and laboratory variables. Model performance was compared with three independent radiologists' prognostic imaging assessments and with established clinical scoring systems (Ranson and Glasgow-Imrie).

RESULTS: A total of 284 patients with AP were included, of whom 140 (49.3%) experienced adverse clinical outcomes. Conventional clinical scores showed limited discrimination, with AUCs of 0.61 for Ranson and 0.67 for Glasgow-Imrie. Imaging-only assessment by three expert radiologists yielded modest predictive performance (average AUC = 0.629; sensitivity = 42.5%, specificity = 83.2%) and moderate interobserver agreement (Fleiss κ = 0.650; ICC = 0.653). Imaging-only radiomics and DL models achieved higher discrimination (AUC 0.77 and 0.76, respectively). Integration of laboratory parameters into the radiomics model further improved predictive performance (AUC of 0.77 to 0.80), whereas the DL and fusion models showed no substantial improvement.

CONCLUSION: Our multimodal AI framework, which combines quantitative CECT features with clinical data, enhances the ability to predict adverse outcomes in early AP compared to traditional clinical and imaging severity scoring systems. These findings should be interpreted as preliminary, and prospective multicenter validation is required before considering clinical implementation.

BACKGROUND: Ileo-colonoscopy provides accurate assessment of mucosal inflammation in Crohn's disease. Magnetic resonance imaging (MRI) offers a non-invasive alternative. MRI-based scores such as the simplified MaRIA (sMaRIA) have been proposed for measuring treatment response in clinical trials, but systematic comparisons with endoscopic scoring systems in prospective datasets are lacking.

METHODS: PROFILE trial participants underwent ileo-colonoscopy and small bowel MRI at baseline and week 48 (end-of-trial). Using this dataset our primary objective was to assess the correlation between Simple Endoscopic Score for Crohn's Disease (SES-CD) and sMaRIA scores using contemporaneous ileo-colonoscopy and MRI studies. We also assessed the utility of sMaRIA as a clinical trial endpoint, and correlation between baseline sMaRIA and need for future surgery. Endoscopic and MRI remission were defined as SES-CD and sMaRIA scores of 0. Ulcer subscores were also examined.

RESULTS: In total, :285 patients had paired baseline ileo-colonoscopy and MRI studies and 220 had paired end-of-trial studies-undertaken a median of 35 and 22 days apart respectively. Correlation between total SES-CD and sMaRIA scores on end-of-trial studies was moderate (Spearman's ρ = 0.428). MRI/sMaRIA identified only 18/143 ulcerated segments seen on ileo-colonoscopy. While remission rates between PROFILE treatment arms were significantly different on ileo-colonoscopy/SES-CD (P = .005), this difference was not seen on MRI/sMaRIA (P = .564). Patients requiring abdominal surgery had higher baseline sMaRIA scores than those who did not (P = .015), while SES-CD scores were not different between these groups (P = .830).

CONCLUSIONS: MRI should be considered as complementary to ileo-colonoscopy for assessing ileal Crohn's disease. sMaRIA should not replace SES-CD in clinical trials.