Giuseppe Costantino

Background/Objectives: To evaluate the concordance of dual-layer spectral CT (DLSCT) with MRI in locoregional staging of rectal cancer, focusing on 40 keV virtual monoenergetic reconstructions. Methods: This retrospective single-center study included 31 patients (mean age, 69 ± 13.3 years) with rectal cancer who underwent both MRI and DLSCT within 30 days before treatment. Venous-phase CT images were reconstructed at 40 keV. Assessed parameters included tumor location, longitudinal extent, distance from the anorectal junction and anal verge, mesorectal infiltration, circumferential resection margin (CRM) involvement, suspicious lymph nodes, extramural vascular invasion (EMVI), desmoplastic reaction, peritoneal involvement, and anal canal invasion. Two radiologists performed consensus readings. Paired continuous measurements were compared with the Wilcoxon signed-rank test. Agreement for categorical variables was evaluated using Cohen’s kappa; sensitivity, specificity, and accuracy were calculated using MRI as the imaging reference standard. Results: No significant differences were found between MRI and DLSCT for the continuous measurements evaluated. Complete agreement was observed for CRM involvement, anal canal invasion, peritoneal involvement, desmoplastic reaction, and suspicious lymph-node classification (accuracy, 100%; κ = 1.00). Agreement was almost perfect for mesorectal infiltration (κ = 0.84). For EMVI, DLSCT reproduced all MRI-positive classifications but generated two additional positive findings, resulting in 100% sensitivity, 71.4% specificity, 93.5% accuracy, and substantial agreement (κ = 0.79). Conclusions: DLSCT showed high concordance with MRI for several locoregional imaging features of rectal cancer. It may provide complementary information, particularly when MRI is contraindicated or inconclusive. In addition, when DLSCT is performed for systemic staging, it has the potential to provide both locoregional and distant disease assessment within a single examination. However, these findings do not establish equivalence to MRI or diagnostic accuracy against histopathology, and further prospective studies with pathological correlation are warranted.

Background: Patients with ulcerative colitis (UC) and Crohn’s disease (CD) have an increased cardiovascular risk (CVR). The aim of the present study was to stratify the CVR of patients with UC and CD according to the most recent guidelines via carotid ultrasound (US) to detect subclinical atherosclerotic disease. Methods: Demographic and disease-related data of consecutive patients with IBD were prospectively collected along with information on blood pressure, body mass index, lipid profile, and concomitant medications. CVR was stratified at inclusion according to the most recent version of Systematic Coronary Risk Evaluation 2 (SCORE2) and re-stratified after carotid US when subclinical atherosclerotic disease was detected. Results: A total of 166 patients aged ≥ 40 years with IBD were included. Before carotid US evaluation, 43.4% of patients with IBD were at moderate risk, 40.3% at high risk, and 16.3% at very high risk. With carotid US, subclinical atherosclerosis was diagnosed in 48% of patients, leading to CVR re-stratification from moderate to high in 18% of patients and from high to very high in 4% of patients. The only predictive factor for re-stratification was failure with more than two biologics (p = 0.047; OR 2.187, 95% CI: 1.004–4.741). Conclusions: CVR is considerably prevalent in patients with IBD. Carotid US may help to re-classify CVR and should be considered as a risk modifier in patients at intermediate risk. Screening for CVD risk factors should be recommended in IBD.

Background/Objectives: Tumor necrosis factor alpha (TNF-α) is the key inflammatory cytokine involved in the pathogenesis of inflammatory bowel diseases (IBDs). Anti-TNF-α therapy has been successfully used for IBD treatment, although the therapeutic response differs among patients due to the genetic background. The aim of this study was to investigate whether the presence of single nucleotide polymorphisms (SNPs) on TNFA, TNFRSF1A, and TNFRSF1B genes could affect anti-TNF-α treatment effectiveness in IBD patients. Methods: In this prospective cohort study, 83 European IBD patients treated with infliximab or adalimumab (with or without steroid bridge therapy) as first-line therapy were enrolled. Genomic DNA was extracted from peripheral blood, and TNF-α (rs1800629, rs361525, rs1799724), TNFRSF1A (rs767455), and TNFRSF1B (rs1061622, rs1061624, rs3397, rs976881) SNPs were assessed. Steroid-free remission (SFR) (clinical remission together with steroid interruption) and anti-TNF-α therapy persistence after 12 months of follow-up were evaluated. Patients who stopped anti-TNF-α therapy before the end of follow-up, due to side effects or treatment failure, were defined as discontinuers. Results: A higher frequency of the G/G genotype in rs1800629 and the A/A genotype in rs1061624 was observed in the SFR group compared to non-SFR (97.7% vs. 82.8%; p = 0.025 and 32.6% vs. 10.3%; p = 0.029, respectively). Moreover, carriers of the A/A genotype in rs361525 and the C/C genotype in rs767455 had a lower probability of achieving SFR than wild-type patients (OR = 0.14; 95% CI= 0.03–0.69; p = 0.016 and OR = 0.10; 95% CI = 0.02–0.60; p = 0.012, respectively). Furthermore, an increased frequency of rs1800629 A allele was observed in patients who discontinued treatment compared to completers (27.3% vs. 6.9%; p = 0.033), as well as a high risk of interrupting therapy (HR = 6.47; 95% CI = 1.15–36.38). Conclusions: These results suggest that the evaluation of SNPs in TNF-α, TNFR1A, and TNFR1B genes could improve the management of IBD, leading to more effective, individualized treatment plans and a reduction in healthcare costs associated with ineffective therapies and disease complications.

Background: The absence of a national register of inflammatory bowel diseases (IBD) hinders effective health care planning in Italy. Aims: to investigate prevalence of IBD in the city of Messina, Italy, based on General Practitioner (GP) records, and to establish current treatments prescribed by different health care providers. Methods: data were extracted from GP databases with the help of disease-specific healthcare cost exemption codes combined with ICD9 codes for ulcerative colitis (UC) and Crohn’s disease (CD), and prescription for mesalazine. Disease and treatment-related data were collected together with information on employment status and the current healthcare provider. Results: Eighty-six GPs participated covering a population of 100,834 people. IBD prevalence (419/10⁵) was 80% higher than estimates of the Regional Health Authorities. Incidence showed a seven-fold increase over the past 30 years. Only 51% of CD and 26% of UC patients were followed by a dedicated IBD centre with more frequent prescriptions of immunomodulators and biologics (pConclusions: Real world data show much higher figures on IBD prevalence than administrative estimates. Differences in therapeutic approaches between IBD-specialists and non-specialists may reflect poor confidence in managing immunosuppressive therapies by the latter, but may lead to inadequate therapy and cancer surveillance.