Gender Medicine in Clinical Radiology Practice

Abstract

Gender Medicine is rapidly emerging as a branch of medicine that studies how many diseases common to men and women differ in terms of prevention, clinical manifestations, diagnostic-therapeutic approach, prognosis, and psychological and social impact. Nowadays, the presentation and identification of many pathological conditions pose unique diagnostic challenges. However, women have always been paradoxically underestimated in epidemiological studies, drug trials, as well as clinical trials, so many clinical conditions affecting the female population are often underestimated and/or delayed and may result in inadequate clinical management. Knowing and valuing these differences in healthcare, thus taking into account individual variability, will make it possible to ensure that each individual receives the best care through the personalization of therapies, the guarantee of diagnostic-therapeutic pathways declined according to gender, as well as through the promotion of gender-specific prevention initiatives. This article aims to assess potential gender differences in clinical-radiological practice extracted from the literature and their impact on health and healthcare. Indeed, in this context, radiomics and radiogenomics are rapidly emerging as new frontiers of imaging in precision medicine. The development of clinical practice support tools supported by artificial intelligence allows through quantitative analysis to characterize tissues noninvasively with the ultimate goal of extracting directly from images indications of disease aggressiveness, prognosis, and therapeutic response. The integration of quantitative data with gene expression and patient clinical data, with the help of structured reporting as well, will in the near future give rise to decision support models for clinical practice that will hopefully improve diagnostic accuracy and prognostic power as well as ensure a more advanced level of precision medicine.

Keywords: diagnosis; gender medicine; prognosis; radiology.

Figure 1

Male, 39-years-old, patients with history of dyslipidemia, type-1 obesity, and higher level of stress at work. The patient reported a non-anginal chest pain for which an ergometric ECG stress test was performed, and the results were negative. According to the Diamond–Forrester score, the patient was first categorized as a low pre-test probability risk of having CAD. To correctly rule-out CAD, the patients underwent CCTA examination, which showed a severe non-calcific plaque in the distal right coronary artery (white arrowhead).

Figure 2

Female, 65-years-old, with typical angina, treated for hypertension and dyslipidemia. The patient was first categorized as intermediate-PPT risk of having CAD, for which CCTA was performed. The CCTA exam showed a regular coronary tree. Different trials have demonstrated that women show more frequent anginal symptoms than men, often with a higher risk profile, although a lower overall burden of CAD, a higher prevalence of NOCAD, and a frequent insufficient ischemia have been highlighted.

Figure 3

A woman and a man with CF with different and higher anatomo-structural involvement at HRCT in women with CF compared with men. (A) Diffuse cystic-varicoid bronchiectasis, with diffuse wall thickening and mucous plug (white arrow) in a young woman patient with cystic fibrosis. (B) Bronchiectasis with thickened walls (white arrow), especially in the medium-lower pulmonary lobes in a male patient with cystic fibrosis.

Figure 4

(A) Diffuse ground glass opacities with reticular thickening of the subpleural interstitium (white arrow), together with traction bronchiectasis in a case of pulmonary fibrosis with UIP pattern and smoking-related interstitial lung disease (ILD) in a female smoker. (B) A typical UIP pattern in a male smoker with idiopathic pulmonary fibrosis, together with diffuse ground glass opacities (white arrow) during an acute exacerbation.

Figure 5

Arrow shows diffuse thickening of the bronchial wall in a former-smoker woman with COPD.

Figure 6

Woman with operated appendiceal tumor ((A): in coronal plane, arrow). CT assessment of peritoneal carcinomatosis ((B,C), arrow).

Figure 7

Man with transverse colon cancer (white arrows): in (A) (axial) and (B) (coronal) CT assessment.

Figure 8

Man with retroareolar tumor and skin thickening.