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Scaglione M, Galluzzo M, Santucci D, Trinci M, Messina L, Laccetti E, Faiella E, Beomonte Zobel B. Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process. Abdom Radiol (NY) 2022; 47:1541-1555. [PMID: 33057806 DOI: 10.1007/s00261-020-02800-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 02/08/2023]
Abstract
The objective of this article is to assess the computed tomography (CT) findings of small bowel obstruction (SBO) complicated by ischemia. SBO is a frequent clinical entity characterized by high morbidity and mortality. The radiologic aim is not just to diagnose the obstruction itself but to rule out the presence of complications related to SBO. This is crucial for differentiating which patients can be safely treated non-operatively from the ones who may need an urgent surgical approach. The main complication of SBO is intestinal ischemia. In the emergency setting, CT imaging is the modality of choice for SBO because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one. On the other hand, the radiologist who documents an intestinal ischemia should think about SBO as possible cause. In this case, the main finding which helps the radiologist in the identification of SBO is the presence of multiple and packed valvulae conniventes in the dilated bowel wall and the "transition zone" that indicates the passage between compressed and decompressed small bowel, otherwise the localization of the obstruction cause. Once the site of obstruction has been recognized, the other issue is to assess the cause of obstruction, considering that the most common cause of SBO remains "unidentified" and related to intra-abdominal adhesions. After that, the following most important point is to rule out the presence of an ischemic bowel and mesenteric changes associated to SBO. CT signs of bowel ischemia include reduced or increased bowel wall enhancement, mesenteric edema or engorgement, fluid or free air in the peritoneal cavity. This condition usually leads to an urgent laparotomy and, in some cases, to a surgical resection.
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Altiero M, Orabona GD, Laccetti E, Rengo A, Danzi R, Romano F, Di Serafino M, Iacobellis F, Francica G, Scaglione M, Romano L. The Use of Ceus Software with No Contrast Media Administration in the Diagnosis of Pneumoperitoneum. Diagnostics (Basel) 2022; 12:diagnostics12020401. [PMID: 35204492 PMCID: PMC8871049 DOI: 10.3390/diagnostics12020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/22/2022] [Accepted: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pneumoperitoneum is defined by the presence of free air in the abdominal cavity; gastrointestinal perforation is an important cause of this pathological condition. In emergency situations, radiology is considered vital in the early detection and identification of the site and cause of the perforation, which is critical for proper surgical planning. Aim: The aim of our study was to evaluate a new diagnostic US tool, based on the US contrast-specific software generally used during contrast-enhanced US examination (CEUS), without the administration of sonographic contrast media, and to describe the specific imaging features in the detection of free intra-peritoneal air. Subjects and Methods: One hundred and fifty-seven consecutive and hemodynamically stable patients, who arrived in our E.D. with an acute abdomen between April 2018 and October 2019, underwent US and CT examination, performed by three radiologists (with 5, 5, and 25 years of experience). The US was performed first and divided into two steps, using B-mode US and both B-mode and contrast-specific software US, with no contrast media administration. All the patients underwent CT examination. Results: In 32 out of 157 patients, the surgery confirmed GI perforation. CT correctly detected 31 out of 32 patients; the contrast-specific software US identified 30 perforated patients. CT reached a sensitivity value of 97% and specificity value of 100%; contrast-specific software US demonstrated higher values than B-mode US in sensitivity (93% vs. 70%, respectively) and specificity (98% vs. 88%, respectively). Conclusion: the use of contrast-specific software in emergencies improves image quality, and reaches higher levels of sensitivity and specificity with no time delay compared to standard US examination, helping radiologists expedite diagnoses.
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Affiliation(s)
- Michele Altiero
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
- Correspondence:
| | - Ettore Laccetti
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Alessandro Rengo
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Roberta Danzi
- Department of Radiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
| | - Federica Romano
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Giampiero Francica
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
- Department of Radiology, University of Sassari, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
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Mainenti PP, Castiglione F, Rispo A, Laccetti E, Guarino S, Romeo V, Testa A, Pace L, Maurea S. MR-enterography in Crohn's disease: what MRE mural parameters are associated to one-year therapeutic management outcome? Br J Radiol 2021; 94:20200844. [PMID: 33186053 DOI: 10.1259/bjr.20200844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the association of mural parameters of MR-enterography (MRE) with one-year therapeutic management of Crohn's disease (CD) patients. METHODS CD patients, undergone MRE with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps between January 2017 and June 2018, were retrospectively enrolled. Extramural complications represented an exclusion criterion because of their potential influence on the intrinsic characteristic of the bowel wall. Two groups of patients were defined on the base of the therapeutic management adopted at 1-year follow-up: Medical-group and surgical-group. The following MRE parameters were evaluated: wall-thickening, longitudinal-extension, T2-fat-suppression-mural-signal, ulcers, mural-oedema, wall-enhancement-rate/pattern, DWI-scores, ADC-values, strictures. RESULTS 70 CD patients were enrolled. 57/70 (81.4%) were included in Medical-group and 13/70 (18.6%) in Surgical-group. ADCmean and strictures resulted to be significantly (p < 0.01) different between the two groups. The ADCmean showed to be significantly associated to conservative management [p < 0.01; OR: 0.0003; 95% CI (0.00-0.13)], while the strictures to surgical management [p < 0.01; OR: 29.7; 95% CI (4.9-179.7)]. ROC curves for ADCmean showed that AUC was 0.717 [95% CI (0.607-0.810), p < 0.01] with an optimal cut-off value of 1.081 × 10-3 mm2 s-1. A negative predictive value of 90.2% was observed associating ADCmean values > 1.081 × 10-3 mm2 s-1 to conservative therapy. 13/17 (76%) strictures with an ADCmean > 1.081 × 10-3 mm2 s-1 benefited of conservative therapy. CONCLUSION ADCmean values calculated on DWI-MRE may be associated to 1-year conservative medical therapy in patients with CD without extramural complications. ADVANCES IN KNOWLEDGE ADC maps may be proposed to select CD patients with a lower burden of mural active inflammatory cells and/or fibrosis benefiting of 1-year conservative treatment.
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Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy
| | - Ettore Laccetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Salvatore Guarino
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy
| | - Leonardo Pace
- Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Romano F, Altiero M, Laccetti E, Calise F, D'Avino R, Benincasa G, Scaglione M. MRI and CT findings of a primary malignant fibrous hystiocitoma presenting as a huge glissonian mass; imaging findings with surgical and histological correlations. BJR Case Rep 2019; 5:20180055. [PMID: 31131128 PMCID: PMC6519500 DOI: 10.1259/bjrcr.20180055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/14/2018] [Accepted: 07/24/2018] [Indexed: 11/05/2022] Open
Abstract
The present case report describes imaging findings (CT and MRI features) of a primary malignant fibrous hystiocitoma, presenting as a dual stage lesion, completely exophytic along liver surface with surgical and histological correlations. Imaging characteristics suggested the nature of the lesion (mesenchymal) and the behavior (expansile growth pattern) which addressed surgeons to a conservative excision.
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Affiliation(s)
- Federica Romano
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Altiero
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Ettore Laccetti
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Fulvio Calise
- Department of Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Raffaele D'Avino
- Department of Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Giulio Benincasa
- Department of Pathology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Mariano Scaglione
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
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Iacobellis F, Laccetti E, Tamburrini S, Altiero M, Iaselli F, Di Serafino M, Gagliardi N, Danzi R, Rengo A, Romano L, Nicola R, Scaglione M. Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience. Gland Surg 2019; 8:184-196. [PMID: 31183328 DOI: 10.21037/gs.2019.02.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatic injuries can occur from either penetrating or blunt abdominal trauma. While there are rare, especially in the setting of blunt abdominal trauma, they are associated with a mortality of up to 30%, and a morbidity of 60%. Multidetector computed tomography (MDCT) is the preferred imaging modality in patients with acute blunt abdominal trauma and for the detection of acute pancreatic injury. Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) plays an important role in the follow-up of pancreatic injury. In this brief review, we discuss the main MDCT acute imaging findings as well as the complications. Finally, we discuss the role of MR and MRCP in follow up of patients with pancreatic injuries.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Ettore Laccetti
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Stefania Tamburrini
- Department of Radiology, "Ospedale del Mare" ASL NA1 Centro-Napoli, Naples, Italy
| | - Michele Altiero
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Francesco Iaselli
- Department of Radiology, "Ospedale del Mare" ASL NA1 Centro-Napoli, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Nicola Gagliardi
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Roberta Danzi
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Alessandro Rengo
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Refky Nicola
- Department of Radiology, SUNY-Upstate University and Medical Center, Syracuse, NY, USA
| | - Mariano Scaglione
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy.,Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland, UK
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Francica G, Altiero M, Laccetti E, Pezzullo F, Tanga M, Avitabile G, Elameer M, Scaglione M. Long-term follow-up of unresectable medium-large hepatocellular carcinoma nodules treated with radiofrequency ablation using a multiple-electrode switching system. Br J Radiol 2018; 92:20180625. [PMID: 30272482 DOI: 10.1259/bjr.20180625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat unresectable medium-large (3.1-6.0 cm) HCC nodules. METHODS RFA using a multiple-electrode switching system was performed for HCC nodules with size > 3.0 < 6.0 cm in nonsurgical candidates. Two electrodes were consecutively placed for 3.1-4.0 cm tumours, and three electrodes for 4.1-5.9 cm tumours, with a 2.0-2.5 cm spacing. The power was switched from one electrode to the next automatically when the impedance reached 30 Ω above the baseline level. 25 patients (M/F = 9/16; median age 76 years, range 61-84) with liver cirrhosis (20 HCV-positive) in Child's Class A (22 cases) and B (3 cases) and 26 HCC nodules (median diameter 4.0 cm; range 3.2-5.5 cm) underwent treatment in 25 sessions from 2013 and 2018. Therapeutic effectiveness was assessed through CT or MRI exam at 30-40 days post-ablation. RESULTS No procedure-related death or major complications occurred. Complete ablation was obtained in all nodules (100%). At a median follow up of 30 months, local tumor progression occurred in five out of 26 nodules (19.2%). Overall survival at 4 years was 49%. CONCLUSION RFA with a multiple-electrode switching system may be a safe, quick and effective therapeutic option for treatment of 3.1-6.0 cm unresectable HCC tumours. ADVANCES IN KNOWLEDGE RFA with multiple electrodes provides favourable clinical results in patients with medium-large HCC nodules who are not suitable for surgery.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Altiero
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Ettore Laccetti
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Filomena Pezzullo
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michela Tanga
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | | | - Mathew Elameer
- Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Mariano Scaglione
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy.,Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
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Mainenti PP, Pizzuti LM, Segreto S, Comerci M, Fronzo SD, Romano F, Crisci V, Smaldone M, Laccetti E, Storto G, Alfano B, Maurea S, Salvatore M, Pace L. Diffusion volume (DV) measurement in endometrial and cervical cancer: A new MRI parameter in the evaluation of the tumor grading and the risk classification. Eur J Radiol 2015; 85:113-124. [PMID: 26724655 DOI: 10.1016/j.ejrad.2015.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 09/07/2015] [Accepted: 10/25/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE A new MRI parameter representative of active tumor burden is proposed: diffusion volume (DV), defined as the sum of all the voxels within a tumor with apparent diffusion coefficient (ADC) values within a specific range. The aims of the study were: (a) to calculate DV on ADC maps in patients with cervical/endometrial cancer; (b) to correlate DV with histological grade (G) and risk classification; (c) to evaluate intra/inter-observer agreement of DV calculation. MATERIALS AND METHODS Fifty-three patients with endometrial (n=28) and cervical (n=25) cancers underwent pelvic MRI with DWI sequences. Both endometrial and cervical tumors were classified on the basis of G (G1/G2/G3) and FIGO staging (low/medium/high-risk). A semi-automated segmentation procedure was used to calculate the DV. A freehand closed ROI outlined the whole visible tumor on the most representative slice of ADC maps defined as the slice with the maximum diameter of the solid neoplastic component. Successively, two thresholds were generated on the basis of the mean and standard deviation (SD) of the ADC values: lower threshold (LT="mean minus three SD") and higher threshold (HT="mean plus one SD"). The closed ROI was expanded in 3D, including all the contiguous voxels with ADC values in the range LT-HT × 10-3mm(2)/s. A Kruskal-Wallis test was used to assess the differences in DV among G and risk groups. Intra-/inter-observer variability for DV measurement was analyzed according to the method of Bland and Altman and the intraclass-correlation-coefficient (ICC). RESULTS DV values were significantly different among G and risk groups in both endometrial (p<0.05) and cervical cancers (p ≤ 0.01). For endometrial cancer, DV of G1 (mean ± sd: 2.81 ± 3.21 cc) neoplasms were significantly lower than G2 (9.44 ± 9.58 cc) and G3 (11.96 ± 8.0 cc) ones; moreover, DV of low risk cancers (5.23 ± 8.0 cc) were significantly lower than medium (7.28 ± 4.3 cc) and high risk (14.7 ± 9.9 cc) ones. For cervical cancer, DV of G1 (0.31 ± 0.13 cc) neoplasms was significantly lower than G3 (40.68 ± 45.65 cc) ones; moreover, DV of low risk neoplasms (6.98 ± 8.08 cc) was significantly lower than medium (21.7 ± 17.13 cc) and high risk (62.9 ± 51.12 cc) ones and DV of medium risk neoplasms was significantly lower than high risk ones. The intra-/inter-observer variability for DV measurement showed an excellent correlation for both cancers (ICC ≥ 0.86). CONCLUSIONS DV is an accurate index for the assessment of G and risk classification of cervical/endometrial cancers with low intra-/inter-observer variability.
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Affiliation(s)
| | | | - Sabrina Segreto
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | | | - Simona De Fronzo
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | - Federica Romano
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | - Vincenzina Crisci
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | - Michele Smaldone
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | - Ettore Laccetti
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | | | | | - Simone Maurea
- Dipartimento di Scienze Biomediche Avanzate, Sezione di Radiologia, Università di Napoli "Federico II", Napoli, Italy
| | | | - Leonardo Pace
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Salerno, Italy
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8
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Maurea S, Mainenti PP, Tambasco A, Imbriaco M, Mollica C, Laccetti E, Camera L, Liuzzi R, Salvatore M. Diagnostic accuracy of MR imaging to identify and characterize focal liver lesions: comparison between gadolinium and superparamagnetic iron oxide contrast media. Quant Imaging Med Surg 2014; 4:181-9. [PMID: 24914419 DOI: 10.3978/j.issn.2223-4292.2014.01.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
To compare the diagnostic value of gadolinium (Gd) and ultrasmall superparamagnetic iron oxide (SPIO) contrast media for characterization of focal liver lesions (FLL), we retrospectively evaluated the results of magnetic resonance (MR) imaging in 68 patients (40 M, 28 F, age from 22 to 81 yrs) of which 36 with diagnosis of colo-rectal cancer, 26 with hepatic cirrhosis and 6 with incidental imaging detection of FLL. MR (Gyroscan Intera 1.5 T, Philips Medical Systems) study was performed using T1 and T2 fast-field-echo (FFE) and T2 turbo-spin-echo (TSE) sequences in axial and coronal views. Dynamic multi-phases gadolinium Gd-enhanced T1-FFE-Bh images were obtained in arterial, portal and equilibrium phases, followed by SPIO-enhanced T2-FFE scans. A qualitative analysis of pre- and post-contrast MR images to classify FLL as benign or malignant was performed using a 3-point scoring system: 0= benign; 1= suspicious for malignancy; 2= malignant. A total of 118 lesions were evaluated. In particular, histology (n=18), cytology (n=14) or clinical-imaging follow-up data (n=86) demonstrated 4 adenomas, 29 cysts, 3 focal steatosis, 25 hemangiomas, 1 focal vascular abnormality, 5 fibrotic lesions as well as 13 regenerative nodules, 6 dysplastic, 14 hepatocellular carcinomas (HCC), 17 metastasis and 1 cholangiocarcinoma. For MR imaging, diagnostic accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of Gd vs. SPIO images were respectively 83% vs. 92%, 79% vs. 74%, 85% vs. 99% (P=0.002), 68% vs. 96% (P=0.005) and 91% vs. 90%, respectively. The results suggest that SPIO-MR provides a diagnostic incremental value, as specificity and PPV, particularly to characterize FLL compared to Gd-MR; thus, we strongly recommend the use of SPIO when liver lesion characterization is requested and Gd images are uncertain.
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Affiliation(s)
- Simone Maurea
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Pier Paolo Mainenti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Annamaria Tambasco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Massimo Imbriaco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Carmine Mollica
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Ettore Laccetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Luigi Camera
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Raffaele Liuzzi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Marco Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
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D'Arco F, Pizzuti LM, Romano F, Natella V, Laccetti E, Storto G, Maurea S, Mainenti PP. MRI findings of a remote and isolated vaginal metastasis revealing an adenocarcinoma of the mid-sigmoid colon. Pol J Radiol 2014; 79:33-5. [PMID: 24567770 PMCID: PMC3930582 DOI: 10.12659/pjr.890032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/12/2013] [Indexed: 12/30/2022] Open
Abstract
A remote vaginal metastasis from a colo-rectal carcinoma is extremely rare. Only few cases have been described in the literature. The radiological appearances of a vaginal metastasis from colon-rectal cancer have not been extensively investigated. We report the MRI findings with clinical and pathological correlations of a remote and isolated vaginal metastasis revealing a mid-sigmoid adenocarcinoma in a 67 years old woman.
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Affiliation(s)
- Felice D'Arco
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Laura Micol Pizzuti
- Institute of Biostructure and Bioimaging, Italian National Research Council, Naples, Italy
| | - Federica Romano
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Valentina Natella
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Ettore Laccetti
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | | | - Simone Maurea
- Biomorphological and Functional Sciences, Section of Radiology, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructure and Bioimaging, Italian National Research Council, Naples, Italy
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