1
|
Granata V, Fusco R, Bicchierai G, Cozzi D, Grazzini G, Danti G, De Muzio F, Maggialetti N, Smorchkova O, D'Elia M, Brunese MC, Grassi R, Giacobbe G, Bruno F, Palumbo P, Lacasella GV, Brunese L, Grassi R, Miele V, Barile A. Diagnostic protocols in oncology: workup and treatment planning. Part 1: the optimitation of CT protocol. Eur Rev Med Pharmacol Sci 2021; 25:6972-6994. [PMID: 34859859 DOI: 10.26355/eurrev_202111_27246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The increase in oncology knowledge and the possibility of creating personalized medicine by selecting a more suitable therapy related to tumor subtypes, as well as the patient's management with cancer within a multidisciplinary team has improved the clinical outcomes. Early detection of cancer through screening-based imaging is probably the major contributor to a reduction in mortality for certain cancers. Nowadays, imaging can also characterize several lesions and predict their histopathological features and can predict tumor behaviour and prognosis. CT is the main diagnostic tool in oncologic imaging and is widely used for the tumors detection, staging, and follow-up. Moreover, since CT accounts for 49-66% of overall patient radiation exposure, the constant reduction, optimization, dose inter- and intraindividual consistency are major goals in radiological field. In the recent years, numerous dose reduction techniques have been established and created voltage modulation keeping a satisfactory image quality. The introduction of CT dual-layer detector technology enabled the acquisition of spectral data without additional CT x-ray tube or additional acquisitions. In addition, since MRI does not expose the body to radiation, it has become a mainstay of non-invasive diagnostic radiology modality since the 1980s.
Collapse
Affiliation(s)
- V Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Granata V, Bicchierai G, Fusco R, Cozzi D, Grazzini G, Danti G, De Muzio F, Maggialetti N, Smorchkova O, D'Elia M, Brunese MC, Grassi R, Giacobbe G, Bruno F, Palumbo P, Grassi F, Brunese L, Grassi R, Miele V, Barile A. Diagnostic protocols in oncology: workup and treatment planning. Part 2: Abbreviated MR protocol. Eur Rev Med Pharmacol Sci 2021; 25:6499-6528. [PMID: 34787854 DOI: 10.26355/eurrev_202111_27094] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Magnetic resonance imaging (MRI) is a non-invasive imaging technique (non-ionizing radiation) with superior soft tissue contrasts and potential morphological and functional applications. However, long examination and interpretation times, as well as higher costs, still represent barriers to MRI use in clinical routine. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. Abbreviated MRI protocols eliminate redundant sequences that negatively affect cost, acquisition time, patient comfort. However, the diagnostic information is generally not compromised. Abbreviated MRI protocols have already been utilized for hepatocellular carcinoma, for prostate cancer detection, and for nonalcoholic fatty liver disease screening.
Collapse
Affiliation(s)
- V Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Granata V, Grassi R, Fusco R, Izzo F, Brunese L, Delrio P, Avallone A, Pecori B, Petrillo A. Current status on response to treatment in locally advanced rectal cancer: what the radiologist should know. Eur Rev Med Pharmacol Sci 2021; 24:12050-12062. [PMID: 33336723 DOI: 10.26355/eurrev_202012_23994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The assessment of tumor response, after neoadjuvant radiochemotherapy (nCRT), allows stratifying the patient in order to consider the proper therapeutical management. Histopathology analysis of the surgical specimen is considered the gold standard to assess tumour response and the definition of a complete cancer response is related to the clinical and endoscopic features, by direct evaluation of the rectal wall. However, imaging studies, especially Magnetic Resonance Imaging (MRI) have provided additional parameters, as the evaluation of nodal or mesorectal status. MRI provides a radiological tumour regression grade (mrTRG) that is correlated with the pathologic tumor regression grade (pTRG). Functional MRI parameters have additional impending in early prediction of the efficacy of therapy and can be valuable in drug development processes. Some of functional methodologies are already part of clinical practice: diffusion-weighted MRI (DW-MRI) and perfusion imaging (dynamic contrast enhanced MRI [DCE-MRI]). Other technologies, such as radiomics with MRI are still in the experimental phase. An adequate radiological report describing the restaging of rectal cancer after nCRT should be a "structured report" to improve communication in a multidisciplinary team.
Collapse
Affiliation(s)
- V Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Macchi M, Belfiore MP, Floridi C, Serra N, Belfiore G, Carmignani L, Grasso RF, Mazza E, Pusceddu C, Brunese L, Carrafiello G. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol 2017; 34:96. [PMID: 28417355 DOI: 10.1007/s12032-017-0946-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Abstract
The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40-87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher's exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12 months (p value = 0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12 months (p value = 0.0003) and between pre-therapy and 12 months (p value = 0.0215). There were not significant differences between the two groups in terms of survival time (p value = 0.883), while the pain level in MWA group was significantly less than in RFA group (1.79 < 3.25, p value = 0.0043). In conclusion, our trial confirms RFA and MWA are both excellent choices in terms of efficacy and safety in lung tumour treatments. However, when compared to RFA therapy, MWA produced a less intraprocedural pain and a significant reduction in tumour mass.
Collapse
Affiliation(s)
- M Macchi
- Department of Radiology, Circolo e Fondazione Macchi Hospital, Insubria University, Varese, Italy
| | - M P Belfiore
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Floridi
- Radiology Department, Fatebenefratelli Hospital, Milan, Italy.
| | - N Serra
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Belfiore
- Department of Radiology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - L Carmignani
- Interventional Radiology Unit, San Jacopo Hospital, Pistoia, Italy
| | - R F Grasso
- Department of Diagnostic and Interventional Radiology, Campus Bio-Medico University, Rome, Italy
| | - E Mazza
- Interventional Radiology Unit, Careggi Hospital, Florence, Italy
| | - C Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital "A. Businco", Cagliari, Italy
| | - L Brunese
- Department of Radiology, University of Molise, Campobasso, Italy
| | - G Carrafiello
- Department of Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Reginelli A, Zappia M, Barile A, Brunese L. Strategies of imaging after orthopedic surgery. Musculoskelet Surg 2017; 101:1. [PMID: 28236248 DOI: 10.1007/s12306-017-0458-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 06/06/2023]
Affiliation(s)
- A Reginelli
- Department of Internal Clinical and Experimental Medicine and Surgery, Second University of Naples, Caserta, Italy.
| | - M Zappia
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - A Barile
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - L Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| |
Collapse
|
6
|
Caranci F, Leone G, Ugga L, Cesarano E, Capasso R, Schipani S, Bianco A, Fonio P, Briganti F, Brunese L. Imaging of post-surgical treatment and of related complications in spinal trauma. Musculoskelet Surg 2017; 101:63-73. [PMID: 28168635 DOI: 10.1007/s12306-017-0457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
Spinal trauma is a devastating event with a high morbidity and mortality. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity of the lesions, to evaluate the potential spinal instability. In case of spinal instability, the goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Particularly, diagnostic imaging, mainly by CT and MR, has a main role in the post-treatment evaluation. The neuroradiological evaluation of the postoperative spine requires a general knowledge of the surgical approach to each spinal region and of the normal temporal evolution of expected postoperative changes. The neuroradiologist should evaluate the devices implanted, their related complications and promptly alert the surgeon of acute complications, mainly vascular and infective. During the follow-up, it is mandatory to know and search chronic complications as pseudomeningocele, accelerated degenerative disease, arachnoiditis, peridural fibrosis. Knowledge of specific complications relating to each surgical approach will assist the neuroradiologist in interpretation of postoperative images.
Collapse
Affiliation(s)
- F Caranci
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy.
| | - G Leone
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Ugga
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - E Cesarano
- Radiology Section, Health Service, Navy Command of Brindisi, Brindisi, Italy
| | - R Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - S Schipani
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - A Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Briganti
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| |
Collapse
|
7
|
Splendiani A, D'Orazio F, Patriarca L, Arrigoni F, Caranci F, Fonio P, Brunese L, Barile A, Di Cesare E, Masciocchi C. Imaging of post-operative spine in intervertebral disc pathology. Musculoskelet Surg 2017; 101:75-84. [PMID: 28168634 DOI: 10.1007/s12306-017-0453-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 12/17/2022]
Abstract
This work is an imaging review of spine after surgery with special regard to imaging modality in intervertebral disc pathology. Advances in imaging technology can be evaluated. Depending on the clinical question is asked to the radiologist, it is possible to evaluate post-operative patients with conventional radiology (X-ray), computed tomography and magnetic resonance. Main indications for each technique are analysed. Imaging is important in the diagnosis of many forms of spine pathology and plays a fundamental role in evaluating post-surgical effects of treatments, according to the imaging method which is used, both on spine and on its surrounding tissues (intervertebral discs, spinal cord, muscles and vessels).
Collapse
Affiliation(s)
- A Splendiani
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - F D'Orazio
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - L Patriarca
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Arrigoni
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Caranci
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Brunese
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Barile
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - E Di Cesare
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - C Masciocchi
- Department of Biotechnologies and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
8
|
David E, Cantisani V, Grazhdani H, Di Marzo L, Venturini L, Fanelli F, Di Segni M, Di Leo N, Brunese L, Calliada F, Ciccariello M, Bottari A, Ascenti G, D'Ambrosio F. What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale. J Ultrasound 2016; 19:281-287. [PMID: 27965719 DOI: 10.1007/s40477-016-0222-5] [Citation(s) in RCA: 24] [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: 06/08/2016] [Accepted: 09/10/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in comparison to CT angiography (CTA) to identify and classify endoleaks following abdominal aortic aneurism repair with endoprosthesis. MATERIALS AND METHODS A retrospective analysis of 181 patients treated with EVAR, from September 2009 to September 2014, was performed. Patients were evaluated with CEUS, CTA and angiography in the cases requiring treatment. Sac diameter, sac integrity, identification and classification of endoleaks were taken into consideration. Sensitivity, specificity, accuracy and negative predictive values were considered for each modality of endoleak identification. RESULTS Forty-two endoleaks (23.2%; type II: 39 cases, type III: 3 cases) were documented. Sensitivity and specificity of CEUS and CT were, respectively, 97.6 and 90.5, 100 and 100%. In two cases, CEUS was able to better classify endoleaks compared to CT. CONCLUSIONS CEUS accuracy to identify endoleaks following EVAR is similar to CT. CEUS should be considered as an effective modality for the long-term surveillance of EVAR because of its capability to correctly classify endoleaks with no ionizing radiation exposure.
Collapse
Affiliation(s)
- E David
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - V Cantisani
- Department of Radiology, Oncology, and Anatomo Pathology, "Sapienza" University of Rome, Rome, Italy
| | - H Grazhdani
- Associazione dei Cavalieri Italiani Sovrano Militare Ordine di Malta; Poliambulatorio Roma, Eur Piazza Guglielmo Marconi 12, 00144 Rome, Italy
| | - L Di Marzo
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - L Venturini
- Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy
| | - F Fanelli
- Department of Radiology, Oncology, and Anatomo Pathology, "Sapienza" University of Rome, Rome, Italy
| | - M Di Segni
- Department of Radiology, Oncology, and Anatomo Pathology, "Sapienza" University of Rome, Rome, Italy
| | - N Di Leo
- Department of Radiology, Oncology, and Anatomo Pathology, "Sapienza" University of Rome, Rome, Italy
| | - L Brunese
- Department of Medicine and Health Sciences, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - F Calliada
- University Hospital of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - M Ciccariello
- Department of Radiology, Oncology, and Anatomo Pathology, "Sapienza" University of Rome, Rome, Italy
| | - A Bottari
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - G Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - F D'Ambrosio
- Department of Radiology, Oncology, and Anatomo Pathology, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
9
|
Cantisani V, David E, Sidhu PS, Sacconi B, Greco A, Pandolfi F, Tombolini M, Lo Mele L, Calliada F, Brunese L, Catalano C, De Vincentiis M, Di Leo N, Ascenti G, D'Ambrosio F. Parotid Gland Lesions: Multiparametric Ultrasound and MRI Features. Ultraschall Med 2016; 37:454-471. [PMID: 27300273 DOI: 10.1055/s-0042-109171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
High-resolution ultrasound (US), as a readily available, cost-effective and harmless imaging technique, is appropriately the initial imaging modality for salivary gland lesions. Benign tumors are reported to present with regular and well-defined margins, a homogeneous hypoechoic structure and demarcated vessel distribution, whereas malignant lesions are irregular, heterogeneous and diffusely perfused. Ultrasound and color Doppler features of benign and malignant salivary gland lesions overlap, and many benign tumors, particularly pleomorphic adenomas, may appear irregularly shaped, with a heterogeneous echo-structure indistinguishable from a malignant lesion. Often skilled US operators are not always able to differentiate benign from malignant lesions. The introduction of US contrast agents has allowed further perspectives in the possible improvement of lesion characterization, and the emergence of US elastography, an innovative tool for assessing lesion stiffness/elasticity characteristics, has been advocated for differentiating salivary gland lesions. When lesions are atypical on US, contrast-enhanced magnetic resonance (MR) imaging is usually the definitive imaging modality. We present a current review of benign and malignant parotid gland tumors with emphasis on the role of multiparametric US and MR imaging.
Collapse
Affiliation(s)
- V Cantisani
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - E David
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - P S Sidhu
- Radiology, King's College London, United Kingdom of Great Britain and Northern Ireland
| | - B Sacconi
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, "Sapienza" University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - A Greco
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy; Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - F Pandolfi
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy; Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - M Tombolini
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy; Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - L Lo Mele
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, "Sapienza" University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - F Calliada
- Department of Radiology, Policlinico San Matteo, Pavia, Italy
| | - L Brunese
- Dipartimento di Medicina e di Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy
| | - C Catalano
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - M De Vincentiis
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy; Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - N Di Leo
- Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, "Sapienza" University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - G Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - F D'Ambrosio
- Radioligical sciences, Policlinico Umberto I, Univ. Sapienza, Roma, Italy
| |
Collapse
|
10
|
Maggialetti N, Capasso R, Pinto D, Carbone M, Laporta A, Schipani S, Piccolo CL, Zappia M, Reginelli A, D'Innocenzo M, Brunese L. Diagnostic value of computed tomography colonography (CTC) after incomplete optical colonoscopy. Int J Surg 2016; 33 Suppl 1:S36-44. [PMID: 27255132 DOI: 10.1016/j.ijsu.2016.05.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study evaluated the role of computed tomography colonography (CTC) in patients who previously underwent incomplete optical colonoscopy (OC). We analyzed the impact of colonic lesions in intestinal segments not studied by OC and extracolonic findings in these patients. METHODS Between January 2014 and May 2015, 61 patients with a history of abdominal pain and incomplete OC examination were studied by CTC. CTCs were performed by 320-row CT scan in both the supine and the prone position, without intravenous administration of contrast medium. In all patients both colonic findings and extracolonic findings were evaluated. RESULTS Among the study group, 24 CTC examinations were negative for both colonic and extracolonic findings while 6 examinations revealed the presence of both colonic and extracolonic findings. In 24 patients CTC depicted colonic anomalies without extracolonic ones, while in 7 patients it showed extracolonic findings without colonic ones. DISCUSSION CTC is a noninvasive imaging technique with the advantages of high diagnostic performance, rapid data acquisition, minimal patient discomfort, lack of need for sedation, and virtually no recovery time. CTC accurately allows the evaluation of the nonvisualized part of the colon after incomplete OC and has the distinct advantage to detect clinically important extracolonic findings in patients with incomplete OC potentially explaining the patient's symptoms and conditioning their therapeutic management. CONCLUSION CTC accurately allows the assessment of both colonic and extracolonic pathologies representing a useful diagnostic tool in patients for whom complete OC is not achievable.
Collapse
Affiliation(s)
- N Maggialetti
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - R Capasso
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
| | - D Pinto
- Radiological Research, Molfetta, BA, Italy.
| | - M Carbone
- Department of Radiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
| | - A Laporta
- Department of Radiology, A.O. Solofra, Italy.
| | - S Schipani
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - C L Piccolo
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - M Zappia
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - A Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
| | | | - L Brunese
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| |
Collapse
|
11
|
Ierardi AM, Xhepa G, Piffaretti G, Bacuzzi A, Tozzi M, Carbone M, Barile A, Squillaci E, Fonio P, Brunese L, Carrafiello G. Clinical experience with Angiojet: a comprehensive review. INT ANGIOL 2015; 34:1-14. [PMID: 26498886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The development of various sophisticated mechanical thrombectomy devices and the amassed experience of physicians in minimal invasive therapy produced a paradigm shift in vascular access management toward percutaneous declotting procedures, using pharmaceutical thrombolysis, mechanical thrombectomy, balloon thrombectomy, and a combination of the above techniques. In this setting, in the last years, AngioJet™ (Possis, Minneapolis, MN, USA) rheolytic thrombectomy (RT) showed an increasing use in emergency and election patients. The purpose of this review is to present the current status of percutaneous rheolytic thrombectomy in different fields of applications.
Collapse
Affiliation(s)
- A M Ierardi
- Department of Radiology, Insubria University, Varese, Italy -
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Ierardi AM, Xhepa G, Duka E, Laganà D, Ianniello A, Floridi C, Bacuzzi A, Reginelli A, Squillaci E, Brunese L, Carrafiello G. Ethylene-vinyl alcohol polymer trans-arterial embolization in emergency peripheral active bleeding: initial experience. INT ANGIOL 2015; 34:28-35. [PMID: 26498889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of this paper was to evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, CA, USA) as the primary treatment in active peripheral emergency arterial bleeding. METHODS Between January 2014 and June 2014, all patients with active peripheral arterial bleeding who were treated by embolization were retrospectively analyzed. We selected 15 (age 37-91 year old) patients embolized with Onyx, chosen as embolic agent in an intention-to-treat fashion. Multidetector computed tomography was performed in all patients. RESULTS Active bleeding was detected in all cases. Digital subtraction angiography confirmed CT findings in all cases. The causes of bleeding were traumatic in 8 patients, angiodysplasia in 1 patient, duodenal ulcer in 1, chronic pancreatitis in 1 and unknown in 4 patients. Nine patients were under anticoagulant or antiplatelet therapy. Embolization was possible in all patients. The technical success rate was 100%. The immediate bleeding control rate was 100%. No rebleeding at 30 days occurred (0%). There were no major complications, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 5.1 months (range, 4.5-6 months). CONCLUSION Control of massive active peripheral emergency arterial bleeding using superselective embolization with Onyx is feasible and safe.
Collapse
Affiliation(s)
- A M Ierardi
- Unit of Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy -
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, Romano L, Brunese L. Radiological and practical aspects of body packing. Br J Radiol 2014; 87:20130500. [PMID: 24472727 DOI: 10.1259/bjr.20130500] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Body packing represents the concealment of illegal substances in a person's body with the aim of smuggling. "Body packers" either swallow drug-filled packets or introduce drug-filled packets into their bodies rectally or vaginally with the purpose of concealing them. The three main smuggled drugs are cocaine, heroin and cannabis products. Body packing represents a serious risk of acute narcotic toxicity from drug exposure, intestinal obstruction owing to pellet impaction and bowel perforation with consequent abdominal sepsis. A suspected body packer is generally admitted to hospital to perform imaging investigations and confirm the presence of drugs in his/her body. Radiological imaging methods are essential to diagnose body packing and to detect potential complications. Increasing sophistication of traffickers and improvements in packaging add to the detection difficulty. Radiologists should be aware of the appearance of drug packets in a range of imaging modalities. This article informs physicians about the challenging aspects of body packing, its background and medicolegal issues, what imaging methods can be used and what criteria are necessary to perform a correct diagnosis.
Collapse
Affiliation(s)
- A Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Rossi C, Reginelli A, D'Amora M, Di Grezia G, Mandato Y, D'Andrea A, Brunese L, Grassi R, Rotondi A. Safety profile and protocol prevention of adverse reactions to uroangiographic contrast media in diagnostic imaging. J BIOL REG HOMEOS AG 2014; 28:155-165. [PMID: 24750802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of the study is to examine the incidence of adverse reactions caused by non-ionic contrast media in selected patients after desensitization treatment and to evaluate the safety profile of organ iodine contrast media (i.c.m.) in a multistep prevention protocol. In a population of 2000 patients that had received a CT scan, 100 patients with moderate/high risk for adverse reactions against iodinated contrast agents followed a premedication protocol and all adverse reactions are reported and classified as mild, moderate or severe. 1.7 percent of the pre-treated patients reported a mild, immediate type reaction to iodine contrast; of these five patients with allergy 0.71 percent had received iomeprol, 0.35 percent received ioversol and 0.71 percent received iopromide. The incidence of adverse reactions was reported to be higher (4 out of 5 patients) among those that referred a history of hypersensitivity against iodinated i.c.m. Although intravenous contrast materials have greatly improved, especially in terms of their safety profile, they should not be administered if there isn't a clear or justified indication. In conclusion, even if we know that the majority of these reactions are idiosyncratic and unpredictable we propose, with the aim of improving our knowledge on this subject, a multicenter study, based on skin allergy tests (prick test, patch test, intradermal reaction) in selected patients that have had previous experiences of hypersensitivity against parenteral organ iodine contrast media.
Collapse
Affiliation(s)
- C Rossi
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - A Reginelli
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - M D'Amora
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - G Di Grezia
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - Y Mandato
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - A D'Andrea
- S.G. Moscati Hospital, Radiology Department, Aversa, Italy
| | - L Brunese
- University of Molise, Department of Health Science, Campobasso, Italy
| | - R Grassi
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - A Rotondi
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| |
Collapse
|
15
|
Zappia M, Reginelli A, Russo A, D'Agosto GF, Di Pietto F, Genovese EA, Coppolino F, Brunese L. Long head of the biceps tendon and rotator interval. Musculoskelet Surg 2013; 97 Suppl 2:S99-108. [PMID: 23949931 DOI: 10.1007/s12306-013-0290-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/13/2013] [Indexed: 01/02/2023]
Abstract
The term "biceps brachii" is a Latin phrase meaning "two-headed (muscle) of the arm." As its name suggests, this muscle has two separate origins. The short head of biceps is extraarticular in location, originates from the coracoid process of the scapula, having a common tendon with the coracobrachialis muscle. The long head of biceps tendon (LBT) has a much more complex course, having an intracapsular and an extracapsular portion. The LBT originates from the supraglenoid tubercle, and in part, from the glenoid labrum; the main labral attachments vary arising from the posterior, the anterior of both aspects of the superior labrum (Bletran et al. in Top Magn Reson Imaging 14:35-49, 2003; Vangsness et al. in J Bone Joint Surg Br 76:951-954, 1994). Before entering the bicipital groove (extracapsular portion), the LBT passes across the "rotator cuff interval" (intracapsular portion). Lesions of the pulley system, the LBT, and the supraspinatus tendon, as well as the subscapularis, are commonly associated (Valadie et al. in J Should Elbow Surg 9:36-46, 2000). The pulley lesion can be caused by trauma or degenerative changes (LeHuec et al. in J Should Elbow Surg 5:41-46, 1996). MR arthrography appears to be a promising imaging modality for evaluation of the biceps pulley, through the distention of the capsule of the rotator interval space and depiction of the associated ligaments.
Collapse
Affiliation(s)
- M Zappia
- Department of Health and Science, University of Molise, Campobasso, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Caranci F, Briganti F, La Porta M, Antinolfi G, Cesarano E, Fonio P, Brunese L, Coppolino F. Magnetic resonance imaging in brachial plexus injury. Musculoskelet Surg 2013; 97 Suppl 2:S181-90. [PMID: 23949940 DOI: 10.1007/s12306-013-0281-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/13/2013] [Indexed: 12/20/2022]
Abstract
Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac.
Collapse
Affiliation(s)
- F Caranci
- Department of Advanced Biomedical Sciences, Unit of Neuroradiology, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Lubrano E, Astorri D, Taddeo M, Salzmann A, Cesarano E, Brunese L, Giganti M, Spadaro A. Rehabilitation and surgical management of ankylosing spondylitis. Musculoskelet Surg 2013; 97 Suppl 2:S191-S195. [PMID: 23949941 DOI: 10.1007/s12306-013-0285-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease which, if untreated, may progress to severe damage of the spine with functional impairment, disability and poor quality of life. An increased mortality has been reported in AS patients compared to the general population. AS requires combined management (pharmacological and non-pharmacological) and advice by different health professionals. Even the pharmacological treatment in the last decade has dramatically changed the outcome, the severity of the disease might require a surgical approach for the hip involvement with total hip replacement, or the corrective spinal surgery. However, this surgery deserves some careful approaches since the complexity of the disease. Rehabilitation still represents a cornerstone of the global management of AS patients. The present review summarizes the state of art of surgical management of these two diseases.
Collapse
Affiliation(s)
- E Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Caranci F, Napoli M, Cirillo M, Briganti G, Brunese L, Briganti F. Basilar artery hypoplasia. Neuroradiol J 2012; 25:739-43. [PMID: 24029187 DOI: 10.1177/197140091202500613] [Citation(s) in RCA: 27] [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] [Received: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 11/15/2022] Open
Abstract
A rare case of segmental hypoplasia of the basilar artery is described in a 49-year-old man with transient vertebrobasilar ischemia, explored by magnetic resonance imaging (MRI) and digital angiography (DA). The embryology, clinical relevance and magnetic resonance findings of this arterial anomaly are discussed, with a review of six previously reported cases. Segmental aplasia was suggested in our case by magnetic resonance, and subsequently confirmed not only by time-of-flight magnetic resonance, but also by DA. Only ultrathin-slice T2-weighted images revealed the real finding of basilar artery hypoplasia. This sequence, not employed in previously reported cases, is mandatory to allow a clear differential diagnosis between basilar artery aplasia and hypoplasia.
Collapse
Affiliation(s)
- F Caranci
- Unit of Interventional Neuroradiology, Department of Neurological Sciences, Federico II University; Naples, Italy -
| | | | | | | | | | | |
Collapse
|
19
|
Reginelli A, Mandato Y, Cavaliere C, Pizza NL, Russo A, Cappabianca S, Brunese L, Rotondo A, Grassi R. Three-dimensional anal endosonography in depicting anal-canal anatomy. Radiol Med 2012; 117:759-71. [PMID: 22228126 DOI: 10.1007/s11547-011-0768-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/25/2011] [Indexed: 01/17/2023]
Abstract
PURPOSE This report describes the advantages of 3D anal endosonography in depicting the normal anatomy of the anal canal in relation to sex and age. MATERIALS AND METHODS A retrospective study was performed of 85 patients, 33 men and 52 women, previously examined with 3D anal ultrasound (US) for clinically suspected anorectal disease but found to be negative. The examinations were performed with a Bruel and Kjaer US system with a 2050 transducer, scanning from the anorectal junction to the subcutaneous portion of the external anal sphincter (EAS). The 3D reconstructions provided an estimation of sphincter length in the anterior and posterior planes, and axial 2D images enabled calculation of the thickness of the internal anal sphincter (IAS) and EAS in the anterior, posterior and lateral transverse planes. RESULTS Distribution of the sphincter complex is asymmetric in both sexes: the EAS and IAS are significantly shorter in females, especially in the anterior longitudinal plane (p=0.005 and p<0.001, respectively). EAS and IAS thickness increases with age, especially the lateral IAS (R(2)=0.37, p<0.001) and the posterior EAS (R(2)=0.29, p=0.01). CONCLUSIONS A good knowledge of anal-canal anatomy is essential to detect sphincter abnormalities when assessing pelvic floor dysfunction.
Collapse
Affiliation(s)
- A Reginelli
- Dipartimento di Internistica Clinica e Sperimentale F. Magrassi e A. Lanzara, Sezione di Radiodiagnostica, Seconda Università degli Studi di Napoli, P.zza Miraglia 2, 80138, Napoli, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
D’Andrea A, Reginelli A, Petrillo M, Iacobellis F, Cappabianca S, Grassi R, Brunese L, Rotondo A. Prognostic value of Multidetector Computed Tomography of cirrhosis. BMC Geriatr 2011. [PMCID: PMC3194397 DOI: 10.1186/1471-2318-11-s1-a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
21
|
Carrafiello G, Fontana F, Cotta E, Petullà M, Brunese L, Mangini M, Fugazzola C. Ultrasound-guided thermal radiofrequency ablation (RFA) as an adjunct to systemic chemotherapy for breast cancer liver metastases. Radiol Med 2011; 116:1059-66. [DOI: 10.1007/s11547-011-0697-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 12/30/2010] [Indexed: 11/30/2022]
|
22
|
Reginelli A, Mandato Y, Russo A, Iacobellis F, Cappabianca S, Brunese L, Grassi R. Morphological rectal alterations following STARR performed for obstructed defecation syndrome. BMC Geriatr 2011. [PMCID: PMC3194380 DOI: 10.1186/1471-2318-11-s1-a51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
23
|
Scialpi M, Cappabianca S, Rotondo A, Scalera GB, Barberini F, Cagini L, Donato S, Brunese L, Piscioli I, Lupattelli L. Pulmonary congenital cystic disease in adults. Spiral computed tomography findings with pathologic correlation and management. Radiol Med 2010; 115:539-50. [PMID: 20058095 DOI: 10.1007/s11547-010-0467-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/03/2009] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to assess the computed tomography (CT) features of intrapulmonary congenital cystic diseases in adults and to correlate the imaging features with the pathological findings, with emphasis on the oncogenic potential of the lesions. MATERIALS AND METHODS We retrospectively reviewed the CT scans in three institutions from August 1996 to December 2008, of nine patients (six men, three women; mean age 48.6 years; range 26-75 years) who had histological diagnosis of pulmonary cystic disease after surgery. Six patients had a diagnosis of intrapulmonary bronchogenic cyst (IBC), and three had a type-I cystic adenomatoid malformation (CAM). In one case, intralobar sequestration (ILS) was associated with type-I CAM. RESULTS Three patients were symptomatic and six were asymptomatic. On CT scans, IBCs showed homogeneous fluid attenuation (n=2), air-fluid level (n=2), air attenuation (n=1) or soft-tissue attenuation (n=1). The surrounding lung tissue showed areas of band-like linear attenuation in three IBCs, atelectasia in two and mucocele-like areas in one. On CT, type-I CAM appeared as a unilocular cystic lesion with air-fluid level (n=1) or air content (n=1). Both cases had thin walls surrounded by normal lung parenchyma. ILS appeared as a fluid-filled cyst with afferent and efferent vessels. Of the six IBCs, one occurred in the upper right lobe, two in the middle lobe and three in the lower right lobe. Of the three type-I CAMs, one was in the upper left lobe and one in the middle lobe. The type-I CAM associated with ILS was located in the left lower lobe. CONCLUSIONS The similar CT patterns preclude differentiation between IBC and type-I CAM. Surgical resection of all intrapulmonary cystic lesions detected in adults is mandatory because type-I CAM is a precursor of mucinous bronchioloalveolar carcinoma.
Collapse
Affiliation(s)
- M Scialpi
- Department of Surgical, Radiologic and Odontostomatologic Sciences, Section of Diagnostic and Interventional Radiology, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Scialpi M, Volterrani L, Mazzei M, Cappabianca S, Barberini F, Piscioli I, Brunese L, Lupattelli L. Small (≤2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT. Radiol Med 2009; 114:935-47. [DOI: 10.1007/s11547-009-0427-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 06/10/2008] [Indexed: 01/26/2023]
|
25
|
Brunese L, Ciccarelli R, Fucili S, Romeo A, Napolitano G, D'Auria V, Collina A, Califano L, Cappabianca S, Sodano A. Pleomorphic adenoma of parotid gland: delayed enhancement on computed tomography. Dentomaxillofac Radiol 2009; 37:464-9. [PMID: 19033432 DOI: 10.1259/dmfr/79964183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess the efficacy of multiphasic CT with 8 min delayed acquisition in the differential diagnosis between pleomorphic adenomas and other parotid neoplasias. METHODS Between January 2004 and April 2007, 62 patients with parotid enlargement were enrolled in this prospective study. The CT protocol applied included the following four acquisitions: without contrast medium and 30 s, 120 s and 8 min after intravenous injection of contrast medium. We considered the degree of the enhancement of the lesions (rated as "low", "moderate" and "strong") and the degree of enhancement homogeneity (rated as "not homogeneous", "mildly homogeneous" and "uniform"). These parameters were compared with Hounsfield values of the lesions computed in each phase. The diagnosis was confirmed in all patients after surgery. RESULTS On histological examination, 36 tumours were classified as pleomorphic adenomas and 26 as non-pleomorphic adenomas. On the basis of a statistical comparison, the third phase proved to be the most effective in the differential diagnosis between pleomorphic adenoma and non-pleomorphic adenomas, both for the assessment of the degree of the enhancement (in this phase, strong enhancement showed a sensitivity of 61.11%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 53.33%) and, above all, for the homogeneity of the enhancement (in this phase, indeed, uniform enhancement showed sensitivity, specificity, PPV and NPV of 100%). CONCLUSIONS Our results seem to indicate that multiphasic CT with 8 min delayed acquisition allows the differential diagnosis between pleomorphic adenomas and other parotid neoplasias.
Collapse
Affiliation(s)
- L Brunese
- Department of Health Sciences, Università del Molise, Contrada Tappino, Campobasso, Molise 86100, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Cappabianca S, Colella G, Pezzullo MG, Russo A, Iaselli F, Brunese L, Rotondo A. Lipomatous lesions of the head and neck region: imaging findings in comparison with histological type. Radiol Med 2008; 113:758-70. [DOI: 10.1007/s11547-008-0258-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 07/16/2007] [Indexed: 11/30/2022]
|
27
|
Montella S, Andreucci MV, Greco L, Barbarano F, De Stefano S, Brunese L, Santamaria F. Clinical utility of CT in children with persistent focal chest abnormality. Eur Respir J 2005; 26:751-2. [PMID: 16204614 DOI: 10.1183/09031936.05.00082205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
28
|
Brunese L, Sparano A, Rispo M, Radice L, Sodano A. Intestinal lipoma: CT findings. Four case reports. Radiol Med 2002; 103:421-3. [PMID: 12107394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- L Brunese
- Dipartimento di Scienze Biomorfologiche e Funzionali, Sezione di Diagnostica per Immagini, Università Federico II, Naples, Italy.
| | | | | | | | | |
Collapse
|
29
|
Grassi R, Rea G, Scaglione M, Brunese L, Scialpi M. Imaging of tracheocele: report of three cases and review of the literature. Radiol Med 2000; 100:285-7. [PMID: 11155458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- R Grassi
- Istituto di Radiologia, Facoltà di Medicina, II Università, Napoli
| | | | | | | | | |
Collapse
|
30
|
Brunese L, Mamone R, Carbone M, Rossi E, Vallone G. [Unusual case of malignant degeneration of multicystic pancreas in von Hippel-Lindau syndrome]. Radiol Med 2000; 99:487-8. [PMID: 11262834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- L Brunese
- Dipartimento di Scienze Biomorfologiche e Funzionali I Servizio di Diagnostica per Immagini, Università Federico II, Napoli
| | | | | | | | | |
Collapse
|
31
|
Brunese L, Mamone R, Rossi E, Carbone M, Vallone G. [Echography of carcinoma of the anal canal before and after conservative treatment. Case report]. Radiol Med 2000; 99:393-5. [PMID: 10938712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- L Brunese
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli
| | | | | | | | | |
Collapse
|
32
|
Tamasi S, Rossi E, Carbone M, Amodio F, Mattace Raso M, Brunese L, Ciccarelli R, Vallone G. [Echographic evaluation of the thymus gland in childhood]. Radiol Med 2000; 99:352-4. [PMID: 10938704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The thymus is a linphoepithelial organ located mostly in the anterior mediastinum and, for a smaller part, in the neck. The gland is particularly developed in the fetus and in children, while it shrinks in young adults following an involution process. We investigated the US appearance of the thymus in normal pediatric subjects to gather information for use in pediatric patients with suspected thymus conditions, using a safe, irradiation-free, technique. MATERIAL AND METHODS We performed a US examination of the anterior mediastinum and the neck in 30 children (14 males and 16 females) ranging in age 6 months to 11 years. We used a Sonora LOGIC 700 MD General Electrics unit with 7.5-13 MHz linear probes and acquired transverse and longitudinal scans on the chest wall and the neck, integrated with intercostal scans. RESULTS The thymus had the same echogenicity as the liver parenchyma in 22 children (73.3%), lower echogenicity in 2 (6.6%, age range 6-12 months) and higher echogenicity with heterogeneous structure in 6 children (20%, age range 8-11 years). The gland was in central and symmetric localization in 20 children (66.6%) while it exhibited a slight deviation leftwards in 7 (23.3%) and rightwards in 3 children (10%). We considered as normal the following values: in the right lobe, 1.4 cm for the AP diameter and 2.5 cm for the longitudinal one; in the left lobe, 1.4 cm for the AP diameter and 2.9 cm for the longitudinal one. DISCUSSION AND CONCLUSION Radiological studies of the thymus are really difficult to perform because the gland is extremely variable in size, extension and shape. The thymus has the same echogenicity as the liver parenchyma and lower echogenicity than the thyroid parenchyma. We believe that US is an effective technique for studying the thymus in all its involution stages and that provides similar information to CT and MRI. Also, US does not use radiations and needs no sedation, which improves safety for young patients.
Collapse
Affiliation(s)
- S Tamasi
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi Federico II, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Salzano A, Nocera V, De Rosa A, Rossi E, Nunziata A, Tuccillo M, Brunese L, Grassi R. [Craniocerebral trauma from bullets: the correlation between computed tomography, the clinical picture, neurosurgical treatment and the long-term sequelae]. Radiol Med 2000; 99:156-60. [PMID: 10879162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE To demonstrate the usefulness of CT findings in the planning of brain neurosurgery in gunshot victims, for prompt and successful treatment. MATERIAL AND METHODS Thirty patients with brain gunshot wounds were examined with CT over 5 years. The patients were 27 men and 3 women whose mean age was 33 years (range: 17-56). Brain CT was carried out with thin (5-mm) slices and 10-mm gap; dynamic scanning (3-mm interscan time) was used especially in case of posterior fossa involvement and diffuse brain damage. The examination was integrated with cervical scout views to detect bullets in the neck and cervical dislocation. CT follow-up was carried out in 20 patients 24 hours postoperatively and every 6 hours in 9 patients in a severe postoperative coma. RESULTS Twelve intracranial hematomas and 9 subdural hematomas, 3 of them bilateral, were treated and hemorrhage was resolved in 8 lacerocontusive foci. Skull plastic surgery was carried out in 5 cases. Surgical maneuvers were most difficult in the 5 crash bone injuries with wedged splinters; postoperative subarachnoid hemorrhage followed in 3 cases. Blood effusion in ventricles was drained in 6 cases; in 2 of them with permanent catheters. Eleven patients died: 4 right after surgery and 7 an average 15 days postoperatively. DISCUSSION AND CONCLUSIONS In our series the mortality rate of firearm wounds of the skull base was 34% higher than that of the hemisphere; this is due to carotid hemorrhage and midbrain damage. Such traumas require emergency radiological diagnosis and neurosurgical treatment because of their severity and early irreversible complications. Complex operations and skilled surgeons may prevent disabling postoperative sequels. CT findings are indispensable and must be correctly interpreted. The radiologist and the neurosurgeon must collaborate closely and both must consider several diagnostic and prognostic factors affecting surgical planning.
Collapse
Affiliation(s)
- A Salzano
- Servizio di Radiologia, Ospedale S. Giovanni di Dio di Frattamaggiore, ASL NA 3, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Amodio F, Rossi E, Carbone M, Brunese L, Tamasi S, Mansueto G, Somma P, Vallone G. [Echographic study with high-frequency and high-spatial resolution transducer in the evaluation of renal transplant in pediatric age]. Radiol Med 2000; 99:68-71. [PMID: 10803190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE We investigated the role of power Doppler US with a high-frequency and high-resolution transducer (13 MHz) in the visualization of interlobular arterioles in patients with normally functioning renal transplants or with chronic rejection. MATERIAL AND METHODS We examined 15 patients (mean age 15 years; range 10-18 years) with a General Electric 500 MD unit using 7.5 and 13 MHz linear transducers. In all the patients serum creatinine and diuresis were evaluated; 4 patients underwent US-guided biopsy that resulted in the diagnosis of chronic rejection. RESULTS Normally functioning renal transplants were found in 11 patients and chronic rejection was seen in 4. In normally functioning renal transplants, interlobular vessels could be depicted as "cortical blush" with the 7.5 MHz transducer; in the same patients power Doppler US with the 13 MHz transducer permitted a correct evaluation of interlobular vessels that were arranged in series like a palisade. In chronic rejection power Doppler US with the 13 MHz transducer better depicted cortical vascularity and showed irregular, narrow arteries. CONCLUSION Power Doppler US with a 13 MHz transducer is particularly useful in children after renal transplants due to their reduced tissutal thickness. The lateral resolution of 13 MHz transducers (< 0.3 mm) allows to separate interlobular vessels from each other and the high frequency of the probe can depict interlobular vessels in the peripheral cortex. The optimal visualization of cortical vascularity with a 13 MHz transducer allows early detection of chronic rejection.
Collapse
Affiliation(s)
- F Amodio
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi Federico II, Napoli, NA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Rossi E, Salzano A, Accattatis V, Carbone M, Brunese L. [Pancreatic echinococcosis. Computed tomography aspects in a case]. Radiol Med 2000; 99:117-8. [PMID: 10803205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- E Rossi
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli
| | | | | | | | | |
Collapse
|
36
|
Salzano A, De Rosa A, Scialpi M, Rossi E, Carbone M, Brunese L, Nocera V, Muto M. [Gunshot wounds of the cranium studied with computerized tomography. Personal experience in 23 cases]. Radiol Med 2000; 99:26-30. [PMID: 10803182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Gunshot wounds to the head are usually mortal injuries. Their frequency has been increasing in the last years because of increasing crime rates. Gunshot wounds to the head require close clinical and diagnostic cooperation of the neurosurgeon and radiologist, detailed assessment of skull and brain damage, and finally prompt treatment. Emergency Computed Tomography (CT) makes a useful tool for depicting bullet course and brain damage, and thus helps plan treatment. We investigated the CT signs of subdural hematoma, lacerocontusive focus, subarachnoid hemorrhage, hemoencephalus, skull bone fracture and thecal hollow and report them as an aid to the neurosurgeon and the radiologist, for best treatment planning, and in an attempt to establish useful prognostic criteria. MATERIAL AND METHODS We retrospectively reviewed 23 cases of gunshot injuries to the head studied with CT at the Emergency Unit of Loreto Mare Hospital in Naples, Italy. Twenty patients were men and 3 women; their mean age was 31 years (range: 18-49). Three women and 2 men had been injured accidentally by wandering bullets, and one case was an attempted suicide; all the other cases resulted from shootings. CT slices were 10 mm thick, with 8 mm gap (5 mm in complex injuries and when posterior cranial fossa was involved); all scans were unenhanced. RESULTS We found 22 penetrating gunshot wounds: 13 of them with thecal entry hole and intracranial bullet retention and 9 with an entry and an exit hole. One case was a superficial wound. Crash skull fractures were seen in 22 cases and they were fragmented in 12, with overlapping thecal fragments in 4, and with deep fragments in 2 cases. There were scattered bone splinters in 3 cases and the bullet was retained in the mastoid bone in one case. Lacerocontusive foci were assessed in 22 cases, brain swelling in 20, subarachnoid hemorrhage in 19, brain hematoma in 15, blood in the ventricular system in 9, pneumoencephalus in 7, air bubbles along the bullet course in 7, impression on ventricula and linear structures in 7, interhemispheric blood in 5, and finally blood effusion in Sylvian scissure in 4 cases. DISCUSSION AND CONCLUSIONS Gunshot wounds to the head are complex and severe traumas with high mortality rates because of both early and late effects and complications. CT provides the neurosurgeon with abundant findings for diagnosis and surgical planning, which may result in improved survival rates. In these patients emergency CT plays a fundamental diagnostic role in depicting brain damage and thus remains the method of choice for thorough, rapid and accurate brain and skull studies, as well as to detect possible injury to the chest and abdomen.
Collapse
Affiliation(s)
- A Salzano
- Servizio di Radiologia, Ospedale Loreto Mare, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Salzano A, Carbone M, Rossi E, Gatta G, Brunese L. [Lipoma of the psoas muscle. A rare case]. Radiol Med 1999; 98:518-9. [PMID: 10755016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- A Salzano
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli
| | | | | | | | | |
Collapse
|
38
|
Salzano A, De Rosa A, Rossi E, Brunese L, Carbone M, Nocera V, Tuccillo M, Scialpi M. [The topicality and use of the radiological exam in gunshot wounds of the limbs. An assessment of 132 cases]. Radiol Med 1999; 98:468-71. [PMID: 10755006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Gunshot wounds of limbs are frequent injuries especially in Western countries. They can be single or associated with other penetrating gunshot wounds, for instance to the chest, abdomen and skull. PURPOSE We investigated the current role and usefulness of conventional radiography in the assessment of gunshot injuries to limbs because, despite major advances in diagnostic imaging, this method remains the examination of choice in this condition. We stress the valuable contribution of conventional radiography to detection of bone blow-out fractures, multifocal traumatic bone changes, bone and joint injuries, bullet retention, and finally subcutaneous emphysema. MATERIAL AND METHODS We retrospectively reviewed 132 cases of firearm injuries of limbs submitted to radiography March 1996 to July 1999. All the patients were men ranging in age 17-66 years (mean: 35). Radiography followed a preliminary physical examination, and follow-ups were carried out in the following days after orthopedic reduction of bone fractures or surgery with metal osteosynthesis. Emergency CT was performed first when chest, abdomen, or skull were involved. RESULTS The lower limbs were involved three times as much as the upper ones; the leg was most frequently involved (61%), followed by thigh (61%), forearm and hands (24%), and feet (15%). The right lower limb was wounded in 65% of cases, especially tibia (55 cases) and femur (46 cases). Spiral injuries to bone diaphysis were the most frequent ones, followed by mixed fractures caused by cortical bone sinking from bullet impact. Bullets were retained in 60% of cases; subcutaneous emphysema was found in 78% of cases and vascular injuries in 25 cases in relation to disarranged fractures. We observed 4 arteriovenous fistulas during 3 years' follow-up. DISCUSSION AND CONCLUSIONS Gunshot wounds to the limbs need a different clinical, diagnostic and therapeutic approach than thoracoabdominal and skull injuries, which require immediate and quick diagnosis and emergency treatment. The cases with injury to a primary artery from open and splintered fractures require emergency surgical reconstruction with vascular anastomosis and reduction of compound fractures, to prevent necrosis and amputation. Conventional radiography does depict the bullet and its site, subcutaneous emphysema, blow-out fractures, and the location of bone splinters. This permits adequate emergency surgery and an efficacious orthopedic approach, as well as selection of the cases to be submitted to clinical monitoring.
Collapse
Affiliation(s)
- A Salzano
- Servizio di Radiologia, Ospedale Loreto Mare, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Mattace Raso M, Tamasi S, Salzano A, Carbone M, Brunese L. [A case of a teratocarcinoma with retroperitoneal location]. Radiol Med 1999; 98:424-6. [PMID: 10780233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- M Mattace Raso
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi Federico II, Napoli, NA
| | | | | | | | | |
Collapse
|
40
|
Rea G, Salzano A, De Rosa A, Carbone M, Brunese L. [Calcified thrombosis of the inferior vena cava and iliac vein. A case report]. Radiol Med 1999; 98:306-8. [PMID: 10615374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- G Rea
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli
| | | | | | | | | |
Collapse
|
41
|
Carbone M, Rossi E, Pellegrino G, Salzano A, Brunese L. [Multiple pancreatic cysts as an atypical presentation of Von Hippel Lindau syndrome. A case report]. Radiol Med 1999; 98:310-2. [PMID: 10615376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M Carbone
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli
| | | | | | | | | |
Collapse
|
42
|
Coppola V, Brunese L, Gatta G, Coppola M, Alfano L, Cariello S, Maioli A. [Follow-up chest radiography in surgical breast cancer patients]. Radiol Med 1999; 98:264-7. [PMID: 10615365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
PURPOSE We investigated to what extent the diagnostic findings of chest radiography can improve prognosis and treatment in surgical breast cancer patients. We also reviewed the literature and our personal findings to choose the optimal follow-up frequency to meet therapeutical and management needs, including radiation protection. MATERIAL AND METHODS We retrospectively reviewed 1556 chest radiographs of 195 surgical patients with M0 breast cancer performed January 1990 to December 1996. Patient's history and clinical data were accurately reviewed to investigate the relation between protocol type and results. The maximalist or intensive protocol featured 3 chest radiographs a year, even in the absence of any specific signs; the results were reviewed in terms of early diagnosis and prolongation of life. RESULTS Only 13% of the examinations had been performed following a specific clinical indication, while 87% had been performed for a generic referral. Recurrences were found in 0.6% only of the latter examinations, which means that radiography provided no diagnostic improvement or important change in treatment in as much as 99.4% of cases. In 1997 radiographic follow-up was made triannual instead of biannual as it used to be. DISCUSSION AND CONCLUSIONS In the absence of specific clinical indications, chest radiography can be performed in the two projections once a year. More aggressive protocols requiring more frequent examinations are not justified, as the patient's life expectancy is not increased. Yearly examinations permit to meet economic and management needs, with a better use of time, staff and materials. Moreover, the clinical-diagnostic yield is not affected by the skipping of unselected examinations. Finally, another pro is the technical thoroughness of the examination with orthogonal projections and the possibility to use ionizing radiations, which improves the management of clinical risks. Maximum radiologist-oncologist cooperation in clinical practice can improve both diagnostic efficiency and treatment efficacy, by reducing the population dose and rationalizing the use of human, instrumental, structural and financial resources.
Collapse
Affiliation(s)
- V Coppola
- Istituto di Scienze Radiologiche, Università degli Studi, Federico II, Napoli
| | | | | | | | | | | | | |
Collapse
|
43
|
Salzano A, Rossi E, De Rosa A, Carbone M, Amodio F, Muto M, Accattatis V, Brunese L. [The role of computed tomography in assessing subphrenic abscesses after posttraumatic splenectomy]. Radiol Med 1999; 98:173-7. [PMID: 10575448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION We studied subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with CT, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. We investigated the diagnostic accuracy of CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. MATERIAL AND METHODS Thirteen patients with left subphrenic inflammatory abscesses after splenectomy for trauma were examined from 1994 to 1998. They were 9 men and 4 women ranging in age 16-67 years (mean: 32). CT demonstrated abscesses early postoperatively in 9 patients and late postoperatively (mean: 3 months) in 4 patients. Abscesses were diagnosed with CT on admission for an abdominal emergency in 3 cases; one abscess was found at outpatient US performed for persisting left abdominal pain. CT-guided percutaneous drainage was performed in all patients with the Trocar technique. RESULTS A large inflammatory liquid collection with the typical "liquid pseudospleen" appearance and characterized by tomodensitometric coefficients of corpusculated fluid was seen in 3 cases. Multiple confluent lesions with septa were found in 3 cases. Contrastography of the abscess cavity with the injection of a water-soluble iodinated contrast agent was performed in 2 cases to detect fistulas connecting to the intestinal loops. Subphrenic abscesses had the same CT patterns both early and late postoperatively, with the collection organizing into thick and corpusculated phlogistic material and exhibiting enhanced capsulofibrous differentiation. Air bubbles and water-air levels within the collection were found in 7 cases and considered a pathognomonic sign of inflammatory abscesses. A periabscessual reaction involving intestinal loops and adjacent organs was seen in 4 cases. DISCUSSION AND CONCLUSIONS Splenectomy causes depressed phagocytosis and decreases serum levels of IgM and antigen response. This calls for careful selection of the patients absolutely requiring splenectomy, such as those with decompensated circulation and multiple parenchymal ruptures or spleen detachment from its stalk. Subphrenic abscesses after splenectomy account for 2.5% of postoperative complications and those after splenectomy for trauma are rarer still, with 1.3%. CT is the imaging method of choice in detecting inflammatory abscesses in the residual splenic cavity and assessing their extent. CT-guided drainage is the first-line treatment, while surgery is reserved to later stages, when drainage fails or other complications occur. Finally, CT permits accurate positioning of the catheter inserted with the Trocar technique and its immediate monitoring, which permits to assess treatment efficacy.
Collapse
Affiliation(s)
- A Salzano
- Servizio di Radiologia, Ospedale Loreto-Mare, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Amodio F, Carbone M, Rossi E, Brunese L, Pisano G, Iorio S, Benincasa G, Vallone G. [An update of B-mode echography in the characterization of nodular thyroid diseases. An echographic study comparing 7.5 and 13 MHz probes]. Radiol Med 1999; 98:178-82. [PMID: 10575449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE We investigated B-mode US capabilities in diagnosis and characterizing thyroid nodules and compared our personal findings with those of the few analytical studies in the literature. We also compared the diagnostic accuracy of conventional 7.5 MHz versus more recent 13 MHz transducers. MATERIAL AND METHODS We examined 136 consecutive patients with a single thyroid nodule: they were 97 women and 39 men, age ranging 15-87 years (mean: 37.4). The patients were submitted to scintigraphy and laboratory tests first and then to US, fine-needle biopsy and/or histologic examination. The final diagnosis was made at cytology and/or histology: we had 98 follicular hyperplasias, 20 follicular adenomas and 18 carcinomas. We studied the presence/absence of the halo sign, cystic portions, microcalcifications; nodule margins and echogenicity relative to the thyroid gland were also studied. RESULTS The presence of microcalcifications had the highest specificity for malignancy. The sensitivity of this parameter was higher with 13 MHz than with 7.5 MHz transducers. Relative to microcalcifications, absence of cystic portions and irregular margins, 13 MHz US had 64.7-89% accuracy. The halo sign and lesion echogenicity did not permit a reliable differential diagnosis between benign and malignant nodules with both 7.5 and 13 MHz transducers. The association of microcalcifications and irregular margins had the highest accuracy, scoring 86% at 7.5 MHz and 90.5% at 13 MHz. CONCLUSIONS High frequency US is a sensitive tool for diagnosing thyroid nodes. Accurate analysis of the US signs can suggest the benign/malignant lesion nature, which must be integrated with color, power and pulsed Doppler findings.
Collapse
Affiliation(s)
- F Amodio
- Dipartimento di Scienze Biomorfologiche e Funzionali, Istituto di Scienze Radiologiche, II Università, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Iurassich S, Rossi E, Carbone M, Brunese L. [Ultrasound patterns of rheumatoid and psoriatic arthritis in finger joints]. Radiol Med 1999; 98:15-8. [PMID: 10566291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE Rheumatoid and psoriasic arthritis involve proximal joints symmetrically and distal joints asymmetrically, respectively, the differential diagnosis between these two types of arthritis is not easy. Therefore we investigated which US signs could help the diagnosis and/or treatment of these conditions and compared them with radiographic patterns and articular and physical symptoms. MATERIAL AND METHODS Fifty-one patients, 30 women and 21 men aged 19-42 years were enrolled in this study. Thirty patients had rheumatoid and 21 psoriasic arthritis. US of the skin and joints of the fingers was performed with a GE Sonora Logic 500 MD unit with 7.5 and 10 MHz scanheads. We studied the shape of articular bone heads, the intra-articular space distance and the thickness of extensor tendon and of the dermis and hypodermis covering it. These findings show the extent of damage in articular bone heads and intra-articular space and they indicate cutaneous and articular inflammation. US patterns were also compared with radiographic findings in all patients. RESULTS US showed bone and joint and/or inflammatory damage in both types of arthritis. Articular bone heads had a bodkin-like appearance in proximal phalanges in rheumatoid arthritis, versus a hook-like appearance in distal phalanges in psoriasic arthritis. Inflammatory damage was indicated by intra-articular space thinning and by tendon, dermis and hypodermis thickening. These signs, confirmed radiographically, account for finger deformation and functional impairment, swelling and pain. CONCLUSION US signs can help the diagnosis of rheumatoid and psoriasic arthritis. US can show inflammatory damage and the disease evolution.
Collapse
Affiliation(s)
- S Iurassich
- Seconda Università degli Studi, Facoltà di Medicina e Chirurgia, Servizio Speciale di Terapia Fisica Dermatologica, Napoli
| | | | | | | |
Collapse
|
46
|
Di Salle F, Formisano E, Pepino A, Garreffa G, Brunese L, Del Vecchio W, Jakobi V, Smaltino F. [Echo-planar sequences in neuroradiology]. Radiol Med 1999; 98:71-6. [PMID: 10566299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- F Di Salle
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università Federico II, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Rossi E, Carbone M, Candela G, Brunese L, Salzano A. [Giant Spigelian hernia: assessment with computerized tomography and surgical correlations. Report of a case]. Radiol Med 1999; 97:196-7. [PMID: 10363066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- E Rossi
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi Federico II, Napoli NA
| | | | | | | | | |
Collapse
|
48
|
Carbone M, Rossi E, Iurassich S, Amodio F, Gatta G, Brunese L, Coppola V, Vallone G. [Assessment of microvascularization around the plaques in Peyronie's disease with Doppler color ultrasonography, power Doppler and ultrasonography contrast media]. Radiol Med 1999; 97:66-9. [PMID: 10319102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The origin of Peyronie's disease remains obscure although the first report of this condition dates back to 1743. The disease prevalence in 388.6 in 100,000 population and little physiopathologic information is available. Repeated microtrauma to the tunica albuginea appears to favor the onset of inflammatory phenomena which result in fibrosis and calcification. The disease activity produces a microvascularization around the fibrocalcific plaques. We studied the evolution of the inflammatory process in Peyronie's disease relative to clinical symptoms, in order to optimize treatment follow-up. MATERIAL AND METHODS We examined 20 patients with Peyronie's disease aged 34 to 56 years using a GE Sonora Logic 500 MD US scanner with linear probes of 7.5 and 13 MHz. The microvascularization around the plaques was studied with color and power Doppler investigations before contrast agent administration and with combined color and power Doppler after contrast agent administration. We injected Levovist (300 mg/mL) and 10 micrograms prostglandin E1 (PGE1). Examinations were repeated after 2-4 months in the patients with evidence of microvascularization around the plaques. RESULTS US demonstrated fibrocalcific plaques in all the patients. The microvascularization around the plaques was seen with color Doppler in 3 cases (15%), with power Doppler in 5 cases (25%) and with contrast-enhanced color and power Doppler in 7 cases (35%). At 2-4 months' follow-up, we observed slight plaque enlargement and worsened symptoms in 5 of 7 patients (71%) with evidence of some microvascularization around the plaque. CONCLUSIONS The plaque presence allows to define the condition and the microvascularization provides information on its evolution. The disease activity can be distinguished into 3 stages which can be related to the painful symptoms. US exhibits a better cost/benefit ratio than contrast-enhanced MRI.
Collapse
Affiliation(s)
- M Carbone
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi Federico II, Napoli NA
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Rotondo A, Di Salle F, Del Viscovo L, Pellegrino G, Brunese L, Florio A, Smaltino F. [Magnetic resonance angiography of the epiaortic vessels of the thorax]. Radiol Med 1998; 96:331-8. [PMID: 9972212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Magnetic Resonance angiography (MRA) is an accurate and non-invasive diagnostic method to evaluate vascular disease. On the basis of its technological advancements, this technique has gained an important role in the diagnostic protocol of cerebral and cervical vascular diseases. Nonetheless, MRA efficacy changes in different anatomic districts as a consequence of the specific anatomy and flow features. Cardiac and respiratory artifact and different coil sensitivity also affect MRA results. For these reasons, intrathoracic epiaortic vessels are a difficult applications for MRA. MATERIAL AND METHODS We examined 20 patients affected with epiaortic atherosclerosis with MRA, carried out with an 0.5 T MR unit (Vectra, GE). Examinations consisted of Phase Contrast (PC) 3D sequences (TR/TE/FA/Venc = 30/13/45/30-50), with 3 axes of flow encode, matrix 128 x 256, 2 mm partition thickness, and axial and/or coronal acquisition volume. The MRA was repeated after Gd-DTPA intravenous perfusion and a qualitative and quantitative evaluation of pre- and post-contrast results was performed. Specific parameters of evaluation were: angiographic contrast, contrast to noise ratio, saturation effect of longitudinal magnetization, contrast between arteries and veins. All patients were examined with Doppler US and angiography. MRA data were compared to angiography in order to establish MRA sensitivity and specificity. RESULTS AND CONCLUSIONS PC sequences showed high accuracy in the examination of the proximal tract of epiaortic vessels; Gd-DTPA administration substantially improved MRA results. The perspectives of technological improvement will probably candidate PC MRA to be a valid alternative to US-Doppler and, perhaps, to angiographic study.
Collapse
Affiliation(s)
- A Rotondo
- Istituto di Scienze Radiologiche, Facoltà di Medicina e Chirurgia, Università Federico II, Napoli
| | | | | | | | | | | | | |
Collapse
|
50
|
Pellegrino G, Pinto A, Gatta G, Pelella I, Brunese L. [Computerized tomography and magnetic resonance findings in adrenal ganglioneuroma. Report of a case]. Radiol Med 1998; 96:135-7. [PMID: 9819642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- G Pellegrino
- Facoltà di Medicina e Chirurgia, Dipartimento Assistenziale di Diagnostica per Immagine e Radioterapia, Università degli Studi Federico II, Napoli
| | | | | | | | | |
Collapse
|