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D'Angelo T, Lanzafame LRM, Liguori C, Mantini C, Russo V, Palumbo P, Scalera GB, Iozzelli A, Borghesi A, Matta G, Greco F, Garretto V, Danti M, Iezzi R, Francone M. Pre-TAVI imaging: an Italian survey by the CT PRotocol optimization (CT-PRO) group. Int J Cardiovasc Imaging 2024; 40:831-839. [PMID: 38263535 PMCID: PMC11052815 DOI: 10.1007/s10554-024-03052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community. METHODS Between December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging. RESULTS 557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient's body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings. CONCLUSIONS This survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.
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Affiliation(s)
- Tommaso D'Angelo
- Unit of Diagnostic and Interventional Imaging, Department BIOMORF, University of Messina, Via Consolare Valeria 1, Messina, 98100, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ludovica R M Lanzafame
- Unit of Diagnostic and Interventional Imaging, Department BIOMORF, University of Messina, Via Consolare Valeria 1, Messina, 98100, Italy
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare, ASL NA1 Centro, Napoli, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "Gabriele D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Russo
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, Radiology Department IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L'Aquila, Italy
| | - Giovanni B Scalera
- Unit of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, Brescia, I - 25123, Italy
| | - Gildo Matta
- Department of Radiology, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy
| | - Fabio Greco
- Department of Radiology, "University Hospitals Bristol and Weston Foundation Trust", Bristol, UK
| | - Valeria Garretto
- Diagnostic Radiology Unit Department, CAST - Policlinico - San Marco Hospital University, Catania, Italy
| | | | - Roberto Iezzi
- Unit of Diagnostic and Interventional Imaging, Department of Diagnostic Imaging, Radiation Therapy and Hematology, IRCCS Policlinico "A. Gemelli", Roma, Italy
- Unit of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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D’Angelo T, Lanzafame LRM, Micari A, Blandino A, Yel I, Koch V, Gruenewald LD, Vogl TJ, Booz C, Bucolo GM, Cannizzaro MT, Ascenti G, Mazziotti S. Improved Coronary Artery Visualization Using Virtual Monoenergetic Imaging from Dual-Layer Spectral Detector CT Angiography. Diagnostics (Basel) 2023; 13:2675. [PMID: 37627934 PMCID: PMC10453590 DOI: 10.3390/diagnostics13162675] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/13/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Background: To evaluate if coronary CT angiography (CCTA) monoenergetic reconstructions, obtained with a dual-layer spectral detector computed tomography (DLCT) system, offer improved image quality compared with 120 kVp conventional images without affecting the quantitative assessment of coronary stenoses. Methods: Fifty CCTA datasets (30 men; mean age: 61.6 ± 12.3 years) acquired with a DLCT system were reconstructed using virtual monoenergetic images (VMI) from 40 to 100 keV with 10 keV increment and compared with conventional images. An analysis of objective image quality was performed, evaluating the signal- and contrast-to-noise ratio. For the subjective assessment, two readers used a 5-point Likert scoring system to evaluate sharpness, noise, demarcation of coronary plaques, vascular contrast, and an overall score. Furthermore, coronary stenoses were analyzed for each vessel to describe the diagnostic agreement between monoenergetic images and conventional images. Results: The objective image analysis showed that all reconstructions from 70 keV to 40 keV show higher SNR (from 61.33 ± 12.46 to 154.22 ± 42.91, respectively) and CNR (from 51.45 ± 11.19 to 135.63 ± 39.38, respectively) compared with conventional images (all p < 0.001). The 40 keV monoenergetic images obtained the best average score for sharpness, vascular contrast, and for the overall impression (all with p < 0.001). The detection and grading of stenoses of the coronary arteries with conventional and monoenergetic images at 70 keV and 40 keV showed an overall excellent interobserver agreement (k= 0.81 [0.72-0.91]). Conclusions: The 40 keV virtual monoenergetic images obtained with a DLCT system allow the objective and subjective image quality of coronary CT angiography to be improved.
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Affiliation(s)
- Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy; (L.R.M.L.); (A.B.); (G.M.B.); (G.A.); (S.M.)
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy; (L.R.M.L.); (A.B.); (G.M.B.); (G.A.); (S.M.)
| | - Antonino Micari
- Department of Clinical and Experimental Medicine, DIMED, University Hospital Messina, 98124 Messina, Italy;
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy; (L.R.M.L.); (A.B.); (G.M.B.); (G.A.); (S.M.)
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (I.Y.); (V.K.); (L.D.G.); (T.J.V.); (C.B.)
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (I.Y.); (V.K.); (L.D.G.); (T.J.V.); (C.B.)
| | - Leon D. Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (I.Y.); (V.K.); (L.D.G.); (T.J.V.); (C.B.)
| | - Thomas J. Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (I.Y.); (V.K.); (L.D.G.); (T.J.V.); (C.B.)
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (I.Y.); (V.K.); (L.D.G.); (T.J.V.); (C.B.)
| | - Giuseppe M. Bucolo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy; (L.R.M.L.); (A.B.); (G.M.B.); (G.A.); (S.M.)
| | - Maria Teresa Cannizzaro
- Radiology Unit (CAST), University Hospital Catania, “Policlinico G. Rodolico–San Marco”, 95123 Catania, Italy;
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy; (L.R.M.L.); (A.B.); (G.M.B.); (G.A.); (S.M.)
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy; (L.R.M.L.); (A.B.); (G.M.B.); (G.A.); (S.M.)
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D’Angelo T, Arico FM, Broccio L, Ascenti G, Mazziotti S, Booz C, Martin SS, Yel I, Lanzafame LRM, Blandino A, Sofia C. Multi-Contrast Differentiation by Dual-Energy Spectral CT Angiography in a Patient with Pulmonary Barium Granulomas. Diagnostics (Basel) 2023; 13:diagnostics13050832. [PMID: 36899976 PMCID: PMC10000742 DOI: 10.3390/diagnostics13050832] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/17/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Barium inhalation usually relates to accidental aspiration during radiological procedures with an oral contrast agent. When present, barium lung deposits are visible as high-density opacities on chest X-ray or CT scan due to high atomic number, and they may be indistinguishable from calcifications. Dual-layer spectral CT has shown good material differentiation capabilities, due to its increased high-Z element range and smaller spectral separation between low- and high-energy spectral data. We present the case of a 17-year-old female with a history of tracheoesophageal fistula, who underwent chest CT angiography on a dual-layer spectral platform. Despite the close Z numbers and K-edge energy levels of the two different contrast materials, spectral CT was able to identify barium lung deposits from a previous swallowing study and to clearly distinguish them from calcium and the surrounding iodine-containing structures.
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Affiliation(s)
- Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Correspondence: (T.D.); (F.M.A.)
| | - Francesco M. Arico
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
- Correspondence: (T.D.); (F.M.A.)
| | - Lydia Broccio
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Simon S. Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Carmelo Sofia
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
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D’Angelo T, Vizzari G, Lanzafame LRM, Pergolizzi F, Mazziotti S, Gaeta M, Costa F, Di Bella G, Vogl TJ, Booz C, Micari A, Blandino A. Spectral CT Imaging of Prosthetic Valve Embolization after Transcatheter Aortic Valve Implantation. Diagnostics (Basel) 2023; 13:diagnostics13040678. [PMID: 36832165 PMCID: PMC9955456 DOI: 10.3390/diagnostics13040678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Transcatheter heart valve (THV) embolization is a rare complication of transcatheter aortic valve implantation (TAVI) generally caused by malpositioning, sizing inaccuracies and pacing failures. The consequences are related to the site of embolization, ranging from a silent clinical picture when the device is stably anchored in the descending aorta to potentially fatal outcomes (e.g., obstruction of flow to vital organs, aortic dissection, thrombosis, etc.). Here, we present the case of a 65-year-old severely obese woman affected by severe aortic valve stenosis who underwent TAVI complicated by embolization of the device. The patient underwent spectral CT angiography that allowed for improved image quality by means of virtual monoenergetic reconstructions, permitting optimal pre-procedural planning. She was successfully re-treated with implantation of a second prosthetic valve a few weeks later.
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Affiliation(s)
- Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Giampiero Vizzari
- Cardiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Correspondence:
| | - Federica Pergolizzi
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Michele Gaeta
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Francesco Costa
- Cardiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Thomas J. Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Antonio Micari
- Cardiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
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Lanzafame LRM, Carerj ML, Rizzo G, Minutoli F, Bucolo GM, Irrera N, Muscogiuri G, Sironi S, Blandino A, D’Angelo T. Multimodality Imaging Evaluation of Coronary IgG4-Related Disease: A "Tumor-Like" Cardiac Lesion. Diagnostics (Basel) 2022; 12:diagnostics12112814. [PMID: 36428873 PMCID: PMC9689228 DOI: 10.3390/diagnostics12112814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory disorder. Coronary IgG4-RD has been scarcely reported and may present as "tumor-like" lesions. These pseudo-masses may be underdiagnosed mainly due to a vague clinical picture that can vary from complete lack of symptoms to acute coronary syndrome or sudden cardiac death. Early recognition of coronary IgG4-RD is essential to monitor disease activity and prevent life-threatening complications. We report a comprehensive non-invasive imaging evaluation of a patient affected by coronary IgG4-RD, which was diagnosed as an incidental finding during routine pre-laparoscopic cholecystectomy checkup. Non-invasive imaging revealed the presence of a peri-coronary soft-tissue mass that was stable at 12 months follow-up.
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Affiliation(s)
- Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Maria Ludovica Carerj
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giovanna Rizzo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Fabio Minutoli
- Nuclear Medicine Unit, BIOMORF Department, University of Messina, 98124 Messina, Italy
| | - Giuseppe M. Bucolo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Natasha Irrera
- Pharmacology Unit, DIMED Department, University Hospital Messina, 98124 Messina, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
| | - Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Messina, 98124 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 Rotterdam, The Netherlands
- Correspondence:
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Lanzafame LRM, Blandino A, Cicero G, Romeo P, Agati S, Zanai R, Celona A, Booz C, Koch V, Mazziotti S, D’Angelo T. Diagnosis and Management of Button Battery Ingestion Complicated by Tracheo-Esophageal and Aorto-Esophageal Fistulas. Diagnostics (Basel) 2022; 12:diagnostics12102369. [PMID: 36292059 PMCID: PMC9600074 DOI: 10.3390/diagnostics12102369] [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: 09/08/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Button battery ingestion (BBI) is common in children and its prevalence has increased in the last decades. BBI can be responsible for very severe and potentially fatal complications if not promptly detected. We describe the successful management of two cases of BBI that occurred in two previously healthy infants. Both patients presented with vague symptoms and no witness of foreign body ingestion. The prolonged time of exposure to the corrosive effects of disk batteries was responsible for the development of tracheo-esophageal fistula (TEF) and aorto-esophageal fistula (AEF). We demonstrate how prompt diagnosis and management are crucial for the infants’ survival.
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Affiliation(s)
- Ludovica R. M. Lanzafame
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Placido Romeo
- Department of Diagnostic and Interventional Radiology, A.O.U. Policlinico San Marco, 95123 Catania, Italy
| | - Salvatore Agati
- Pediatric Cardiac Surgery, “Centro Cardiologico Pediatrico del Mediterraneo-Bambino Gesù”, 98039 Taormina, Italy
| | - Rosanna Zanai
- Pediatric Intensive Care Unit, “Centro Cardiologico Pediatrico del Mediterraneo-Bambino Gesù”, 98039 Taormina, Italy
| | - Antonio Celona
- Department of Radiology, “S. Vincenzo” Hospital Taormina, 98121 Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, 98121 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 Rotterdam, The Netherlands
- Correspondence:
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