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Parillo M, Mallio CA, Dekkers IA, Rovira À, van der Molen AJ, Quattrocchi CC. Late/delayed gadolinium enhancement in MRI after intravenous administration of extracellular gadolinium-based contrast agents: is it worth waiting? MAGMA 2024; 37:151-168. [PMID: 38386150 DOI: 10.1007/s10334-024-01151-0] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
The acquisition of images minutes or even hours after intravenous extracellular gadolinium-based contrast agents (GBCA) administration ("Late/Delayed Gadolinium Enhancement" imaging; in this review, further termed LGE) has gained significant prominence in recent years in magnetic resonance imaging. The major limitation of LGE is the long examination time; thus, it becomes necessary to understand when it is worth waiting time after the intravenous injection of GBCA and which additional information comes from LGE. LGE can potentially be applied to various anatomical sites, such as heart, arterial vessels, lung, brain, abdomen, breast, and the musculoskeletal system, with different pathophysiological mechanisms. One of the most popular clinical applications of LGE regards the assessment of myocardial tissue thanks to its ability to highlight areas of acute myocardial damage and fibrotic tissues. Other frequently applied clinical contexts involve the study of the urinary tract with magnetic resonance urography and identifying pathological abdominal processes characterized by high fibrous stroma, such as biliary tract tumors, autoimmune pancreatitis, or intestinal fibrosis in Crohn's disease. One of the current areas of heightened research interest revolves around the possibility of non-invasively studying the dynamics of neurofluids in the brain (the glymphatic system), the disruption of which could underlie many neurological disorders.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Autonomous University of Barcelona and Hospital Vall d'Hebron, Passeig Vall d'Hebron, Barcelona, Spain
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Parillo M, Vaccarino F, De Stefano D, Beomonte Zobel B. Cardiac computed tomography angiography findings in a case of spontaneous coronary artery dissection. Acta Cardiol 2024; 79:247-248. [PMID: 38032254 DOI: 10.1080/00015385.2023.2286422] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Domenico De Stefano
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Parillo M, Bitonti MT, Vaccarino F, Zobel BB, Mallio CA. Temporal Bone High Resolution Computed Tomography Findings in a Case of Postpartum Otosclerosis. Indian J Otolaryngol Head Neck Surg 2024; 76:1130-1133. [PMID: 38440651 PMCID: PMC10908701 DOI: 10.1007/s12070-023-04167-5] [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: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 03/06/2024] Open
Abstract
We describe temporal bone high resolution computed tomography (HRCT) findings in a case of bilateral mixed fenestral and retrofenestral otosclerosis with onset in the postpartum period. This condition should be considered in women complaining of postpartum hearing loss and temporal bone HRCT is a fundamental tool leading to the diagnosis.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Maria Teresa Bitonti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
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Parillo M, Bernetti C, Altomare C, Beomonte Zobel B, Quattrocchi CC. Extrahepatic abscess and dropped gallstones: a case report and a narrative review of an unusual delayed complication of laparoscopic cholecystectomy. Acta Chir Belg 2024; 124:57-61. [PMID: 36576306 DOI: 10.1080/00015458.2022.2163957] [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] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the most common minimally invasive abdominal surgery procedure performed in Western countries; it offers several advantages over laparotomy but still carries some risks, such as intraoperative spillage of bile and gallstones. Diagnosis of dropped gallstones could be challenging, it is frequently delayed, and this can lead to further complications such as abscesses formation. METHODS We report the history of a 51-year-old male with persistent dull abdominal pain in association to appetite loss, vomiting episodes and changes in regular bowel habits, a past medical history of laparoscopic cholecystectomy for biliary lithiasis (1.5 years earlier) and minimum elevation of inflammatory markers and gamma-GT values. RESULTS Ultrasound examination showed perihepatic stones and magnetic resonance imaging revealed the presence of multiple perihepatic abscesses, findings compatible with fibrotic-inflammatory phenomena from 'dropped gallstones'. A re-laparoscopy was then performed with an abscess collection containing multiple gallstones; a liver wedge resection was also required due to strong adhesions. At follow up, the patient had improved both on clinical and biochemical perspective. CONCLUSION Dropped gallstones are an underreported cause of morbidity and diagnostic dilemmas in subjects who underwent to laparoscopic cholecystectomy, in relation to infectious complications that can occur even several months or years after surgery. Imaging represents a valuable aid in the correct non-invasive diagnostic process, but proper awareness of this insidious condition is necessary. Surgeons and radiologists should always consider this eventuality in the differential diagnosis of a patient presenting with abdominal abscesses and history of cholecystectomy.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Caterina Bernetti
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Carlo Altomare
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Dekkers IA, Karst U, Stroomberg G, Clement O, Gianolio E, Nederveen AJ, Radbruch A, Quattrocchi CC. The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS). MAGMA 2024; 37:15-25. [PMID: 37702845 PMCID: PMC10876744 DOI: 10.1007/s10334-023-01113-y] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023]
Abstract
Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 48, 48149, Münster, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Olivier Clement
- Service de Radiologie, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, 20 Rue LeBlanc, 75015, Paris, France
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Via Nizza 52, 10125, Turin, Italy
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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Parillo M, Vaccarino F, Di Gennaro G, Kumar S, Van Goethem J, Beomonte Zobel B, Quattrocchi CC, Parizel PM, Mallio CA. Overview of the Current Knowledge and Conventional MRI Characteristics of Peri- and Para-Vascular Spaces. Brain Sci 2024; 14:138. [PMID: 38391713 PMCID: PMC10886993 DOI: 10.3390/brainsci14020138] [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: 12/09/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Brain spaces around (perivascular spaces) and alongside (paravascular or Virchow-Robin spaces) vessels have gained significant attention in recent years due to the advancements of in vivo imaging tools and to their crucial role in maintaining brain health, contributing to the anatomic foundation of the glymphatic system. In fact, it is widely accepted that peri- and para-vascular spaces function as waste clearance pathways for the brain for materials such as ß-amyloid by allowing exchange between cerebrospinal fluid and interstitial fluid. Visible brain spaces on magnetic resonance imaging are often a normal finding, but they have also been associated with a wide range of neurological and systemic conditions, suggesting their potential as early indicators of intracranial pressure and neurofluid imbalance. Nonetheless, several aspects of these spaces are still controversial. This article offers an overview of the current knowledge and magnetic resonance imaging characteristics of peri- and para-vascular spaces, which can help in daily clinical practice image description and interpretation. This paper is organized into different sections, including the microscopic anatomy of peri- and para-vascular spaces, their associations with pathological and physiological events, and their differential diagnosis.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro "Magna Græcia", 88100 Catanzaro, Italy
| | - Sumeet Kumar
- Department of Neuroradiology, National Neuroscience Institute, Singapore 308433, Singapore
- Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Johan Van Goethem
- Department of Radiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
| | - Paul M Parizel
- Royal Perth Hospital & University of Western Australia, Perth, WA 6000, Australia
- Medical School, University of Western Australia, Perth, WA 6009, Australia
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Parillo M, Vaccarino F, Taffon C, Vantaggi S, Rossi SM, Beomonte Zobel B, Mallio CA. Imaging findings in malignant hepatic infiltration from neuroendocrine tumor presenting with acute liver failure and mimicking cirrhosis: a case description. Quant Imaging Med Surg 2024; 14:1193-1199. [PMID: 38223115 PMCID: PMC10784085 DOI: 10.21037/qims-23-1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Chiara Taffon
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sara Vantaggi
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Maria Rossi
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Parillo M, van der Molen AJ, Asbach P, Elsholtz FHJ, Laghi A, Ronot M, Wu JS, Mallio CA, Quattrocchi CC. The role of iodinated contrast media in computed tomography structured Reporting and Data Systems (RADS): a narrative review. Quant Imaging Med Surg 2023; 13:7621-7631. [PMID: 37969632 PMCID: PMC10644138 DOI: 10.21037/qims-23-603] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective In recent years, there has been a large-scale dissemination of guidelines in radiology in the form of Reporting & Data Systems (RADS). The use of iodinated contrast media (ICM) has a fundamental role in enhancing the diagnostic capabilities of computed tomography (CT) but poses certain risks. The scope of the present review is to summarize the current role of ICM only in clinical reporting guidelines for CT that have adopted the "RADS" approach, focusing on three specific questions per each RADS: (I) what is the scope of the scoring system; (II) how is ICM used in the scoring system; (III) what is the impact of ICM enhancement on the scoring. Methods We analyzed the original articles for each of the latest versions of RADS that can be used in CT [PubMed articles between January, 2005 and March, 2023 in English and American College of Radiology (ACR) official website]. Key Content and Findings We found 14 RADS suitable for use in CT out of 28 RADS described in the literature. Four RADS were validated by the ACR: Colonography-RADS (C-RADS), Liver Imaging-RADS (LI-RADS), Lung CT Screening-RADS (Lung-RADS), and Neck Imaging-RADS (NI-RADS). One RADS was validated by the ACR in collaboration with other cardiovascular scientific societies: Coronary Artery Disease-RADS 2.0 (CAD-RADS). Nine RADS were proposed by other scientific groups: Bone Tumor Imaging-RADS (BTI-RADS), Bone‑RADS, Coronary Artery Calcium Data & Reporting System (CAC-DRS), Coronavirus Disease 2019 Imaging-RADS (COVID-RADS), COVID-19-RADS (CO-RADS), Interstitial Lung Fibrosis Imaging-RADS (ILF-RADS), Lung-RADS (LU-RADS), Node-RADS, and Viral Pneumonia Imaging-RADS (VP-RADS). Conclusions This overview suggests that ICM is not strictly necessary for the study of bones and calcifications (CAC-DRS, BTI-RADS, Bone-RADS), lung parenchyma (Lung-RADS, LU-RADS, COVID-RADS, CO-RADS, VP-RADS and ILF-RADS), and in CT colonography (C-RADS). On the other hand, ICM plays a key role in CT angiography (CAD-RADS), in the study of liver parenchyma (LI-RADS), and in the evaluation of soft tissues and lymph nodes (NI-RADS, Node-RADS). Future studies are needed in order to evaluate the impact of the new iodinated and non-iodinate contrast media, artificial intelligence tools and dual energy CT in the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Aart J. van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Asbach
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Radiology, Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Henry Jürgen Elsholtz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Radiology, Campus Benjamin Franklin, Berlin, Germany
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology-Sapienza University of Rome, Roma, Italy
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon, AP-HP Nord, Clichy, France
- Université Paris Cité, CRI UMR1148, Paris, France
| | - Jim S. Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Parillo M, Mallio CA, Pileri M, Dirawe D, Romano A, Bozzao A, Weinberg B, Quattrocchi CC. Interrater reliability of Brain Tumor Reporting and Data System (BT-RADS) in the follow up of adult primary brain tumors: a single institution experience in Italy. Quant Imaging Med Surg 2023; 13:7423-7431. [PMID: 37969622 PMCID: PMC10644140 DOI: 10.21037/qims-22-850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/12/2022] [Indexed: 11/17/2023]
Abstract
Background In 2018, a new system was proposed for classifying and reporting post-treatment adult brain tumor on magnetic resonance imaging, named as Brain Tumor Reporting and Data System (BT-RADS), that needs a validation by means of agreement studies. Methods A retrospective study was designed with the aim of identifying contrast-enhanced magnetic resonance imaging (MRI) of adult patients on follow-up for primary brain tumor at Fondazione Policlinico Campus Bio-Medico. Four radiologists (2 radiology residents, 1 general radiologist, 1 neuroradiologist) read and scored each study using the BT-RADS scoring tool, blinded to the MRI original report. Interobserver agreement and Fleiss' k were calculated to assess the level of diagnostic agreement. It was assessed how many times the assignment of different scoring of BT-RADS would have led to a different patient management. Results The total number of patients included in the study was 23 with 147 MRIs and a total of 588 BT-RADS scores retrospectively evaluated. The two most frequent tumor types were astrocytoma grade 4 (62%) and oligodendroglioma grade 3 (21%). The overall agreement rate for all 4 radiologists was 82% with a Fleiss' k of 0.70. The overall agreement rate between general radiologist and neuroradiologist was 91% with a Fleiss' k of 0.86. The overall agreement rate between 2 radiology residents and neuroradiologist was 80% with a Fleiss' k of 0.66. Astrocytoma grade 3 (k: 0.51) and oligodendroglioma grade 2 (k: 0.32) showed a poor agreement while higher values of agreement were found for astrocytoma grade 4 (k: 0.70), astrocytoma grade 2 (k: 0.78) and oligodendroglioma grade 3 (k: 0.78). All the radiologists agreed on BT-RADS assignment in 70% patients, three radiologists agreed in 17% and two radiologists agree in 13%. In no cases there was a complete disagreement among the readers. In 18% of cases the discrepancy in the estimated BT-RADS would have led to a different follow-up management. Conclusions BT-RADS can be considered a valid tool for neuroradiologists and radiologists even with little experience in the interpretation of patients' images during follow-up for adult primary brain tumors supporting standardized interpretation, reporting and clinical management.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Carlo Augusto Mallio
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Matteo Pileri
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Diab Dirawe
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department (Neuroscience, Mental Health, Sense Organs), Sant’Andrea Hospital, Medical and Psychology School, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department (Neuroscience, Mental Health, Sense Organs), Sant’Andrea Hospital, Medical and Psychology School, La Sapienza University, Rome, Italy
| | - Brent Weinberg
- Neuroradiology Division, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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Mallio CA, Vaccarino F, Parillo M, Annibali O, Rigacci L, Meduri GM, Pilato F, Beomonte Zobel B, Di Lazzaro V. Artery of Huebner stroke chameleon presenting as central nervous system lymphoma: a case description. Quant Imaging Med Surg 2023; 13:7646-7649. [PMID: 37969621 PMCID: PMC10644133 DOI: 10.21037/qims-23-437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/02/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Ombretta Annibali
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Hematology and Stem Cell Transplantation, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Luigi Rigacci
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Hematology and Stem Cell Transplantation, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Guido M. Meduri
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Nuclear Medicine, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Fabio Pilato
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Vincenzo Di Lazzaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Parillo M, Vaccarino F, Quattrocchi CC. Imaging findings in a case of leptomeningeal myelomatosis, a rare but critical central nervous system complication of multiple myeloma. Neuroradiol J 2023; 36:616-620. [PMID: 36627179 PMCID: PMC10569195 DOI: 10.1177/19714009221150849] [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] [Indexed: 01/12/2023] Open
Abstract
Leptomeningeal myelomatosis is a rare complication of multiple myeloma (<1% of the patients). There was an increase in the incidence of leptomeningeal myelomatosis during the last decade; the prognosis of leptomeningeal myelomatosis remains poor, (overall median survival from the time of diagnosis of 2 months). We discuss a rare case of a monoclonal gammopathy evolving into multiple myeloma and finally into a rapidly progressing leptomeningeal disease. A 76 year-old woman in hematologic follow-up for advanced stage multiple myeloma in sixth-line treatment had an episode of generalized tonic-clonic seizure with sphincter release followed by altered state of consciousness. The unenhanced head CT scan showed a mild enlargement of the ventricular system without intra-axial or extra-axial hemorrhages nor significant changes in brain parenchyma. The subsequent contrast-enhanced brain MRI revealed a widespread nodular leptomeningeal enhancement characterized by contrast-enhancement of the pia mater extended into the subarachnoid spaces of the sulci and cisterns, involving supra- and sub-tentorial regions and the statoacoustic nerve in the inner ear canal bilaterally. The fluid-attenuated inversion recovery MRI images demonstrated an abnormally elevated signal within the sulci in the parieto-occipital regions. The radiological diagnosis of leptomeningeal myelomatosis was made. The patient died 4 days after the examination. In patients with long-lasting multiple myeloma and onset of neurological signs or symptoms, a contrast-enhanced brain MRI should be performed to assess the actual burden of central nervous system involvement in leptomeningeal myelomatosis; CT may provide a clue to the diagnosis when progressive enlargement of the ventricles over time is noted.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Parillo M, Vaccarino F, Mallio CA, Quattrocchi CC. Right Condylar Jugular Diverticulum: Contrast-enhanced Computed Tomography Findings of a Rare Anatomical Variant of Jugular Bulb. Indian J Otolaryngol Head Neck Surg 2023; 75:2257-2259. [PMID: 37636734 PMCID: PMC10447777 DOI: 10.1007/s12070-023-03554-2] [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: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
This is the first description of condylar jugular diverticulum (CJD) by means of contrast-enhanced computed tomography scan in the medical literature. CJD is a rare anatomical variant of jugular bulb that should be known to avoid radiological and surgical errors and achieve an appropriate pre-surgical planning of skull base pathologies.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carlo Augusto Mallio
- Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena, 1, 38122 Trento, Italy
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Ramalho J, Ramalho M, Gianolio E, Karst U, Radbruch A, Stroomberg G, Clement O, Dekkers IA, Nederveen AJ, Quattrocchi CC. Skin Toxicity After Exposure to Gadolinium-Based Contrast Agents in Normal Renal Function, Using Clinical Approved Doses: Current Status of Preclinical and Clinical Studies. Invest Radiol 2023; 58:530-538. [PMID: 37185158 DOI: 10.1097/rli.0000000000000973] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. MATERIALS AND METHODS A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m 2 ), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). RESULTS Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. CONCLUSIONS Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.
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Affiliation(s)
- Marco Parillo
- From the Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo A Mallio
- From the Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Turin, Italy
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Nieuwegein, the Netherlands
| | - Olivier Clement
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Paris, France
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Parillo M, Vaccarino F, Quattrocchi CC. Right common iliac vein fenestration: Computed tomography and venography findings of rare venous anatomic variant. J Vasc Surg Venous Lymphat Disord 2023; 11:659-660. [PMID: 37080689 DOI: 10.1016/j.jvsv.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 04/22/2023]
Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy.
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
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Quattrocchi CC, Parillo M, Spani F, Landi D, Cola G, Dianzani C, Perrella E, Marfia GA, Mallio CA. Skin Thickening of the Scalp and High Signal Intensity of Dentate Nucleus in Multiple Sclerosis: Association With Linear Versus Macrocyclic Gadolinium-Based Contrast Agents Administration. Invest Radiol 2023; 58:223-230. [PMID: 36729383 DOI: 10.1097/rli.0000000000000929] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the presence of detectable changes of skin thickness on clinical brain magnetic resonance imaging (MRI) scans in patients with MS, history of multiple gadolinium-based contrast agents (GBCAs) administrations, and evidence of gadolinium deposition in the brain. MATERIALS AND METHODS In this observational cross-sectional study, 71 patients with MS who underwent conventional brain MRI with an imaging protocol including enhanced 3D volumetric interpolated breath-hold examination (VIBE) T1-weighted with fat saturation were assessed. Patients with bilateral isointense dentate nucleus on unenhanced T1-weighted images were assigned to group A (controls without MRI evidence of gadolinium deposition), and patients with visually hyperintense dentate nuclei were assigned to group B. Qualitative and quantitative assessment of the skin thickness were performed. RESULTS Group A included 27 patients (median age, 33 years [IQR, 27-46]; 20 women), and group B included 44 patients (median age, 42 years [IQR, 35-53]; 29 women). Qualitative and quantitative assessment of the skin revealed significant differences between group A and group B. The average skin-to-scalp thickness ratios was significantly higher in group B than in group A (mean ± standard deviation = 0.52 ± 0.02 in group B vs 0.41 ± 0.02 in group A, P < 0.0001) and showed a positive correlation with the total number of enhanced MRI scans ( r = 0.39; 95% confidence interval, 0.17-0.57, P < 0.01). CONCLUSIONS Brain MRI detects increased skin thickness of the scalp in patients with MS and dentate nucleus high signal intensity on unenhanced T1-weighted images and shows positive association with previous exposures to linear GBCAs rather than macrocyclic GBCAs.
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Affiliation(s)
- Carlo C Quattrocchi
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
| | - Marco Parillo
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
| | - Federica Spani
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
| | | | - Gaia Cola
- Unit of Neurology, Policlinico Tor Vergata
| | | | - Eleonora Perrella
- Pathology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | | | - Carlo A Mallio
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
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Parillo M, Quattrocchi CC, Pilato F, Di Lazzaro V, Beomonte Zobel B. Whole-body computed tomography as first-line imaging procedure to exclude cancer in patients with neurological suspicion of paraneoplastic syndromes: shall clinical practice adhere to recommendations? Radiography (Lond) 2023; 29:8-13. [PMID: 36179410 DOI: 10.1016/j.radi.2022.09.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION To assess the efficacy of whole-body computed tomography (WB-CT) as imaging procedure to exclude cancer in patients with neurological symptoms and signs at clinical onset. METHODS A retrospective observational study was designed to identify consecutive WB-CT requested by the Neurology Unit with a suspicion of an underlying tumor potentially linked to a paraneoplastic neurological syndrome (PNS) between January 2019 and February 2022. The following data were collected: diagnosis at admission and at discharge, the presence of onconeural antibodies, the scans dose length product (DLP), the estimated effective dose (ED), the total estimated time requested; the PNS-Care-Score was retrospectively calculated only in subjects with available antibodies. RESULTS The total number of patients included was 158. In 13/158 (positive group) a malignant or locally aggressive neoplasm was found while in 145/158 no malignant lesions were found on the WB-CT. Among the positive group, in 7/13 onconeural antibodies were diagnosed, resulting negative in all cases and the most frequent tumor was lung cancer (30.8%). PNS-Care-Score was of 6-7 in 2/7 (probable PNS) and in no case the PNS-Care-Score was ≥8 (definite PNS). The mean DLP for all the scans was 2798 ± 952 mGy cm (average estimated ED of 42 ± 14 mSv). The total estimated time requested for all scans was 11,060 min. CONCLUSION If a PNS is suspected, we encourage the prescription of unenhanced chest CT and/or abdomen/testis/female pelvis ultrasound and/or mammography based on clinical picture. The WB-CT using a single portal phase would be appropriate as a second-line technique while magnetic resonance imaging might be indicated for the exclusion of nervous system diseases. IMPLICATIONS FOR PRACTICE Our suggestion results in saving in terms of radiation exposure, financial resources and time.
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Affiliation(s)
- M Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - C C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - F Pilato
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy
| | - V Di Lazzaro
- Neurology Unit, Campus Bio-Medico University Hospital Foundation, Via Álvaro del Portillo 200, 00128 Rome, Italy
| | - B Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University Hospital Foundation, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Caretto A, Pintus S, Petroni ML, Osella AR, Bonfiglio C, Morabito S, Zuliani P, Sturda A, Castronuovo M, Lagattolla V, Maghetti A, Lapini E, Bianco AM, Cisternino M, Cerutti N, Mulas CA, Hassan O, Cardamone N, Parillo M, Sonni L. Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis. Int J Obes (Lond) 2022; 46:1280-1287. [PMID: 35306529 PMCID: PMC8933751 DOI: 10.1038/s41366-022-01100-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 12/12/2021] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic. METHODS We designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression. RESULTS A total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity. The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement. CONCLUSIONS Among Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.
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Affiliation(s)
- A Caretto
- Endocrinology, Metabolic diseases and Clinical Nutrition, Ospedale Perrino, Brindisi, Italy.
| | - S Pintus
- Bariatric Surgery Center, ARNAS Brotzu, Cagliari, Italy
| | - M L Petroni
- Metabolism and Clinical Nutrition Unit, IRCCS Policlinico S. Orsola, Alma Mater University of Bologna, Bologna, Italy
| | - A R Osella
- Epidemiology and Statistics, IRCCS Saverio De Bellis, Castellana Grotte, BA, Italy
| | - C Bonfiglio
- Epidemiology and Statistics, IRCCS Saverio De Bellis, Castellana Grotte, BA, Italy
| | | | - P Zuliani
- Obesity Day Center, Sorrento, NA, Italy
| | - A Sturda
- Endocrinology, Metabolic diseases and Clinical Nutrition, Ospedale Perrino, Brindisi, Italy
| | | | - V Lagattolla
- Endocrinology, Metabolic diseases and Clinical Nutrition, Ospedale Perrino, Brindisi, Italy
| | - A Maghetti
- Metabolism and Clinical Nutrition Unit, IRCCS Policlinico S. Orsola, Alma Mater University of Bologna, Bologna, Italy
| | - E Lapini
- Obesity Rehab Unit, Ospedali Privati Forli, Forlì, Italy
| | - A M Bianco
- U.O.C. Igiene degli Alimenti e della Nutrizione ASP, Potenza, Italy
| | - M Cisternino
- Clinical Nutrition, IRCCS "S. De Bellis", Castellana Grotte, BA, Italy
| | - N Cerutti
- UOSD Medicina Generale a Indirizzo Dietologico ASST, Pavia, Italy
| | - C A Mulas
- Clinical Dietary Service "Holy Spirit" Hospital Casale Monferrato ASLAL, Alessandria, Italy
| | - O Hassan
- UOSD Diabetology, San Camillo Hospital -, Roma, Italy
| | | | - M Parillo
- Azienda ospedaliera S. Anna S. Sebastiano, Caserta, Italy
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Parillo M, Vaccarino F, Beomonte Zobel B, Quattrocchi CC. A Rare Case of Contained Chronic Rupture of Abdominal Aortic Aneurysm Associated With Vertebral Erosion: Pre- and Post-operative Findings on Computed Tomography and a Narrative Review. Vasc Endovascular Surg 2022; 56:15385744221108040. [PMID: 35688795 DOI: 10.1177/15385744221108040] [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] [Indexed: 11/15/2022]
Abstract
Contained chronic rupture of aortic aneurysm (CCR-AA) is a rare condition that can be associated with vertebral body erosion (VBE) and is often a diagnostic challenge; in fact, CCR-AAs are in general hemodynamically stable and the patients tend to present with a non-specific low-back pain syndrome secondary to vertebral involvement. Furthermore, the differential diagnosis of a retroperitoneal mass can be difficult on medical imaging. We discuss the case of a 79-years-old man, heavy smoker without history of cardiovascular diseases, admitted to the emergency department with signs of left lower limb ischemia. The patient was hemodynamically stable and the medical examination revealed a pulsatile abdominal mass. Doppler ultrasound showed the presence of aneurysmal dilatation of infra-renal abdominal aorta and chronic femoropopliteal occlusion on the left side. The subsequent computed tomography angiography (CTA) demonstrated a voluminous retroperitoneal mass continuous with the infra-renal aorta, which infiltrated the psoas muscles and caused vertebral bodies erosion of the anterior wall in L2, L3 and L4 suspected for CCR-AA or mycotic aortic aneurysm. Furthermore, the examination confirmed the occlusion of the peripheral arterial circulation of the left lower limb. The patient underwent a successful open replacement of the infra-renal abdominal aorta through aorto-aortic prosthetic graft insertion; the visualization during the surgical procedure of a posterior vessel wall opening in continuity with the eroded vertebral bodies associated with negative microbiological culture of the thrombotic material sample, led to the definitive diagnosis of CCR-AA. The post-operative CTA showed successful open vascular treatment. A bypass surgery of the left lower limb was then performed with positioning saphenous graft between femoral common artery and posterior tibial artery. The patient was finally discharged in good clinical conditions.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Parillo M, Altomare C, Bianchi A, Beomonte Zobel B, De Cicco Nardone C, Quattrocchi CC. A rare case of left Nuck’s canal cystic endometriosis: Computed Tomography findings. Journal of Endometriosis and Pelvic Pain Disorders 2021. [DOI: 10.1177/22840265211037235] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Endometriosis is a common and chronic gynaecological condition but the implant in the canal of Nuck constitutes a very unusual state with an estimated prevalence of 0.3%–0.6% of all endometriosis cases. The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora, thus represents a communication between the peritoneal cavity and the female inguinal canal. This condition may permit the seeding of endometriotic tissue in the inguinal soft tissues, becoming a possible cause of inguinal swelling or pain. Case description: A 43-years-old woman presented with painful swelling in her left groin. Ultrasound and a subsequent pelvic computed tomography showed a cystic lesion as for a Nuck’s canal encysted hydrocele. The patient underwent an anterior open surgery and the histologic examination revealed an endometrium-like tissue in the cystic wall. Conclusion: In women presenting with painful swelling of the groin, despite its rarity, endometriosis of the Nuck’s canal must be differentiated from other more common pathologies like hernias, varicoceles, neoplasms, and lymphadenopathies. Imaging can aid in differential diagnosis, but the final diagnosis is entrusted to histology, which enable to exclude an underlying malignancy.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo Altomare
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonella Bianchi
- Unit of Pathology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo De Cicco Nardone
- Unit of Ginecology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo Cosimo Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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De Stefano D, Parillo M, Garipoli A, Zobel BB. IMAGING FINDINGS IN A CASE OF MYO-PERICARDITIS ASSOCIATED WITH SARS CoV-2 DISEASE. J Cardiol Cases 2021; 24:210-214. [PMID: 34367382 PMCID: PMC8328569 DOI: 10.1016/j.jccase.2021.07.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to use the host protein angiotensin-converting enzyme 2 as a co-receptor to gain intracellular entry into different organs, including the heart. Cardiac involvement is one of the clinical manifestations of coronavirus disease 2019 (COVID-19) and is associated with a worse prognosis; in this setting, few cases of myo-pericarditis with complete imaging documentation have been reported. We discuss a case of a woman admitted to the emergency department with dyspnea. Nasopharyngeal swab showed positive results for SARS-CoV-2. A subsequent 12-lead electrocardiogram showed modifications of T-wave in leads V1 to V6 while blood tests revealed increased levels of troponin I. Coronary computed tomography angiography was performed, excluding hemodynamically significant coronary stenosis. Cardiac magnetic resonance (CMR) was also performed, showing findings fulfilling Lake Louise criteria for the diagnosis of acute myo-pericarditis. To date, myocardial inflammation was recognized as connected with COVID-19 mortality. CMR is an indispensable tool for non-invasive diagnosis of this pathology; however, most clinical studies demonstrated the presence of intramyocardial edema using T1 and T2 mapping sequences. In our case, extensive intramyocardial edema was well demonstrated using TIRM sequences, with a short TI to obtain fat suppression. <Learning objective: Coronavirus disease 2019 (COVID-19) may cause acute myo-pericarditis. Clinicians need to be aware of cardiovascular involvement during COVID-19 due to its mortality. Cardiac magnetic resonance, used in the right clinical setting, can easily diagnose myocarditis in a non-invasive way.>
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Affiliation(s)
- Domenico De Stefano
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Garipoli
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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21
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Mallio CA, Parillo M, Zobel BB, Parizel PM, Quattrocchi CC. Effect of Exposure to Gadodiamide and Brain Irradiation on
T
1
‐Weighted Images and
ADC
Maps of the Dentate Nucleus. J Magn Reson Imaging 2020; 52:1525-1530. [DOI: 10.1002/jmri.27198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Carlo A. Mallio
- Departmental Faculty of Medicine and Surgery Università Campus Bio‐Medico di Roma Rome Italy
| | - Marco Parillo
- Departmental Faculty of Medicine and Surgery Università Campus Bio‐Medico di Roma Rome Italy
| | - Bruno Beomonte Zobel
- Departmental Faculty of Medicine and Surgery Università Campus Bio‐Medico di Roma Rome Italy
| | - Paul M. Parizel
- Department of Radiology Antwerp University Hospital Edegem Belgium
| | - Carlo C. Quattrocchi
- Departmental Faculty of Medicine and Surgery Università Campus Bio‐Medico di Roma Rome Italy
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22
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Affiliation(s)
- M. Zibella
- AORN, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - M. Parillo
- AORN, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
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Parillo M, Licenziati MR, Vacca M, De Marco D, Iannuzzi A. Metabolic changes after a hypocaloric, low-glycemic-index diet in obese children. J Endocrinol Invest 2012; 35:629-33. [PMID: 21897113 DOI: 10.3275/7909] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 12/29/2022]
Abstract
BACKGROUND A low glycemic index (LGI) diet has been proposed as a treatment for obesity in adults; few studies have evaluated LGI diets in obese children. AIM The purpose of the study was to compare the effects of two diets, with similar energy intakes, but different glycemic indexes in a pediatric outpatient setting. SUBJECTS AND METHODS A parallel- group, randomized controlled trial was conducted, and 22 obese outpatient children with a body mass index (BMI) Z-score >2 (11 females and 11 males, BMI 28.9±2.9 kg/m²) were included in the study. Patients were randomly allocated to a hypocaloric LGI (GI:60), or to a hypocaloric high glycemic index (HGI) diet (GI:90). The LGI and HGI diets were almost equivalent for macronutrient composition. Anthropometric and biochemical parameters were measured at baseline and after 6 months. RESULTS In both groups there were significant decreases in BMI, BMI Z-score, blood pressure, and high-sensitivity C-reactive protein. Only LGI diets produced a significant decrease in waist circumference and homeostasis model assessment. Analysis of variance demonstrated that the BMI Z-score decrease from baseline values was significantly greater after the LGI diet than after the HGI diet [-0.20 (95% confidence interval (CI) -0.29 to -0.10) vs -0.34 (95%CI -0.43 to -0.24)], mean difference between groups -0.14 (95%CI -0.27 to -0.01), p<0.05). Changes in triglyceride concentrations were significantly lower in LGI as compared to HGI diet (p<0.05). CONCLUSIONS This study demonstrates that a hypocaloric LGI diet has beneficial metabolic effects in comparison to a hypocaloric HGI diet in obese children.
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Affiliation(s)
- M Parillo
- Department of Internal Medicine, St. Anna and St. Sebastian Hospital, Caserta, Italy
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24
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Parillo M, Annuzzi G, Rivellese AA, Bozzetto L, Alessandrini R, Riccardi G, Capaldo B. Effects of meals with different glycaemic index on postprandial blood glucose response in patients with Type 1 diabetes treated with continuous subcutaneous insulin infusion. Diabet Med 2011; 28:227-9. [PMID: 21219435 DOI: 10.1111/j.1464-5491.2010.03176.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of high-glycaemic index and low-glycaemic index meals on postprandial blood glucose in patients with Type 1 diabetes treated with continuous subcutaneous insulin infusion. METHODS Sixteen patients with Type 1 diabetes under continuous subcutaneous insulin infusion treatment, age 36±0.5 years (mean±sem), HbA(1c) 7.6±0.2% (56±1.1 mmol/mol), consumed two test meals with an identical macronutrient composition, but with a different glycaemic index: 59 vs. 90. Blood glucose was checked before the test meal and every 30 min thereafter for 180 min. The same preprandial insulin dose was administered on the two occasions. RESULTS Blood glucose concentrations following the low-glycaemic index meal were significantly lower than those of the high-glycaemic index meal (P<0.05 to P<0.01). The blood glucose area under the curve after the low-glycaemic index meal was 20% lower than after the high-glycaemic meal (P=0.006). CONCLUSIONS Our data show that meals with the same carbohydrate content but a different glycaemic index produce clinically significant differences in postprandial blood glucose.
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Affiliation(s)
- M Parillo
- AORN S. Anna S. Sebastiano Hospital, Caserta, Italy.
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25
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Mannarino E, Pirro M, Cortese C, Lupattelli G, Siepi D, Mezzetti A, Bertolini S, Parillo M, Fellin R, Pujia A, Averna M, Nicolle C, Notarbartolo A. Effects of a phytosterol-enriched dairy product on lipids, sterols and 8-isoprostane in hypercholesterolemic patients: a multicenter Italian study. Nutr Metab Cardiovasc Dis 2009; 19:84-90. [PMID: 18762410 DOI: 10.1016/j.numecd.2008.03.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 03/21/2008] [Accepted: 03/31/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Plant sterols, added to several food sources, lower serum cholesterol concentrations. Plant sterol-induced cholesterol lowering is paralleled by a mild decrease in plasma levels of the antioxidant beta-carotene, the amount of this decrease being considered clinically non-significant. Whether the effect on lipid profile of daily consumption of plant sterol-enriched low-fat fermented milk (FM) is paralleled by a concomitant variation in a reliable marker of the oxidative burden like plasma isoprostane levels is unresolved. METHODS AND RESULTS The effect of plant sterol consumption on plasma lipid and isoprostane levels of hypercholesterolemic patients was evaluated in a multicenter, randomized double blind study. Hypercholesterolemic patients consumed a FM daily for 6 weeks. Subjects were randomized to receive either 1.6g of plant sterol-enriched FM (n=60) or control FM product (n=56). After 6 weeks of plant sterol-enriched FM consumption, LDL cholesterol was reduced from 166.2+/-2.0 to 147.4+/-2.8 mg/dL (p=0.01). A significant reduction was observed for total cholesterol (from 263.5+/-2.6 to 231.0+/-3.2mg/dL, p=0.01). There was greater LDL cholesterol lowering among hypercholesterolemic patients with higher LDL cholesterol at baseline. We found a reduction of plasma 8-isoprostane in patients taking plant sterol-enriched FM (from 43.07+/-1.78 to 38.04+/-1.14 pg/ml, p=0.018) but not in patients taking the control product (from 42.56+/-2.12 to 43.19+/-2.0 pg/ml, p=NS). Campesterol and beta-sitosterol levels were not influenced by phytosterol consumption. CONCLUSIONS Daily consumption of low-fat plant sterol dairy product favourably changes lipid profile by reducing LDL-cholesterol, and may also have an anti-oxidative effect through a reduction of plasma isoprostanes.
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Affiliation(s)
- E Mannarino
- Medicina Interna, Angiologia e Malattie da Arteriosclerosi, Università di Perugia, Perugia, Italy.
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Pipicelli G, Fatati G, Leotta S, Parillo M, Tagliaferri M, Tomasi F, Pucci A. Recommendations for the nutritional medical treatment of diabetes mellitus. Mediterranean Journal of Nutrition and Metabolism 2009. [DOI: 10.3233/s12349-008-0030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Pipicelli
- U.O.C. Diabetologia e Dietologia Territoriale, ASP Catanzaro, Italy. e-mail:
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
| | - G. Fatati
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
| | - S. Leotta
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
| | - M. Parillo
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
| | - M. Tagliaferri
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
| | - F. Tomasi
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
| | - A. Pucci
- Diabetes and Nutrition Study Group; G. Pipicelli (Association of Medical Diabetologists, AMD), Coordinator; G. Fatati (Italian Association for Clinical Dietetics and Nutrition, ADI); S. Leotta (AMD); M. Parillo (ADI); M. Tagliaferri (ADI); F. Tomasi (AMD); A. Pucci, Secretary
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27
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Fatati G, Mirri E, Palazzi M, Vendetti AL, Pierotti F, Weber P, Mattei R, Parillo M, Coaccioli S, Puxeddu A. Insulin glargine in patients with severe hepato-gastroenterology diseases and hyperglycemia receiving parenteral nutrition. Clin Ter 2006; 157:511-5. [PMID: 17228850] [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: 05/13/2023]
Abstract
OBJECTIVE The aim of this nonrandomized observational study is to verify and confirm whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving parenteral nutrition (PN) and whether the analogue is capable of obtaining and maintaining good glycemic control without inducing hypoglycemia. MATERIALS AND METHODS The sample is made up of 25 patients with severe hepato-gastroenterology diseases receiving parenteral nutrition, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving PN. RESULTS Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first eight months of 2005. Four out of these 25 cannot be evaluated, either because (2/4) they did not begin or complete the treatment with Lantus or because the proper number of glycemic tests were not done (2/4); 21/25 patients, 84% of the sample with a mean age of 65.9 years (range 46-93 yr), finished the study and can be evaluated. The mean glycemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycemias occurred which required medical intervention. CONCLUSIONS This study confirms the possibility of using insulin glargine in patients receiving parenteral nutrition with hyperglycemia diagnosed diabetics or not diabetics.
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Affiliation(s)
- G Fatati
- Diabetology, Dietetics and Clinical Nutrition Unit, Santa Maria Hospital Terni, Italy
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Abstract
In the last 10 years nutritional research on diabetes has improved dramatically in terms of both number of studies produced and quality of methodologies employed. Therefore, it is now possible to attempt to provide the evidence on which nutritional recommendations for the prevention of type 2 diabetes could be based. We therefore performed a literature search and, among the papers published in indexed journals, we selected relevant epidemiological (mostly prospective) and controlled intervention studies. Lifestyle factors that have, so far, been consistently associated with increased risk of type 2 diabetes are overweight and physical inactivity. However, recent evidence from epidemiological studies has shown that the risk of type 2 diabetes is also associated with diet composition, particularly with: (1) low fibre intake; (2) a high trans fatty acid intake and a low unsaturated:saturated fat intake ratio; (3) absence of or excess alcohol consumption. All these factors are extremely common in Western populations and therefore the potential impact of any intervention on them is large: indeed, >90 % of the general population has one or more of these risk factors. The ability to correct these behaviours in the population is estimated to reduce the incidence of diabetes by as much as 87 %. Recent intervention studies have shown that type 2 diabetes can be prevented by lifestyle changes aimed at body-weight reduction, increased physical activity and multiple changes in the composition of the diet. Within this context, the average amount of weight loss needed is not large, about 5 % initial weight, which is much less than the weight loss traditionally considered to be clinically significant for prevention of type 2 diabetes. In conclusion, new emphasis on prevention by multiple lifestyle modifications, including moderate changes in the composition of the habitual diet, might limit the dramatic increase in incidence of type 2 diabetes envisaged worldwide.
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Affiliation(s)
- M Parillo
- Azienda Ospedaliera S. Sebastiano di Caserta, Via tescioni 1, 81100, Caserta, Italy
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29
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Manzella D, Parillo M, Razzino T, Gnasso P, Buonanno S, Gargiulo A, Caputi M, Paolisso G. Soluble leptin receptor and insulin resistance as determinant of sleep apnea. Int J Obes (Lond) 2002; 26:370-5. [PMID: 11896492 DOI: 10.1038/sj.ijo.0801939] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2001] [Revised: 06/12/2001] [Accepted: 10/26/2001] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the possible associations between sleep apnea syndrome, hyperinsulinemia/insulin resistance and hyperleptinemia in subjects with different degrees of body mass index. DESIGN To test for the presence or absence of sleep apnea syndrome in association with hyperinsulinemia/insulin resistance and hyperleptinemia. SUBJECTS Twenty subjects with different body mass index (mean BMI 30.9+/-4.2). MEASUREMENTS Insulin action and plasma soluble leptin receptor were measured by euglycemic hyperinsulinemic glucose clamp and by ELISA method, respectively. Occurrence of sleep apnea syndrome was assessed by clinical and nocturnal monitoring using a validated sleep apnea recorder. RESULTS The apnea/hypopnea index (AHI) was positively correlated with plasma soluble leptin receptor (0.76; P<0.001) and negatively with the degree of insulin-mediated glucose uptake (r=-0.73; P<0.001). In a multivariate analysis AHI was associated with plasma soluble leptin receptor and insulin mediated glucose uptake independently of age, gender, BMI, plasma leptin levels and PaCO(2). CONCLUSION Sleep apnea syndrome is associated with plasma soluble leptin receptor and insulin resistance independently of BMI.
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Affiliation(s)
- D Manzella
- Dipartimento di Gerontologia, Geriatria e Malattie del Metabolismo-II University of Naples, Naples, Italy
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Parillo M, Genovese S, Rivellese AA. Monitoring of cardiovascular risk factors in the diabetic clinics of an Italian region: the MOFRAD study. Diabetes Nutr Metab 2001; 14:212-6. [PMID: 11716291] [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: 02/22/2023]
Abstract
In 1994 the Group for Diabetes Lipoprotein and Atherosclerosis of the Italian Society of Diabetology formulated specific guidelines for the evaluation and reduction of cardiovascular risk in diabetic patients. The aim of our study was to evaluate the level of implementation of these guidelines in Campania, an Italian Region. The 22 diabetes outpatient clinics in Campania were sent a simple questionnaire to report information on main cardiovascular risk factors for each diabetic patient. Each center had to recruit 50 diabetic patients consecutively seen during the first five months of 1996. The data refer to 778 patients, age 55.6+/-6.4 yr, body mass index: 29.0+/-4.9 kg/m2. Almost 27% were smokers; HbA1C was reported in only 69% of them, while plasma cholesterol and triglycerides in almost 94%; plasma fibrinogen and HDL levels in only 18% and 41%, respectively. The target value for triglycerides (<2.3 mmol/l) and/or cholesterol (<5.2mmol/l) was reached in only 30% of patients, while pharmacological treatment was prescribed to about 52% of patients with increased plasma lipid. Blood pressure was below 140/90 mmHg in almost 68% of patients and pharmacological treatment was prescribed to 64% of those with high blood pressure levels. In conclusion this survey shows that smoking is still a common habit among diabetic patients; the frequency of determination is optimal for plasma cholesterol and triglycerides, moderate for HbA1c, and insufficient for HDL and plasma fibrinogen. Lipid level control is also insufficient. More favorable data are reported for the frequency of measurement and blood pressure control.
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Affiliation(s)
- M Parillo
- Azienda Ospedaliera, Ospedale Civile di Caserta, Section of Diabetes, Italy.
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31
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Giacco R, Brighenti F, Parillo M, Capuano M, Ciardullo AV, Rivieccio A, Rivellese AA, Riccardi G. Characteristics of some wheat-based foods of the Italian diet in relation to their influence on postprandial glucose metabolism in patients with type 2 diabetes. Br J Nutr 2001; 85:33-40. [PMID: 11227031 DOI: 10.1079/bjn2000218] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present study was aimed at evaluating in patients with type 2 diabetes: (1) the glycaemic response to four starchy foods based on wheat, typical of the Italian diet; (2) the importance of some food characteristics in relation to their effects on postprandial glucose response. Seventeen patients with type 2 diabetes (eleven men and six women) participated in the study. All patients consumed, in random order and on alternate days, 50 g available carbohydrate provided by 90 g white bread and, according to a randomised procedure, an equivalent amount of carbohydrate provided by one (n 8) or two (n 9) of three other different test foods (g): pizza 85, potato dumplings 165, hard toasted bread 60. Foods had a similar nutrient composition. Plasma glucose response, measured for 180 min, was significantly lower after the potato dumplings than after white bread at 90 (P < 0.05), 120 (P < 0.01), and 150 (P < 0.05) min. No difference was observed in postprandial plasma insulin response after the various test foods. The percentage of starch hydrolysed after 5 h in vitro hydrolysis with alpha-amylase was about 30 % lower for potato dumplings than for the other foods. However, no differences in the resistant starch content, the rate of diffusion of simple sugars added to a dialysis tube containing the food, and the viscosity of digesta were observed among the test foods. Scanning electron microscopy of potato dumplings showed a compact structure compatible with impaired accessibility of starch to digestive enzymes. In conclusion, carbohydrate-rich foods typical of the Italian diet which are often consumed as an alternative to pasta dishes are not equivalent in terms of metabolic impact in diabetic patients. Due to their low blood glucose response, potato dumplings represent a valid alternative to other starchy foods in the diabetic diet. Food structure plays an important role in determining starch accessibility to digestion, thus influencing the postprandial blood glucose response.
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Affiliation(s)
- R Giacco
- Institute of Food Science and Technology of National Research Council, Avellino, Italy
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32
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Giacco R, Parillo M, Rivellese AA, Lasorella G, Giacco A, D'Episcopo L, Riccardi G. Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care 2000; 23:1461-6. [PMID: 11023137 DOI: 10.2337/diacare.23.10.1461] [Citation(s) in RCA: 198] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate in type 1 diabetic patients 1) the long-term feasibility of a high-fiber (HF) diet composed exclusively of natural foodstuffs and 2) the efficacy of this diet in relation to blood glucose control and incidence of hypoglycemic episodes. RESEARCH DESIGN AND METHODS The study was randomized with parallel groups. Participants were part of a larger multicenter study on the effects of acarbose on glucose control in diabetes. A total of 63 type 1 diabetic patients, age 28 +/- 9 years, BMI 24 +/- 0.6 kg/m2, after a 4-week run-in period on their habitual diet, were randomized to either an HF (n = 32) or a low-fiber (LF) diet (n = 31) for 24 weeks. The two diets, composed exclusively of natural foodstuffs, were weight-maintaining and, aside from their fiber content, were similar for all nutrients. At the end of the run-in period and the dietary treatment, fasting blood samples for the measurement of plasma cholesterol, HDL cholesterol, triglyceride, and HbA(1c) were collected. A daily glycemic profile was performed on a day in which the participants had consumed a standard menu representative of their treatment diet (HF or LF). RESULTS Of the 63 study subjects, 29 in the HF group (91%) and 25 in the LF group (81%) completed the study Compared with the LF diet, the HF diet after 24 weeks decreased both mean daily blood glucose concentrations (P < 0.05) and number of hypoglycemic events (P < 0.01). When compliance to diet was taken into account, 83% of the subjects on the HF diet and 88% on the LF diet were compliant. In this subgroup, compared with the LF diet, the HF diet significantly reduced mean daily blood glucose concentrations (P < 0.001), HbA(1c) (P < 0.05), and number of hypoglycemic events (P < 0.01). CONCLUSIONS In type 1 diabetic patients, an HF diet is feasible in the long term and, compared with an LF diet, improves glycemic control and reduces the number of hypoglycemic events.
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Affiliation(s)
- R Giacco
- Institute of Food Sciences and Technology of Consiglio Nationale delle Ricerche, Avellino, Italy
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Riccardi G, Giacco R, Parillo M, Turco S, Rivellese AA, Ventura MR, Contadini S, Marra G, Monteduro M, Santeusanio F, Brunetti P, Librenti MC, Pontiroli AE, Vedani P, Pozza G, Bergamini L, Bianchi C. Efficacy and safety of acarbose in the treatment of Type 1 diabetes mellitus: a placebo-controlled, double-blind, multicentre study. Diabet Med 1999; 16:228-32. [PMID: 10227568 DOI: 10.1046/j.1464-5491.1999.00047.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The aim of the study was to evaluate the efficacy and safety of acarbose in patients with Type 1 diabetes mellitus (DM). METHODS A multicentre double-blind, randomized, placebo-controlled study was performed. After a 6-week run-in, 121 patients were randomized to acarbose or placebo and to high- or low-fibre diet for 24 weeks. Acarbose dose was 50 mg t.d.s. for the first 2 weeks and 100 mg t.d.s. for the subsequent weeks. RESULTS At the end of 24 weeks of treatment the intention to treat analysis showed that acarbose compared with placebo decreased 2 h postprandial plasma glucose levels (12.23 +/- 0.83 vs. 14.93 +/- 0.87 mmol/l; F = 6.1, P < 0.02) (least square means +/- SEM). No significant effect of acarbose was recorded on HbA1c or on the number of hypoglycaemic episodes. The effect of acarbose on blood glucose control was not influenced by the amount of carbohydrate and/or fibre intake. The incidence of adverse events were 75% and 39% in acarbose and placebo groups, respectively; they were mild and confined to the gastrointestinal tract. CONCLUSIONS The use of acarbose in combination with insulin reduces postprandial plasma glucose levels in Type 1 diabetic patients who are not satisfactorily controlled with insulin alone but without significant effect on HbA1c.
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Affiliation(s)
- G Riccardi
- Department of Clinical and Experimental Medicine, Medical School, University of Naples Federico II, Italy
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Giacco R, Brighenti F, Parillo M, Rivellese AA, Riccardi G. Potato dumplings elicit a low plasma glucose response in NIDDM patients. Diabetes Care 1997; 20:460. [PMID: 9051406 DOI: 10.2337/diacare.20.3.460a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Parillo M, Giacco R, Ciardullo AV, Rivellese AA, Riccardi G. Does a high-carbohydrate diet have different effects in NIDDM patients treated with diet alone or hypoglycemic drugs? Diabetes Care 1996; 19:498-500. [PMID: 8732716 DOI: 10.2337/diacare.19.5.498] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effects of a nigh-carbohydrate diet on blood glucose and plasma lipids in NIDDM patients with either mild or severe glucose intolerance. RESEARCH DESIGN AND METHODS A crossover design with a 15-day intervention diet was used. Eighteen patients were separated into two groups on the basis of hypoglycemic treatment (diet, n = 9, or diet plus glibenclamide, n = 9) and were assigned to a 15-day treatment with a high-carbohydrate/low-fiber diet containing 60% energy from carbohydrate and 20% from fat or a low-carbohydrate/low-fiber diet with 40% energy from carbohydrate and 40% from fat and then crossed over to the other diet for 15 more days. RESULTS The high-carbohydrate diet produced a significant increase in postprandial blood glucose in patients on glibenclamide (13.6 +/- 1.4 vs. 11.0 +/- 1.8 mmol/l, P < 0.002, while no difference was recorded in the group on diet alone (9.7 +/- vs. 8.9 +/- 0.6 mmol/l). Postprandial insulin levels were significantly higher after the high-carbohydrate diet in the group on diet along (248 +/- 32 vs. 192 +/- 28 pmol/l, P < 0.01), while no significant differences were observed in the other group (226 +/- 19 vs. 202 +/- 24 pmol/l) The high-carbohydrate diet also induced a significant increase in fasting plasma triglyceride concentrations in both groups (1.36 +/- 0.2 vs. 1.12 +/- 0.2 mmol/l, P < 0.05 and 1.4 +/- 0.3 vs. 1.1 +/- 0.1 mmol/l, P < 0.05). No differences were observed in fasting plasma cholesterol and HDL. CONCLUSIONS The effects of the high-carbohydrate diet on blood glucose control in NIDDM patients differ according to severity of glucose intolerance.
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Affiliation(s)
- M Parillo
- Institute of Internal Medicine and Metabolic Diseases, Medical School, University of Naples Federico II, Italy
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Parillo M, Riccardi G. Dietary carbohydrates and glucose metabolism in diabetic patients. Diabete Metab 1995; 21:391-401. [PMID: 8593919] [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: 01/31/2023]
Abstract
Dietary carbohydrates represent one of the major sources of energy for the human body. However, the main (if not the only) therapy for diabetes since ancient times has been based on reducing dietary carbohydrates drastically because of their effects on blood glucose levels. The introduction of insulin in the 1920s and then of oral hypoglycaemic drugs led to various studies evaluating the biochemical characteristics of carbohydrates and their effects on glucose metabolism in diabetic patients. This review considers the role of dietary carbohydrates in the diet of diabetic patients in the light of the most recent studies and provides a short summary of the biochemistry of carbohydrates and the physiology of carbohydrate digestion.
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Affiliation(s)
- M Parillo
- Institute of Internal Medicine and Metabolic Diseases, Federico II University Medical School, Naples, Italy
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Affiliation(s)
- G Riccardi
- Institute of Internal Medicine and Metabolic Disease, University Federico II, Naples, Italy
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Parillo M, Rivellese AA, Ciardullo AV, Capaldo B, Giacco A, Genovese S, Riccardi G. A high-monounsaturated-fat/low-carbohydrate diet improves peripheral insulin sensitivity in non-insulin-dependent diabetic patients. Metabolism 1992; 41:1373-8. [PMID: 1461145 DOI: 10.1016/0026-0495(92)90111-m] [Citation(s) in RCA: 151] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
It is commonly believed that high-carbohydrate (CHO) diets improve peripheral insulin sensitivity; however, this concept is based on anecdotal evidence. Furthermore, it has been demonstrated that in non-insulin-dependent diabetic patients treated with insulin, a high-monounsaturated-fat (MUFA) diet is more effective than a high-complex-CHO diet in reducing blood glucose levels. The aim of our study was to compare the effect of a high-MUFA diet and a high-CHO diet on peripheral insulin sensitivity and metabolic control in non-insulin-dependent diabetic patients. Ten non-insulin-dependent diabetic patients aged 52 +/- 8 years with a body mass index (BMI) of 26.7 +/- 3.5 kg/m2 who were being treated with diet alone (n = 5) or with diet plus glibenclamide (n = 5) were randomly assigned to a 15-day period of either a high-MUFA/low-CHO diet (CHO, 40%; fat, 40%; protein, 20%; fiber, 24g) or a low-MUFA/high-CHO diet (CHO, 60%; fat, 20%; protein, 20%; fiber, 24g) and were then crossed-over to the other diet. Diets were similar in their content of monosaccharides, disaccharides, and saturated fats, and were administered to the patients in a metabolic ward. The dosage of hypoglycemic drugs was maintained at a constant level throughout the study. With the high-MUFA/low-CHO diet, a decrease in both postprandial glucose (8.76 +/- 2.12 v 10.08 +/- 2.76 mmol/L; P < .05) and plasma insulin (195.0 +/- 86.4 v 224.4 +/- 75.6 pmol/L; P < .02) levels was observed. Furthermore, fasting plasma triglyceride levels were reduced after the high-MUFA fat/low-CHO diet (1.16 +/- 0.59 v 1.37 +/- 0.59 mmol/L; P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Parillo
- Institute of Internal Medicine and Metabolic Diseases, University Federico II, Naples, Italy
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Abstract
OBJECTIVE To evaluate whether an insulin regimen with a long-acting zinc insulin (Ultratard HM) could help control fasting hyperglycemia in insulin-dependent diabetes mellitus (IDDM) patients. RESEARCH DESIGN AND METHODS A randomized sequential crossover trial with 6-wk treatment periods was used. Ten IDDM patients from the diabetes clinic at the Medical School who had persistent fasting hyperglycemia (greater than 10 mmol/L) were studied. Patients with nocturnal hypoglycemia were excluded. All patients completed the study. Insulin regimens consisted of three daily injections of a short-acting insulin (Actrapid HM) before meals and either a long-acting zinc insulin (Ultratard HM) or an intermediate isophane insulin (Protaphane HM) before the evening meal. Each regimen was followed for 6 wk. RESULTS Fasting blood glucose levels (at 06:00 and 08:00) were significantly lower after the long-acting insulin regimen (6.26 +/- 0.88 vs. 10.82 +/- 4.27 mM, P less than 0.05 and 9.26 +/- 1.02 vs. 14.03 +/- 1.08 mM, P less than 0.05, respectively). Plasma-free insulin levels mirrored blood glucose concentrations because they were significantly higher at 06:00 and 08:00 after the long-acting insulin regimen (49.5 +/- 10.1 vs. 20.1 +/- 4.3 pM, P less than 0.05 and 31.6 +/- 5.0 vs. 16.5 +/- 3.4 pM, P less than 0.05, respectively). At any other time of the day, blood glucose and plasma insulin levels were not significantly different with either one of the two insulin regimens. CONCLUSIONS A long-acting zinc human insulin injected before the evening meal can help to control persistent fasting hyperglycemia in IDDM patients.
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Affiliation(s)
- M Parillo
- Institute of Internal Medicine and Metabolic Disease, University of Naples, Italy
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Abstract
The importance of diet in the prevention and treatment of atherosclerosis is well known. Among the different nutrients, lipids certainly have a primary role. Dietary cholesterol can influence the progression of atherosclerosis by increasing cholesterol levels or by modifying the composition of lipoproteins. Epidemiological and clinical studies have clearly demonstrated a relationship between the intake of saturated fatty acids and atherosclerosis. Among these fatty acids, stearic acid has the smallest effect on cholesterol levels. Until a few years ago it was though that monounsaturated fatty acids (MUFA) did not affect lipoprotein metabolism. However, very recently it has been shown that MUFA have the same hypocholesterolemic effect as polyunsaturated fatty acids; moreover they do not induce a decrease in high-density lipoprotein cholesterol. Therefore the overall metabolic effect of MUFA seems to be beneficial.
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Affiliation(s)
- M Mancini
- Institute of Internal Medicine and Metabolic Diseases, 2nd Medical School, University of Naples, Italy
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Parillo M, Riccardi G, Pacioni D, Iovine C, Contaldo F, Isernia C, De Marco F, Perrotti N, Rivellese A. Metabolic consequences of feeding a high-carbohydrate, high-fiber diet to diabetic patients with chronic kidney failure. Am J Clin Nutr 1988; 48:255-9. [PMID: 2841839 DOI: 10.1093/ajcn/48.2.255] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to compare the metabolic effects of a high-carbohydrate (CHO), high-fiber diet with only moderate protein restriction with those of a low-CHO, low-fiber diet with a low protein content in six diabetic patients with moderate chronic renal failure. The high-CHO, high-fiber diet induced a significant improvement in blood glucose control, a significant decrease in serum cholesterol, and a significant increase in fecal nitrogen losses. Other variables evaluated were not significantly different between the two diets, except for a significant increase in serum phosphorus during the high-CHO, high-fiber diet. N balance was not significantly different from 0 at the end of either dietary period and was very similar for both diets. The high-CHO, high-fiber diet presents many beneficial metabolic effects in diabetic patients with chronic renal failure.
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Affiliation(s)
- M Parillo
- Institute of Internal Medicine and Metabolic Disease, 2nd Medical School, University of Naples, Italy
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Abstract
Plasma glucose and insulin responses to both a 75-g oral glucose challenge and to conventional meals were determined in eight patients with hypertension and compared with values of a control population. The results indicated that patients with hypertension had significantly higher than normal plasma glucose and insulin concentrations in both situations. Furthermore, when dietary carbohydrate was increased by 16% of total calories (with a reciprocal reduction in dietary fat), the hyperglycemia and hyperinsulinemia present in patients with hypertension were accentuated. Since low fat-high carbohydrate diets are usually recommended for patients with hypertension, these data suggest that abnormalities of glucose and insulin metabolism associated with hypertension would be increased if patients with high blood pressure followed conventional dietary advice. Since hyperglycemia and hyperinsulinemia have been shown to be associated with an increased risk of developing coronary artery disease, it may be appropriate to reevaluate the clinical utility of low fat-high carbohydrate diets in the treatment of hypertension.
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Affiliation(s)
- M Parillo
- Department of Medicine, Stanford University School of Medicine, California
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Abstract
To evaluate whether the same amount of carbohydrate (CHO) in different foods gives different glycaemic responses when consumed in the context of a real meal, seven diabetic patients were given in a random order and on alternate days three test meals of identical composition. Each meal consisted of a fixed part to which a 50 g CHO portion of either bread (90 g) or spaghetti (65 g) or potatoes (285 g) was added. The glycaemic response was significantly higher after ingestion of bread than after the spaghetti meal both at 2 (5.9 +/- 0.8 vs 4.3 +/- 0.7 mmol/l X hour, p less than 0.05) and at 5 hours (16.5 +/- 3.6 vs 9.8 +/- 2.3 mmol/l X hour, p less than 0.05). The glycaemic response to the potato meal was similar to that for bread at 2 hours (6.2 +/- 1.2 mmol/l X hour, p less than 0.05 vs spaghetti) and intermediate between the two other test meals at 5 hours (14.6 +/- 4.3 mmol/l X hour). Meal planning for diabetic patients should be based not only on the biochemical properties but also on the glycaemic response to the food.
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Parillo M, Perrotti N, Iovine C, Pacioni D, Rivellese A, Riccardi G, Mancini M. [Fiber-rich diet in the treatment of diabetics in renal failure]. MINERVA ENDOCRINOL 1984; 9:317-9. [PMID: 6095006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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