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Campo I, Granata A, Derchi LE, Piccoli G, Cassetti P, Cova MA, Bertolotto M. Tips and tricks for a correct interpretation of contrast-enhanced ultrasound. Radiol Med 2024; 129:536-548. [PMID: 38512611 DOI: 10.1007/s11547-024-01784-0] [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: 09/04/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Although contrast-enhanced ultrasound (CEUS) is a widespread and easily manageable technique, image interpretation errors can occur due to the operator's inexperience and/or lack of knowledge of the frequent pitfalls, which may cause uncertain diagnosis and misdiagnosis. Indeed, knowledge of the basic physical and technical principles of ultrasound is needed both to understand sonographic image findings and to evaluate the potential and limits of the method. Like the B-mode ultrasound, the quality of the CEUS examination is also subject not only to the adequate manual skill of the operator but also to his/her deep knowledge of the technique which improves the quality of the image helping avoid misleading artifacts. In this review, the main parameters influencing a CEUS examination will be described by taking into account the most common errors and pitfalls and their possible solutions.
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Affiliation(s)
- Irene Campo
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy.
| | - Antonio Granata
- Nephrology and Dialysis Unit, Ospedale Cannizzaro in via Messina, 829, 95126, Catania, CT, Italy
| | - Lorenzo E Derchi
- Radiology Section, Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | | | - Paolo Cassetti
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale San Giovanni di Dio, Via Fatebenefratelli, 34, 34170, Gorizia, Italy
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
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2
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Tirelli G, Marcuzzo AV, Gardenal N, Tofanelli M, Degrassi F, Cova MA, Sacchet E, Giudici F, Polesel J, Boscolo-Rizzo P. Prognostic role of the MRI-based involvement of superior pharyngeal constrictor muscle in oropharyngeal squamous cell carcinoma. Head Neck 2024; 46:161-170. [PMID: 37909147 DOI: 10.1002/hed.27566] [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: 04/11/2023] [Revised: 08/23/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the impact of the involvement of the superior pharyngeal constrictor muscle (SPCM) evaluated by magnetic resonance imaging (MRI) on outcome in oropharyngeal squamous cell carcinomas (OPSCCs). METHODS A retrospective study including consecutive patients with OPSCC treated with curative intent. RESULTS A total of 82 consecutive patients with OPSCC met inclusion criteria. At multivariate analysis, patients with SPCM infiltration were at significantly higher risk of death (HR: 3.37, CI: 1.21-9.38) and progression (HR: 3.39, CI: 1.38-8.32). In a multivariate model conditioned on HPV status, a significantly higher risk of death and progression was observed by combining both SPCM and HPV status with patients harboring an HPV-negative OPSCC with SPCM infiltration showing the poorest outcome. CONCLUSION MRI evidence of SPCM involvement significantly and independently increases the risk of death and progression in subjects with OPSCC. Considering both MRI-assessed SPCM infiltration and HPV status significantly improved risk stratification in these malignancies.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Ferruccio Degrassi
- Department of Medical, Surgical and Health Sciences, Section of Radiology, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Medical, Surgical and Health Sciences, Section of Radiology, University of Trieste, Trieste, Italy
| | - Erika Sacchet
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Fabiola Giudici
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
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3
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Tagliati C, Fogante M, Palmisano A, Catapano F, Lisi C, Monti L, Lanni G, Cerimele F, Bernardini A, Procaccini L, Argalia G, Esposto Pirani P, Marcucci M, Rebonato A, Cerimele C, Luciano A, Cesarotto M, Belgrano M, Pagnan L, Sarno A, Cova MA, Ventura F, Regnicolo L, Polonara G, Uguccioni L, Quaranta A, Balardi L, Barbarossa A, Stronati G, Guerra F, Chiocchi M, Francone M, Esposito A, Schicchi N. Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background. Medicina (Kaunas) 2023; 60:70. [PMID: 38256331 PMCID: PMC10818366 DOI: 10.3390/medicina60010070] [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: 11/14/2023] [Revised: 12/09/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.
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Affiliation(s)
- Corrado Tagliati
- Radiologia, AST Pesaro Urbino, 61121 Pesaro, Italy; (C.T.); (A.R.)
| | - Marco Fogante
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.P.); (A.E.)
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Lanni
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Federico Cerimele
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Antonio Bernardini
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Luca Procaccini
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Giulio Argalia
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Paolo Esposto Pirani
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Matteo Marcucci
- U.O.C. di Radiodiagnostica, Ospedale Generale Provinciale di Macerata, 62100 Macerata, Italy;
| | - Alberto Rebonato
- Radiologia, AST Pesaro Urbino, 61121 Pesaro, Italy; (C.T.); (A.R.)
| | - Cecilia Cerimele
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Alessandra Luciano
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Matteo Cesarotto
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Manuel Belgrano
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.B.); (M.A.C.)
| | - Lorenzo Pagnan
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Alessandro Sarno
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Maria Assunta Cova
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.B.); (M.A.C.)
| | | | - Luana Regnicolo
- Department of Neuroradiology, University Hospital of Marche, 60126 Ancona, Italy;
| | - Gabriele Polonara
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, 60126 Ancona, Italy;
| | - Lucia Uguccioni
- Emodinamica e Cardiologia Interventistica, AST Pesaro Urbino, 61121 Pesaro, Italy;
| | - Alessia Quaranta
- Cardiologia, Distretto Sanitario di Civitanova Marche, AST 3, 62012 Civitanova Marche, Italy;
| | - Liliana Balardi
- Health Professions Area, Diagnostic Technical Area, University Hospital of Marche, 60126 Ancona, Italy;
| | - Alessandro Barbarossa
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Marcello Chiocchi
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.P.); (A.E.)
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy;
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4
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Cifaldi R, Salton F, Confalonieri P, Trotta L, Barbieri M, Ruggero L, Valeri G, Pozzan R, Della Porta R, Kodric M, Baratella E, Bellan M, Lerda S, Hughes M, Confalonieri M, Cova MA, Gandin I, Mondini L, Ruaro B. Pulmonary Sarcoidosis and Immune Dysregulation: A Pilot Study on Possible Correlation. Diagnostics (Basel) 2023; 13:2899. [PMID: 37761266 PMCID: PMC10530165 DOI: 10.3390/diagnostics13182899] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Sarcoidosis is a systemic inflammatory disease characterized by an altered inflammatory response. OBJECTIVE The aim of this study was to evaluate whether immune system alterations detected by lymphocyte typing in peripheral blood correlate with the severity of sarcoidosis, calculated according to two separate severity scores proposed by Wasfi in 2006 and Hamzeh in 2010. MATERIALS AND METHODS Eighty-one patients were recruited, and clinical data and laboratory tests at the time of diagnosis were obtained in order to assess the severity index score and investigate any statistically significant correlation with the cytofluorimetry data. RESULTS Our data demonstrated that none of the two scores show an association with the level of total lymphocytes or lymphocyte subclasses. LIMITATIONS First of all, the sample taken into consideration is small. The assessment was performed only at disease onset and not during the disease. Furthermore, the severity scores do not take into account disease activity (measured by PET/CT or gallium scintigraphy). CONCLUSIONS Lymphocyte subpopulation values at the time of diagnosis do not appear to correlate with disease severity at onset.
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Affiliation(s)
- Rossella Cifaldi
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gianmaria Valeri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Rossana Della Porta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine, University Hospital, Maggiore della Carità, 28100 Novara, Italy
| | - Selene Lerda
- Management Specialization School, University of Milan, 20149 Milano, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Ajčević M, Iscra K, Furlanis G, Michelutti M, Miladinović A, Buoite Stella A, Ukmar M, Cova MA, Accardo A, Manganotti P. Cerebral hypoperfusion in post-COVID-19 cognitively impaired subjects revealed by arterial spin labeling MRI. Sci Rep 2023; 13:5808. [PMID: 37037833 PMCID: PMC10086005 DOI: 10.1038/s41598-023-32275-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023] Open
Abstract
Cognitive impairment is one of the most prevalent symptoms of post Severe Acute Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) state, which is known as Long COVID. Advanced neuroimaging techniques may contribute to a better understanding of the pathophysiological brain changes and the underlying mechanisms in post-COVID-19 subjects. We aimed at investigating regional cerebral perfusion alterations in post-COVID-19 subjects who reported a subjective cognitive impairment after a mild SARS-CoV-2 infection, using a non-invasive Arterial Spin Labeling (ASL) MRI technique and analysis. Using MRI-ASL image processing, we investigated the brain perfusion alterations in 24 patients (53.0 ± 14.5 years, 15F/9M) with persistent cognitive complaints in the post COVID-19 period. Voxelwise and region-of-interest analyses were performed to identify statistically significant differences in cerebral blood flow (CBF) maps between post-COVID-19 patients, and age and sex matched healthy controls (54.8 ± 9.1 years, 13F/9M). The results showed a significant hypoperfusion in a widespread cerebral network in the post-COVID-19 group, predominantly affecting the frontal cortex, as well as the parietal and temporal cortex, as identified by a non-parametric permutation testing (p < 0.05, FWE-corrected with TFCE). The hypoperfusion areas identified in the right hemisphere regions were more extensive. These findings support the hypothesis of a large network dysfunction in post-COVID subjects with cognitive complaints. The non-invasive nature of the ASL-MRI method may play an important role in the monitoring and prognosis of post-COVID-19 subjects.
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Affiliation(s)
- Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Katerina Iscra
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Marco Michelutti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | | | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Maja Ukmar
- Radiology Unit, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Unit, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy.
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6
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Eusebi L, Masino F, Gifuni R, Fierro D, Bertolotto M, Cova MA, Guglielmi G. Role of Multiparametric-MRI in Bladder Cancer. Curr Radiol Rep 2023. [DOI: 10.1007/s40134-023-00412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Abstract
Purpose of Review
This narrative review article aims to show the actual role of imaging, in particular MRI, and the role of VI-RADS Score, in recognition and follow-up of the tumor.
Recent Findings
A team of professionals created VI-RADS with the goal of standardizing the acquisition and interpretation of multiparametric-MRI in bladder cancer.
Summary
Bladder cancer is the most common cancer involving the urinary system. It is the fourth most common urological cancer in men and the second most frequent cancer affecting the urinary tract. Main risks factors are advanced age, male sex, and cigarette smoking. Bladder cancer ranges from unaggressive and usually non-invasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. At the time of diagnosis, 70% of patients are experiencing non-muscle-invasive bladder cancer. Vesical imaging-reporting and data system score (VI-RADS) is a scoring system useful to standardize the approach to multiparametric-MRI interpretation, and reporting for bladder cancer.
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Losurdo P, Gandin I, Belgrano M, Fiorese I, Verardo R, Zanconati F, Cova MA, de Manzini N. microRNAs combined to radiomic features as a predictor of complete clinical response after neoadjuvant radio-chemotherapy for locally advanced rectal cancer: a preliminary study. Surg Endosc 2023; 37:3676-3683. [PMID: 36639577 DOI: 10.1007/s00464-022-09851-1] [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: 07/18/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To define a predictive Artificial Intelligence (AI) algorithm based on the integration of a set of biopsy-based microRNAs expression data and radiomic features to understand their potential impact in predicting clinical response (CR) to neoadjuvant radio-chemotherapy (nRCT). The identification of patients who would truly benefit from nRCT for Locally Advanced Rectal Cancer (LARC) could be crucial for an improvement in a tailored therapy. METHODS Forty patients with LARC were retrospectively analyzed. An MRI of the pelvis before and after nRCT was performed. In the diagnostic biopsy, the expression levels of 7 miRNAs were measured and correlated with the tumor response rate (TRG), assessed on the surgical sample. The accuracy of complete CR (cCR) prediction was compared for i) clinical predictors; ii) radiomic features; iii) miRNAs levels; and iv) combination of radiomics and miRNAs. RESULTS Clinical predictors showed the lowest accuracy. The best performing model was based on the integration of radiomic features with miR-145 expression level (AUC-ROC = 0.90). AI algorithm, based on radiomics features and the overexpression of miR-145, showed an association with the TRG class and demonstrated a significant impact on the outcome. CONCLUSION The pre-treatment identification of responders/NON-responders to nRCT could address patients to a personalized strategy, such as total neoadjuvant therapy (TNT) for responders and upfront surgery for non-responders. The combination of radiomic features and miRNAs expression data from images and biopsy obtained through standard of care has the potential to accelerate the discovery of a noninvasive multimodal approach to predict the cCR after nRCT for LARC.
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Affiliation(s)
- Pasquale Losurdo
- Surgical Clinic Unit, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical and Surgical Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Manuel Belgrano
- Radiology Unit, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Ilaria Fiorese
- Radiology Unit, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Roberto Verardo
- LNCIB - Consorzio Interuniversitario per le Biotecnologie c/o BIC Incubatori FVG, Srl - Via Flavia 23/1, 34149, Trieste, Italy
| | - Fabrizio Zanconati
- Pathology Unit, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Unit, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Nicolò de Manzini
- Surgical Clinic Unit, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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8
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Baratella E, Fiorese I, Minelli P, Veiluva A, Marrocchio C, Ruaro B, Cova MA. Aging-Related Findings of the Respiratory System in Chest Imaging: Pearls and Pitfalls. Curr Radiol Rep 2023; 11:1-11. [PMID: 36471674 PMCID: PMC9713755 DOI: 10.1007/s40134-022-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review The purpose of this review is to describe the main features of the aging chest, studied through different imaging modalities. Recent Findings Aging-related changes of the respiratory system are inevitable. Therefore, it is mandatory to be familiar with the para-physiological changes that occurs, in order to avoid inappropriate interpretation of radiological findings that put patients at risk of over or undertreatment. Summary The role of the radiologist is fundamental in evaluating aging-related processes affecting the respiratory system and in distinguishing them from frank diseases.
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Affiliation(s)
- Elisa Baratella
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Ilaria Fiorese
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Pierluca Minelli
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Alberto Veiluva
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Cristina Marrocchio
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Barbara Ruaro
- grid.5133.40000 0001 1941 4308Department of Pulmonology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Maria Assunta Cova
- grid.5133.40000 0001 1941 4308Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
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9
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Baratella E, Cernic S, Minelli P, Furlan G, Crimì F, Rocco S, Ruaro B, Cova MA. Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis. Tomography 2022; 8:2828-2838. [PMID: 36548528 PMCID: PMC9786845 DOI: 10.3390/tomography8060236] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0-60% incidence) and pulmonary hemorrhage (4-27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. MATERIALS AND METHODS Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. RESULTS There was sensitivity of 90.07% (95% CI 86.05-93.25%), accuracy of 98.87% (95% CI 98.12-99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23-99.10%). Specificity settled at 100% (93.84-100%). The AUC was 0.952 (95% CI 0.924-0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. CONCLUSIONS The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
- Correspondence:
| | - Stefano Cernic
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Pierluca Minelli
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Giovanni Furlan
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Filippo Crimì
- Institute of Radiology, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy
| | - Simone Rocco
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
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10
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D'Errico S, Bergamini PR, Fattorini P, Zanconati F, Bussani R, Cova MA, Pagnan L, Belgrano M, Gasparini P, Girotto G, Lenarduzzi S, Addobbati R, Rakar S, Aleksova A, Dal Ferro M, Zecchin M, Sinagra G. [The Regional Registry of Sudden Cardiac Death of Friuli Venezia Giulia. Protocols, best practices and results of a multidisciplinary project]. G Ital Cardiol (Rome) 2022; 23:827-835. [PMID: 36300386 DOI: 10.1714/3900.38822] [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: 06/16/2023]
Abstract
With the regional law n. 26 of December 30, 2020, the Friuli Venezia Giulia Region wanted to promote the establishment of the Regional Register of Sudden Cardiac Death, with the aim of favoring the study of all those deaths that occurred suddenly and unexpectedly under the age of 50 years in which it is not possible to trace the cause of death with certainty. Such dramatic events, difficult to quantify considering the complexity of data collection, are often accepted with resignation without any further investigation of the possible causes. The Regional Register of Sudden Cardiac Deaths of Friuli Venezia Giulia was born from this premise and from the awareness of the importance of going back with a rigorous scientific methodology and through a multidisciplinary approach, to the diagnosis of hereditary heart diseases which, when determined, allow the enrollment of relatives in a cardiological screening process and, therefore, primary prevention of potentially fatal events. The authors describe the operating procedures feeding the Regional Register and present the results of the first year of activity on 26 cases.
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Affiliation(s)
- Stefano D'Errico
- SC UCO Medicina Legale, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Pier Riccardo Bergamini
- SC UCO Medicina Legale, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Paolo Fattorini
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Fabrizio Zanconati
- SC UCO Anatomia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Rossana Bussani
- SC UCO Anatomia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Maria Assunta Cova
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Lorenzo Pagnan
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Manuel Belgrano
- SC UCO Diagnostica per Immagini, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Paolo Gasparini
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Giorgia Girotto
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Stefania Lenarduzzi
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Riccardo Addobbati
- Dipartimento dei Servizi e di Diagnostica Avanzata, IRCCS Materno Infantile Burlo Garofolo, Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Serena Rakar
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Aneta Aleksova
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Matteo Dal Ferro
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Massimo Zecchin
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
| | - Gianfranco Sinagra
- SC Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale di Cattinara, Rete Europea Malattie Cardiache Rare (ERN Guard-Heart), Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi, Trieste
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11
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Manganotti P, Furlanis G, Cova MA, Olivo S, Dore F, Sartori A, Naccarato M. Isolated aphasic status epilepticus: CT perfusion, SPECT and EEG reveal neurovascular coupling and support the differential diagnosis. Epileptic Disord 2022; 24:549-554. [PMID: 35653085 DOI: 10.1684/epd.2022.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/03/2022] [Indexed: 11/08/2023]
Abstract
Objective Among the clinical manifestations of stroke mimics, isolated aphasia is one of the most challenging due to its aetiopathogenic diagnosis. This short communication describes a specific perfusion and brain oscillatory pattern in a challenging case of prolonged isolated aphasia caused by status epilepticus, jointly investigated by computed tomography (CT) perfusion, single-photon emission computerized tomography (SPECT)/CT and EEG qualitative and quantitative analysis. Methods We discuss the different patterns of perfusion neuroimaging and EEG between SE and ischaemic stroke or postictal (Todd's)-related isolated aphasia, and propose these differences as a basis to support the differential diagnosis. Results The pattern associated with SE was characterized by focal hyperperfusion on CT perfusion maps (the left mean transit time was shorter with >10% asymmetry, and left cerebral blood volume and cerebral blood flow increased or slightly altered, relative to the contralateral side) and SPECT (focal left temporal hyperperfusion), without any early ischaemic signs on non-enhanced CT, while the EEG showed a predominant left hemispheric slow delta power. The aforementioned perfusion pattern contrasts with postictal epileptic Todd's phenomenon, which is characterized by hypoperfusion on CT perfusion (the mean transit time is prolonged and cerebral blood volume and cerebral blood flow are reduced, compared to the contralateral hemisphere) and SPECT (focal hypoperfusion), not restricted to the specific vascular territories. Significance CT perfusion patterns may add valuable information to support the differential diagnosis of status epilepticus, rather than acute ischaemic stroke or postictal Todd's phenomenon, in cases with challenging symptoms of prolonged isolated aphasia.
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12
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Occhipinti AA, Di Bella S, Degrassi F, Tornese G, Cova MA, Barbi E. Painful thoracic swelling in a refugee teenager. Arch Dis Child Educ Pract Ed 2022; 107:31-33. [PMID: 32839192 DOI: 10.1136/archdischild-2020-319658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/04/2020] [Indexed: 11/04/2022]
Abstract
A 14-year-old refugee, escaping from a Middle East war zone, was admitted with a 3-month history of chest pain and a 2-week history of sternal swelling. The patient had no previous medical history, but reported having been beaten by a policeman at a border at the beginning of his journey. He did not have the following symptoms: cough, wheezing fever, weight loss and sweating. When he was admitted to the hospital, he was afebrile; blood pressure was 120/70 mm Hg, pulse 95 beats per minute and oxygen saturation 97% while breathing ambient air. On physical examination, there was a 10 cm fluctuating swelling in the sternal region. The lesion was reddish, warm, tender and painful (figure 1). Digital clubbing was also noticed. The remaining examination was normal. White blood cell count was 9000 cells per mm3, haemoglobin 145 g/L, erythrocyte sedimentation rate and C reactive protein were normal as well as renal and liver function tests. ECG was regular.
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Affiliation(s)
- Alessandro Agostino Occhipinti
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Friuli-Venezia Giulia, Università degli Studi di Trieste, Trieste, Friuli-Venezia Giulia, Italy, Trieste, Italy
| | - Stefano Di Bella
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Friuli-Venezia Giulia, Università degli Studi di Trieste, Trieste, Friuli-Venezia Giulia, Italy, Trieste, Italy
| | - Ferruccio Degrassi
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Friuli-Venezia Giulia, Università degli Studi di Trieste, Trieste, Friuli-Venezia Giulia, Italy, Trieste, Italy
| | - Gianluca Tornese
- Department of Paediatrics, Istituto di Ricovero e Cura a Carattere Scientifico materno infantile Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy
| | - Maria Assunta Cova
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Friuli-Venezia Giulia, Università degli Studi di Trieste, Trieste, Friuli-Venezia Giulia, Italy, Trieste, Italy
| | - Egidio Barbi
- Department of Paediatrics, Istituto di Ricovero e Cura a Carattere Scientifico materno infantile Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy
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13
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Baratella E, Roman-Pognuz E, Zerbato V, Minelli P, Cavallaro MFM, Cova MA, Luzzati R, Lucangelo U, Sanson G, Friso F, Bussani R, Pinamonti M, Busetti M, Salton F, Confalonieri M, Ruaro B, Di Bella S. Potential links between COVID-19-associated pulmonary aspergillosis and bronchiectasis as detected by high resolution computed tomography. Front Biosci (Landmark Ed) 2021; 26:1607-1612. [PMID: 34994174 DOI: 10.52586/5053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this observational study was to highlight high resolution CT scan characteristics of COVID-19-associated pulmonary aspergillosis (CAPA) with a focus on the detection of de-novo appeared or evolved bronchiectasis. METHODS From March 2020 to May 2021, we enrolled 350 consecutive mechanically ventilated ICU patients with COVID-19. Patients with CAPA and at least one chest CT scan performed within 15 days from the diagnosis were included. Two radiologists were asked to identify typical and atypical signs of COVID-19 pneumonia. Bronchiectasis locations were described and a modified Reiff score was calculated, as severity score. A total of 19 CAPA patients (median age 71.0, Interquartile range (IQR) 62.5-75.0; male 16, 84.2%) were included. RESULTS According to the 2020 ECMM/ISHAM criteria, 18 patients had probable CAPA and one had proven CAPA. The median time between hospital admission and CT scan was 21 days (IQR 14.5-25.0). The incidence of bronchiectasis in the study population was 57.9% (n = 11). Tubular bronchiectasis was detected in 10 patients and were scored as follows: three patients had a score of 1, three patients had a score of score 2, one patient had a score of 5 and four patients had a score of 6. Eight patients had a previous CT scan (performed at hospital admission), among them: 5 patients developed de-novo bronchiectasis, while 2 patients demonstrated a volumetric increase of bronchiectasis. At the 6-months follow-up, the mortality rate for patients with CAPA was >60%. CONCLUSION the radiologic detection of de-novo appearance or volumetric increase of bronchiectasis in COVID-19 should lead clinicians to search for fungal superinfections.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Erik Roman-Pognuz
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Verena Zerbato
- Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy
| | - Pierluca Minelli
- Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | | | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Roberto Luzzati
- Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy
| | - Umberto Lucangelo
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, 34128 Trieste, Italy
| | - Federica Friso
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Rossana Bussani
- Department of Pathology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Maurizio Pinamonti
- Department of Pathology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Marina Busetti
- Microbiology Unit, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Francesco Salton
- Department of Pneumology, Cattinara Hospital, 34128 Trieste, Italy
| | | | - Barbara Ruaro
- Department of Pneumology, Cattinara Hospital, 34128 Trieste, Italy
| | - Stefano Di Bella
- Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy
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14
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Ruaro B, Baratella E, Confalonieri P, Confalonieri M, Vassallo FG, Wade B, Geri P, Pozzan R, Caforio G, Marrocchio C, Cova MA, Salton F. High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose? Diagnostics (Basel) 2021; 11:2293. [PMID: 34943531 PMCID: PMC8700001 DOI: 10.3390/diagnostics11122293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Fabio Giuseppe Vassallo
- Department of Pulmonology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy;
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Gaetano Caforio
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
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15
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Ruaro B, Baratella E, Confalonieri P, Wade B, Marrocchio C, Geri P, Busca A, Pozzan R, Andrisano AG, Cova MA, Confalonieri M, Salton F. High-Resolution Computed Tomography: Lights and Shadows in Improving Care for SSc-ILD Patients. Diagnostics (Basel) 2021; 11:1960. [PMID: 34829307 PMCID: PMC8617987 DOI: 10.3390/diagnostics11111960] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and classification of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is essential to improve the prognosis of systemic sclerosis (SSc) patients. The risk-stratification of disease severity and follow-up requires a multidisciplinary approach, integrating high-resolution computed tomography (HRTC) of the lung, pulmonary function tests (PFT), along with clinical and symptomatic evaluations. The use of HRCT in detecting SSc-ILD is not so much based on a definitive validation, but rather reflects the widespread clinician recognition of dissatisfaction with other modalities. However, due to the heterogeneity of SSc-ILD and the potential absence of symptoms in early or mild disease, it is prudent to consider as many parameters as possible in the assessment and monitoring of newly diagnosed patients. An early diagnosis meets the primary goal, i.e., the prevention of disease progression. The current first line treatment regimens are mainly centered on immunosuppressive therapy. This review assesses the role HRCT plays in optimizing care and improving clinical outcomes in SSc-ILD patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Annalisa Busca
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Alessia Giovanna Andrisano
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
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16
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Baratella E, Marrocchio C, Bozzato AM, Roman-Pognuz E, Cova MA. Chest X-ray in intensive care unit patients: what there is to know about thoracic devices. Diagn Interv Radiol 2021; 27:633-638. [PMID: 34559048 DOI: 10.5152/dir.2021.20497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Critically ill patients admitted to the intensive care unit require continuous monitoring of vital functions as well as mechanical and pharmacological support, provided through different devices. Chest radiographs play a fundamental role in monitoring the conditions of these patients and assessing the intensive-care devices after their insertion; therefore, the radiologist needs to know their normal appearance and their correct position and should be aware of the possible complications that may occur after their placement. This pictorial review illustrates the radiographic appearance of non-cardiological devices commonly used in clinical practice (central venous catheters, tunneled catheters, Swan-Ganz catheters, chest tubes, endotracheal tubes, and nasogastric tubes), their correct position and the most common complications that may occur after their placement.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, University of Trieste, Trieste, Italy
| | - Cristina Marrocchio
- Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | | | - Erik Roman-Pognuz
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI, Trieste, Italy
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17
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Stacul F, Sachs C, Giudici F, Bertolotto M, Rizzo M, Pavan N, Balestreri L, Lenardon O, Pinzani A, Pola L, Cicero C, Celia A, Cova MA. Cryoablation of renal tumors: long-term follow-up from a multicenter experience. Abdom Radiol (NY) 2021; 46:4476-4488. [PMID: 33912986 PMCID: PMC8346457 DOI: 10.1007/s00261-021-03082-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
Purpose To retrospectively investigate long-term outcomes of renal cryoablation from a multicenter database. Methods 338 patients with 363 renal tumors underwent cryoablation in 4 centers in North-Eastern Italy. 340/363 tumors (93.7%) were percutaneously treated with CT guidance. 234 (68.8%) were treated after conscious sedation, 76 (22.3%) under local lidocaine anesthesia only and 30 (8.8%) under general anesthesia. Treatment efficacy and complication rate considered all procedures. Oncologic outcomes considered a subset of 159 patients with 159 biopsy proven renal cell carcinoma. Results Mean tumor size was 2.53 cm. Technical success was achieved in 355/363 (97.8%) treatments. Treatment efficacy after the first treatment was achieved in 348/363 (95.9%) tumors. Statistical analysis revealed a significant lower treatment efficacy for ASA score >3, Padua score >8, tumor size >2.5 cm, use of >2 cryoprobes, presence of one single kidney. In the subset of 159 patients, recurrence-free survival rates were 90.5% (95% CI 83.0%, 94.9%) at 3 years and 82.4% (95% CI 72.0%, 89.4%) at 5 years; overall survival rates were 96.0% (95% CI 90.6%, 98.3%) at 3 years and 91.0% (95% CI 81.7%, 95.7%) at 5 years; no patient in this subset developed metastatic disease. Clavien-Dindo >1 complications were recorded in 14/369 procedures (3.8%) and were related to age >70 years, tumor size >4 cm and use of >2 cryoprobes. Conclusion Cryoablation performed across four different centers in a large cohort of predominantly small renal tumors showed that this technique provides good recurrence-free survival rates and overall survival rates at three- and five-year with very low major complications rate. Electronic supplementary material The online version of this article (10.1007/s00261-021-03082-z) contains supplementary material, which is available to authorized users.
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18
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Baratella E, Bussani R, Zanconati F, Marrocchio C, Fabiola G, Braga L, Maiocchi S, Berlot G, Volpe MC, Moro E, Confalonieri P, Cova MA, Confalonieri M, Salton F, Ruaro B. Radiological-pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for the Sonic hedgehog and Wnt5a pathways? ERJ Open Res 2021; 7:00346-2021. [PMID: 34435038 PMCID: PMC8381265 DOI: 10.1183/23120541.00346-2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Pneumomediastinum is a rare complication of acute respiratory distress syndrome (ARDS), when air leaks into the mediastinum. An increased pneumomediastinum incidence, of up to 5–13%, was reported during the coronavirus disease 2019 (COVID-19) pandemic [1, 2] and even occurred spontaneously without a history of mechanical ventilation [3], similarly to the previous severe acute respiratory syndrome (SARS)-1 [4]. Almost half of the 30 consecutive COVID-19 patients who had prolonged invasive mechanical ventilation had full-thickness tracheal lesions and pneumomediastinum [5]. Although pronation and high positive end-expiratory pressure levels were presumed to be the putative causes of pneumomediastinum [5], the mechanism of this COVID-19 complication remains unknown. We hypothesise that sonic hedgehog (SHH) and Wnt5a signalling, crucial pathways in tracheal morphogenesis, and repair/regeneration of cartilage lesions in adulthood [6, 7], could play a role in pneumomediastinum-related COVID-19 tracheal lesions. Pneumomediastinum is a rare complication of ARDS but is more common during #COVID19. The fibrous hyaline degeneration of the tracheal rings seen in this autoptic series is an original observation that has not been previously described in COVID-19 patients.https://bit.ly/3vxTQde
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Affiliation(s)
- Elisa Baratella
- Dept of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Rossana Bussani
- Dept of Pathology, Cattinara University Hospital, Trieste, Italy
| | | | - Cristina Marrocchio
- Dept of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Giudici Fabiola
- Biostatistics Unit, Dept of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luca Braga
- Functional Cell Biology Unit, ICGEB, Trieste, Italy
| | | | - Giorgio Berlot
- Intensive Care Unit, Cattinara University Hospital, Trieste, Italy
| | | | - Edoardo Moro
- Intensive Care Unit, Cattinara University Hospital, Trieste, Italy
| | | | - Maria Assunta Cova
- Dept of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | | | | | - Barbara Ruaro
- Pulmonology Dept, Cattinara University Hospital, Trieste, Italy
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19
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Zerbato V, Bozzato AM, Di Bella S, Giuffrè M, Martingano P, Di Giusto A, Battisti S, Cova MA, Luzzati R, Cavallaro MFM. Spontaneous psoas haematoma: a life-threatening complication of anticoagulation in COVID-19. A case series of four episodes. Infect Dis (Lond) 2021; 53:724-729. [PMID: 33939587 DOI: 10.1080/23744235.2021.1918347] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Anticoagulant prophylaxis is part of the standard management of hospitalized COVID-19 patients. Despite adequate thromboprophylaxis, one-third of COVID-19 patients with pneumonia developed pulmonary embolism. This high rate of thrombotic complications has led to higher doses of anticoagulants according to clinical complexity (e.g. intensive care unit (ICU) patients) and D-dimer levels. On the other side of the coin, haemorrhagic complications are being increasingly reported. CASES PRESENTATION We herein report four cases of spontaneous psoas haematomas (SPH) among 548 patients hospitalized for SARS-CoV-2 pneumonia between March 2020 and January 2021 (incidence of 7.3 cases per 1000 patients). All patients had pneumonia, with age ranging between 62 and 83 years. All patients received anticoagulant therapy with low weight molecular heparin (100 U.I. anti-Xa/kg 2 times/d) from admission: in two cases, a diagnosis of pulmonary embolism was made. In another case, a thrombosis of left axillary and basilic veins was found, and only in one case anticoagulant therapy was started because of elevated levels of D-dimer. In all cases, signs of anaemia were detected and patients experienced low back or abdominal pain. The diagnosis of spontaneous psoas haematoma was made by computed tomography (CT) after a median of 12.5 d (9;16) from admission and 19.5 d (14.75; 24.25) from the beginning of COVID-19 symptoms. Half of these patients died from haemorrhagic shock. CONCLUSIONS Given the potential life-threatening of SPH and the possible subtle clinical presentation, we believe it is crucial to raise clinicians awareness of this complication among COVID-19 patients undergoing anticoagulants.
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Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital, Trieste, Italy
| | | | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Infectious Diseases Unit, Trieste University, Trieste, Italy
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, Liver Unit, Trieste University, Trieste, Italy
| | - Paola Martingano
- Department of Radiology, Trieste University Hospital, Trieste, Italy
| | - Anna Di Giusto
- Department of Radiology, Trieste University Hospital, Trieste, Italy
| | - Sofia Battisti
- Department of Radiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy.,Scientific Institute of Romagna for the Study and Treatment of Tumors, Meldola, Italy.,Department of Specialized Medicine Diagnostic and Experimental Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Infectious Diseases Unit, Trieste University, Trieste, Italy
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20
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Baratella E, Ruaro B, Giudici F, Wade B, Santagiuliana M, Salton F, Confalonieri P, Simbolo M, Scarpa A, Tollot S, Marrocchio C, Cova MA, Confalonieri M. Evaluation of Correlations between Genetic Variants and High-Resolution Computed Tomography Patterns in Idiopathic Pulmonary Fibrosis. Diagnostics (Basel) 2021; 11:diagnostics11050762. [PMID: 33922858 PMCID: PMC8146750 DOI: 10.3390/diagnostics11050762] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 03/31/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background. Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease (ILD). This prospective observational study aimed at the evaluation of any correlation between genetic variants associated with IPF susceptibility and high-resolution computed tomography (HRCT) patterns. It also aimed at evidencing any differences in the HRTC pattern between the familial and sporadic form at diagnosis and after two years. Methods. A total of 65 IPF patients (mean age at diagnosis 65 ± 10) were enrolled after having given written informed consent. HRCT and genetic evaluations were performed. Results. A total of 19 familial (mean age 62 ± 15) and 46 sporadic (mean age 70 ± 9) IPF patients were enrolled. A statistically significant difference was evidenced in the HRTC pattern at diagnosis between the two groups. Sporadic IPF patients had a predominantly usual interstitial pneumonia (UIP) pattern compared with those patients with familial IPF (60.0% vs. 21.1%, respectively). Moreover, familial IPF patients had more alternative diagnoses than those with sporadic IPF (31.6% vs. 2.2%, respectively). Furthermore, there was a slight increase in the typical UIP pattern in the familial IPF group at two years from diagnosis. Conclusions. Genetic factors play a pivotal role in the risk of developing IPF. However, further studies are required to clarify how these genetic factors may guide clinical treatment decisions.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (S.T.); (C.M.); (M.A.C.)
- Correspondence: ; Tel.: +39-040-399-4372
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34127 Trieste, Italy; (B.R.); (M.S.); (F.S.); (P.C.); (M.C.)
| | - Fabiola Giudici
- Biostatistics Unit, Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy;
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10126 Torino, Italy;
| | - Mario Santagiuliana
- Department of Pulmonology, University Hospital of Cattinara, 34127 Trieste, Italy; (B.R.); (M.S.); (F.S.); (P.C.); (M.C.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34127 Trieste, Italy; (B.R.); (M.S.); (F.S.); (P.C.); (M.C.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34127 Trieste, Italy; (B.R.); (M.S.); (F.S.); (P.C.); (M.C.)
| | - Michele Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, 37219 Verona, Italy; (M.S.); (A.S.)
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, 37219 Verona, Italy; (M.S.); (A.S.)
| | - Saverio Tollot
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (S.T.); (C.M.); (M.A.C.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (S.T.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (S.T.); (C.M.); (M.A.C.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34127 Trieste, Italy; (B.R.); (M.S.); (F.S.); (P.C.); (M.C.)
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21
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Umari P, Rizzo M, Billia M, Stacul F, Bertolotto M, Cova MA, Bondonno G, Perri D, Liguori G, Volpe A, Trombetta C. Oncological outcomes of active surveillance and percutaneous cryoablation of small renal masses are similar at intermediate term follow-up. Minerva Urol Nephrol 2021; 74:321-328. [PMID: 33781019 DOI: 10.23736/s2724-6051.21.04217-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Active surveillance (AS) and minimally invasive ablative therapies such as percutaneous cryoablation (PCA) are emerging as alternative treatment modalities in the management of small renal masses (SRMs). METHODS Fifty-nine patients underwent PCA since 2011 and 75 underwent AS since 2010 at two different institutions. Only patients with follow-up ≥ 6 months were included. All patients were followed with a standardized protocol. Treatment failure was defined by dimensional progression for AS and renal recurrence for PCA, in addition to stage and/or metastatic progression for both groups. RESULTS Treatment failure was observed in 14 cases (18,7%) during AS (mainly due to dimensional progression) and 12 patients (16%) underwent delayed intervention with a mean follow-up of 36,83 months. Seven patients (11,9%) in the PCA group experienced treatment failure with a mean follow-up of 33,39 months and 3 of them underwent re-ablation successfully. Cancer-specific-survival at 2 and 5 years was 100% and 95,8% in AS-group vs. 98,2% and 98,2% in PCA-group (p=0,831). One patient in both groups died from metastatic disease. Overall-survival at 2 and 5 years was 91,7% and 82,4% in the AS-group vs. 96,5% and 96,5% in the PCA-group (p=0,113). Failure-free survival at 2 and 5 years was 90,9% and 70,1% in the AS-group vs. 93,1% and 70,9% in the PCA-group (p=0,645). CONCLUSIONS AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.
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Affiliation(s)
- Paolo Umari
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy -
| | - Michele Rizzo
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Michele Billia
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Fulvio Stacul
- Radiology Department, Maggiore Hospital, Trieste, Italy
| | - Michele Bertolotto
- Radiology Department, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Department, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Gianmarco Bondonno
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Davide Perri
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
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22
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Campo I, Valentino M, Sidhu PS, Magi Meconi L, Van Nieuwenhove S, Cova MA, Derchi LE, Bertolotto M. Nonscrotal Causes of Acute Scrotum. J Ultrasound Med 2021; 40:597-605. [PMID: 32790121 DOI: 10.1002/jum.15431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.
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Affiliation(s)
- Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, Conegliano, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale di Tolmezzo, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital National Health Service Foundation Trust, London, UK
| | - Luca Magi Meconi
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | | | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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23
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Buoite Stella A, Ajčević M, Furlanis G, Lugnan C, Gaio M, Cillotto T, Scali I, Caruso P, Cova MA, Naccarato M, Manganotti P. A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper-acute ischaemic stroke patients. Clin Physiol Funct Imaging 2021; 41:235-244. [PMID: 33497005 DOI: 10.1111/cpf.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/27/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
Hypohydration may be associated with vascular diseases, poor prognosis and worse outcomes in stroke. The underlying mechanisms have not yet been completely investigated, although some studies suggested potential associations with brain perfusion and collaterals status. Despite the potentially different mechanisms promoting serum or urine biomarkers of hypohydration, few studies have investigated both markers separately. A prospective descriptive study was conducted in stroke patients admitted to a stroke unit <4.5 h from symptoms onset. All patients underwent neurological evaluation and whole-brain computed tomography perfusion (CTP) upon admission. Blood and urine samples were immediately collected at admission, and patients were defined as "hypohydrated" (HYP) if blood urea nitrogen-to-creatinine ratio was >15 and "underhydrated" (UND) if urine osmolality was >500 mOsm/kg. CTP images were processed to calculate core, penumbra, their mismatch and total hypoperfused volume. Forty-six patients were included and were grouped according to hydration status. Despite no different NIHSS at baseline, at CTP HYP was independently associated with core-penumbra mismatch (β: -0.157, 95% CI: -0.305 to -0.009; p = .04), while UND was independently associated with the total hypoperfused volume (β: 31.502, 95% CI: 8.522-54.481; p = .01). Using CTP imaging, this study proposes a physiological insight of some possible mechanisms associated with the better outcomes observed in acute stroke patients when properly hydrated. These results suggest different associations between hydration status and CTP parameters depending on serum or urine biomarkers in the hyper-acute phase and encourage the association between hydration status and stroke characteristics.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Miloš Ajčević
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy.,Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Carlo Lugnan
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Marina Gaio
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Tommaso Cillotto
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Ilario Scali
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
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24
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Bertolotto M, Campo I, Sachs C, Ciabattoni R, Cicero C, Drudi FM, Derchi LE, Cova MA. Contrast-enhanced ultrasound after successful cryoablation of benign and malignant renal tumours: how long does tumour enhancement persist? J Med Imaging Radiat Oncol 2021; 65:272-278. [PMID: 33547767 DOI: 10.1111/1754-9485.13149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/24/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To investigate how long successfully ablated tumours take to become completely avascular at CEUS after cryoablation. METHODS Ninety-five patients had percutaneous cryoablation of 103 renal tumours investigated at CEUS on post-operative day one. If the lesion was avascular, a contrast-CT/MR was scheduled six months after the procedure, while CEUS was repeated if the lesion still displayed enhancement, until the disappearance of intralesional vascularity. Technical success was defined when the tumour was covered completely by the ablation zone. Technique efficacy was assessed at six months of follow-up. RESULTS Technical efficacy was obtained for 101/103 cryoablations, 56% of which (57/101) were avascular on post-operative day one. After one week, two weeks, one month 83%, 91% and 100% of these 101 lesions, respectively, were avascular. Two tumours were unsuccessfully treated. They displayed persistent intralesional vascularity at CEUS one month after the procedure. CONCLUSIONS After cryoablation, obtaining CEUS before one month may be misleading. When technical efficacy is obtained, disappearance of intralesional enhancement is observed within two weeks in the majority of cases (91%), but can persist until one month. Identification of tumour enhancement after one month may be concerning for residual viable tumour.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, ULSS 2 Marca Trevigiana, Conegliano (TV), Italy
| | - Camilla Sachs
- S.C. Radiologia Pordenone - Sacile, Azienda sanitaria Friuli Occidentale (ASFO), Pordenone (PN), Italy
| | - Riccardo Ciabattoni
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Calogero Cicero
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | - Francesco Maria Drudi
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Policlinico San Martino IST, Genova, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Furlanis G, Ajčević M, Scali I, Buoite Stella A, Olivo S, Lugnan C, Caruso P, Pozzi Mucelli RA, Accardo A, Cova MA, Naccarato M, Manganotti P. CT perfusion in hyper-acute ischemic stroke: the acid test for COVID-19 fear. Neuroradiology 2021; 63:1419-1427. [PMID: 33532920 PMCID: PMC7853703 DOI: 10.1007/s00234-021-02639-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The fear of COVID-19 infection may discourage patients from going to the hospital even in case of sudden onset of disabling symptoms. There is growing evidence of the reduction of stroke admissions and higher prevalence of severe clinical presentation. Yet, no studies have investigated the perfusion pattern of acute strokes admitted during the lockdown. We aimed to evaluate the effects of the COVID-19 pandemic on hyper-acute stroke CT perfusion (CTP) pattern during the first months of the pandemic in Italy. METHODS In this retrospective observational study, we analyzed CTP images and clinical data of ischemic stroke patients admitted between 9 March and 2 June 2020 that underwent CTP (n = 30), to compare ischemic volumes and clinical features with stroke patients admitted during the same period in 2019 (n = 51). In particular, CTP images were processed to calculate total hypoperfused volumes, core volumes, and mismatch. The final infarct volumes were calculated on follow-up CT. RESULTS Significantly higher total CTP hypoperfused volume (83.3 vs 18.5 ml, p = 0.003), core volume (27.8 vs 1.0 ml, p < 0.001), and unfavorable mismatch (0.51 vs 0.91, p < 0.001) were found during the COVID-19 period compared to no-COVID-19 one. The more unfavorable perfusion pattern at admission resulted in higher infarct volume on follow-up CT during COVID-19 (35.5 vs 3.0 ml, p < 0.001). During lockdown, a reduction of stroke admissions (- 37%) and a higher prevalence of severe clinical presentation (NIHSS ≥ 10; 53% vs 36%, p = 0.029) were observed. CONCLUSION The results of CTP analysis provided a better insight in the higher prevalence of major severity stroke patients during the COVID-19 period.
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Affiliation(s)
- Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10, 34127, Trieste, Italy.
| | - Ilario Scali
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Sasha Olivo
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Carlo Lugnan
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Roberta Antea Pozzi Mucelli
- Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10, 34127, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
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Tirelli G, de Groodt J, Sia E, Belgrano MG, Degrassi F, Boscolo-Rizzo P, Cova MA, Marcuzzo AV. Accuracy of the Anatomage Table in detecting extranodal extension in head and neck cancer: a pilot study. J Med Imaging (Bellingham) 2021; 8:014502. [PMID: 33542944 DOI: 10.1117/1.jmi.8.1.014502] [Citation(s) in RCA: 6] [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: 09/19/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ( pENE + ) were considered "cases" and patients with negative histological examination for ENE ( pENE - ) were considered "controls." Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT > 15 mm ) and a minor nodes (MiN) group (lymph nodes on CT ≤ 15 mm ). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE + patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE - patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.
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Affiliation(s)
- Giancarlo Tirelli
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | - Jasmina de Groodt
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Egidio Sia
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | | | - Ferruccio Degrassi
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- University of Padua, Treviso Regional Hospital, Otolaryngology, Treviso, Italy
| | - Maria Assunta Cova
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy.,ENT and Head and Neck Surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUGI, Trieste, Italy
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Baratella E, Marrocchio C, Cifaldi R, Santagiuliana M, Bozzato AM, Crivelli P, Ruaro B, Salton F, Confalonieri M, Cova MA. Interstitial lung disease in patients with antisynthetase syndrome: a retrospective case series study. Jpn J Radiol 2021; 39:40-46. [PMID: 32876818 PMCID: PMC7813732 DOI: 10.1007/s11604-020-01030-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Antisynthetase syndrome (ASS) is a rare systemic autoimmune condition associated to the presence of anti-aminoacyl-tRNA synthetase antibodies. Interstitial lung disease (ILD) is the most prevalent manifestation of ASS and is a major determinant of morbidity and mortality. The aim of this study was to describe the radiological characteristics of patients with ASS-associated-ILD in our institution. MATERIALS AND METHODS Medical records from 2014 to 2020 were retrospectively reviewed and patients with a diagnosis of ASS and evidence of ILD on HRCT were included. HRCT images were reviewed by two thoracic radiologists in consensus. Five HRCT patterns were defined: cellular non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP), mixed NSIP/OP pattern, acute interstitial pneumonia (AIP) pattern and fibrotic pattern. Descriptive statistics was calculated for all variables. RESULTS Twenty-two patients with ASS who met inclusion criteria were included. The disease presented with the typical triad of ASS in 45% of patients, 55% had ILD only at the onset. Cellular NSIP was present in 27% of patients, OP in 23%, mixed NSIP/OP in 9%, AIP in 18% and a fibrotic pattern in 23%. CONCLUSION HRCT findings in ASS-associated ILD are often non-specific; nevertheless, it is important to consider this diagnosis, especially in patients presenting with acute onset of symptoms.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, University of Trieste, Strada di Fiume 447, 34128, Trieste, Italy.
| | - Cristina Marrocchio
- Department of Medicine, Surgery and Health Science, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Rossella Cifaldi
- Department of Pneumology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Strada di Fiume 447, Trieste, Italy
| | - Mario Santagiuliana
- Department of Pneumology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Strada di Fiume 447, Trieste, Italy
| | - Alessandro Marco Bozzato
- Department of Medicine, Surgery and Health Science, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Paola Crivelli
- Diagnostic Imaging 2, AOU Sassari, viale S. Pietro 43, Sassari, Italy
| | - Barbara Ruaro
- Department of Pneumology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Strada di Fiume 447, Trieste, Italy
| | - Francesco Salton
- Department of Pneumology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Strada di Fiume 447, Trieste, Italy
| | - Marco Confalonieri
- Department of Pneumology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Strada di Fiume 447, Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Strada di Fiume 447, 34128, Trieste, Italy
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Baratella E, Bozzato AM, Marrocchio C, Natali C, Di Giusto A, Quaia E, Cova MA. Digital tomosynthesis and ground glass nodules: Optimization of acquisition protocol. A phantom study. Radiography (Lond) 2020; 27:574-580. [PMID: 33341379 DOI: 10.1016/j.radi.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/13/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Ground-glass nodules may be the expression of benign conditions, pre-invasive lesions or malignancies. The aim of our study was to evaluate the capability of chest digital tomosynthesis (DTS) in detecting pulmonary ground-glass opacities (GGOs). METHODS An anthropomorphic chest phantom and synthetic nodules were used to simulate pulmonary ground-glass nodules. The nodules were positioned in 3 different regions (apex, hilum and basal); then the phantom was scanned by multi-detector CT (MDCT) and DTS. For each set (nodule-free phantom, nodule in apical zone, nodule in hilar zone, nodule in basal zone) seven different scans (n = 28) were performed varying the following technical parameters: Cu-filter (0.1-0.3 mm), dose rateo (10-25) and X-ray tube voltage (105-125 kVp). Two radiologists in consensus evaluated the DTS images and provided in agreement a visual score: 1 for unidentifiable nodules, 2 for poorly identifiable nodules, 3 for nodules identifiable with fair certainty, 4 for nodules identifiable with absolute certainty. RESULTS Increasing the dose rateo from 10 to 15, GGOs located in the apex and in the basal zone were better identified (from a score = 2 to a score = 3). GGOs located in the hilar zone were not visible even with a higher dose rate. Intermediate density GGOs had a good visibility score (score = 3) and it did not improve by varying technical parameters. A progressive increase of voltage (from 105 kVp to 125 kVp) did not provide a better nodule visibility. CONCLUSION DTS with optimized technical parameters can identify GGOs, in particular those with a diameter greater than 10 mm. IMPLICATIONS FOR PRACTICE DTS could have a role in the follow-up of patients with known GGOs identified in lung apex or base region.
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Affiliation(s)
- E Baratella
- Department of Radiology, University of Trieste, Trieste, Italy.
| | - A M Bozzato
- Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - C Marrocchio
- Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - C Natali
- Department of Radiology, Radiology of Gorizia and Monfalcone, Italy
| | - A Di Giusto
- Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - E Quaia
- Department of Medicine - DIMED, Radiology Institute, University of Padua, Padua, Italy
| | - M A Cova
- Department of Radiology, University of Trieste, Trieste, Italy
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Baratella E, Crivelli P, Marrocchio C, Bozzato AM, Vito AD, Madeddu G, Saderi L, Confalonieri M, Tenaglia L, Cova MA. Severity of lung involvement on chest X-rays in SARS-coronavirus-2 infected patients as a possible tool to predict clinical progression: an observational retrospective analysis of the relationship between radiological, clinical, and laboratory data. ACTA ACUST UNITED AC 2020; 46:e20200226. [PMID: 32965310 PMCID: PMC7572267 DOI: 10.36416/1806-3756/e20200226] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 12/26/2022]
Abstract
Objective: To investigate the diagnostic accuracy of a chest X-ray (CXR) score and of clinical and laboratory data in predicting the clinical course of patients with SARS coronavirus 2 (SARS-CoV-2) infection. Methods: This is a pilot multicenter retrospective study including patients with SARS-CoV-2 infection admitted to the ERs in three hospitals in Italy between February and March of 2020. Two radiologists independently evaluated the baseline CXR of the patients using a semi-quantitative score to determine the severity of lung involvement: a score of 0 represented no lung involvement, whereas scores of 1 to 4 represented the first (less severe) to the fourth (more severe) quartiles regarding the severity of lung involvement. Relevant clinical and laboratory data were collected. The outcome of patients was defined as severe if noninvasive ventilation (NIV) or intubation was necessary, or if the patient died. Results: Our sample comprised 140 patients. Most of the patients were symptomatic (132/138; 95.7%), and 133/140 patients (95.0%) presented with opacities on CXR at admission. Of the 140 patients, 7 (5.0%) showed no lung involvement, whereas 58 (41.4%), 31 (22.1%), 26 (18.6%), and 18 (12.9%), respectively, scored 1, 2, 3, and 4. In our sample, 66 patients underwent NIV or intubation, 37 of whom scored 1 or 2 on baseline CXR, and 28 patients died. Conclusions: The severity score based on CXR seems to be able to predict the clinical progression in cases that scored 0, 3, or 4. However, the score alone cannot predict the clinical progression in patients with mild-to-moderate parenchymal involvement (scores 1 and 2).
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Affiliation(s)
- Elisa Baratella
- . Dipartimento di Radiologia, Università degli Studi di Trieste, Trieste, Italia
| | - Paola Crivelli
- . Diagnostica per immagini 2, AOU Sassari, Sassari, Italia
| | - Cristina Marrocchio
- . Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Trieste, Trieste, Italia
| | - Alessandro Marco Bozzato
- . Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Trieste, Trieste, Italia
| | - Andrea De Vito
- . Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Giordano Madeddu
- . Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Laura Saderi
- . Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Marco Confalonieri
- . Dipartimento di Pneumologia, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italia
| | - Luigi Tenaglia
- . Dipartimento ad Attività Integrata di Emergenza, Urgenza ed Accettazione, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italia
| | - Maria Assunta Cova
- . Dipartimento di Radiologia, Università degli Studi di Trieste, Trieste, Italia
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Crivelli P, Baratella E, Zedda S, Marrocchio C, Cova MA, Conti M. Imaging of Skeletal Involvement in Hemolymphatic Disorders. Curr Radiol Rep 2020. [DOI: 10.1007/s40134-020-00361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ajčević M, Furlanis G, Stella AB, Cillotto T, Caruso P, Ridolfi M, Lugnan C, Miladinović A, Ukmar M, Cova MA, Accardo A, Manganotti P, Naccarato M. A CT perfusion based model predicts outcome in wake-up stroke patients treated with recombinant tissue plasminogen activator. Physiol Meas 2020; 41:075011. [PMID: 32531770 DOI: 10.1088/1361-6579/ab9c70] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Advanced neuroimaging has proved to be pivotal in the management of acute ischemic stroke. The use of CT perfusion (CTP) core and penumbra parameters to predict the outcome in wake-up stroke (WUS) patients in everyday clinical scenarios has not yet been investigated. The aim of our study was to investigate the predictive power of CTP parameters on functional and morphological outcomes in WUS patients treated with recombinant tissue plasminogen activator (rTPA). APPROACH We analyzed clinical data and processed CTP images of 83 consecutive WUS patients treated with rTPA. The predictive power of whole-brain CTP features and of the clinical stroke-related parameters to predict the National Institutes of Health Stroke Scale (NIHSS) score at the seventh day and ischemic lesion volume outcome was investigated by means of multivariate regression analysis as well as least absolute shrinkage and selection operator (LASSO) modeling. MAIN RESULTS Multivariate analysis showed that CTP core volume (β = 0.403, p = 0.000), NIHSS at admission (β = 0.323, p = 0.005) and Alberta Stroke Program Early CT (ASPECT) score (β = -0.224, p = 0.012) predict NIHSS at 7 days, while total hypoperfused volume (β = 0.542, p = 0.000) and core volume on CTP (β =0.441, p = 0.000) predict infarct lesion volume at follow-up CT. The LASSO modeling approach confirmed the significant predictive power of CTP core volume, total hypoperfused CTP volume, NIHSS at baseline and ASPECT score, producing a sparse model with adequate reliability (the root mean square error on a previously unseen testing dataset was 3.68). SIGNIFICANCE Our findings highlight the importance of CT multimodal imaging features for decision-making and prediction in the hyperacute phase of WUS. The predictive model supports the hypothesis that an irreversible necrotic core rather than the extent of the penumbra is the main prognostic factor in WUS patients treated with rTPA.
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Affiliation(s)
- Miloš Ajčević
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy. Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10, 34127, Trieste, Italy
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Abstract
Erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection for a satisfactory sexual activity. It is secondary to several organic, psychogenic, and combined causes, and represents a serious health dilemma affecting both men and their partners. The diagnostic approach to erectile dysfunction has significantly changed in the last years with the advent of phosphodiesterase-5 (PDE5) inhibitors, and with the recognition that surgical treatment of both arterial insufficiency and penile venous leak have poor long-term clinical outcomes. Although imaging modalities have diminished in importance, differentiating among causes of erectile dysfunction remains mandatory in good medical practice, and ultrasound (US) still remains the cornerstone of the diagnostic workup. US provides an objective, minimally invasive evaluation of penile hemodynamics. Moreover, it provides an excellent depiction of the penile anatomy and of its changes in pathological conditions such as in patients with Peyronie's disease, priapism, and posttraumatic erectile dysfunction.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, ULSS 2 Marca Trevigiana, Via Brigata Bisagno, 2, 31015, Conegliano, TV, Italy
| | - Camilla Sachs
- S.C. Radiologia Pordenone - Sacile, Azienda sanitaria Friuli Occidentale (ASFO), Via della Vecchia Ceramica, 1, 33170, Pordenone, PN, Italy
| | - Riccardo Ciabattoni
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Sandy Van Nieuwenhove
- Department of Radiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
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Affiliation(s)
- Nicola Di Meo
- Dermatology and Venereology Department, Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology and Venereology Department, Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy -
| | - Katiuscia Nan
- Dermatology and Venereology Department, Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Andrea Romano
- UCO Anatomia e Istologia Patologica, ASUITS, Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Ferruccio Degrassi
- Department of Radiology, Maggiore Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Maggiore Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Maja Ukmar
- Department of Radiology, Maggiore Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology and Venereology Department, Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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Bernardi S, Cavallaro M, Colombin G, Giudici F, Zuolo G, Zdjelar A, Dobrinja C, De Manzini N, Zanconati F, Cova MA, Stacul F, Fabris B. Initial Ablation Ratio Predicts Volume Reduction and Retreatment After 5 Years From Radiofrequency Ablation of Benign Thyroid Nodules. Front Endocrinol (Lausanne) 2020; 11:582550. [PMID: 33597921 PMCID: PMC7883676 DOI: 10.3389/fendo.2020.582550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/12/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) has gained ground as an effective and well-tolerated technique to treat benign thyroid nodules. Most of the available studies have described the short-term outcomes of RFA, whereas there is a limited number of studies evaluating long-term issues, such as regrowth and the likelihood of retreatments. In addition, risk markers of regrowth and retreatment remain to be defined. The initial ablation ratio (IAR) is an index that measures the amount of ablation after RFA, which has been associated with technique efficacy (i.e. volume reduction >50% after 1 year from the procedure). This study aimed at evaluating i) IAR reproducibility and ii) IAR predictive value for RFA 5-year outcomes. MATERIALS AND METHODS This is a retrospective single center study on patients with benign thyroid nodules treated with RFA and followed for 5 years after initial treatment. IAR interobserver reproducibility was evaluated with Bland-Altman method and Lin's concordance correlation coefficient (ρc). IAR predictive value for RFA 5-year outcomes was evaluated with linear and logistic regression models, as well as with Cox models, while receiver operating characteristic (ROC) analyses were used for cut-offs. RESULTS We selected 78 patients with 82 benign thyroid nodules. The procedure significantly reduced nodule volume and this reduction was generally maintained over time. Technique efficacy was achieved in 92% of patients, while 23% of nodules regrew and 12% of nodules were retreated. Median IAR was 83%. Lin's concordance and Pearson's correlation coefficients suggested a good interobserver reproducibility of this index, consistent with the limits of agreement of the Bland-Altman plot. IAR was significantly associated with technique efficacy, 1- and 5-year volume reduction ratio, and with the likelihood of a retreatment, but not with nodule regrowth. ROC analyses showed that IAR cut-off was 49% for technique efficacy and 73% for retreatment. CONCLUSIONS Our results show for the first time that IAR is reproducible and that it predicts the volume reduction and the likelihood of a retreatment after 5 years from RFA.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
- *Correspondence: Stella Bernardi,
| | - Marco Cavallaro
- Unit of Radiology, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Giacomo Colombin
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Fabiola Giudici
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giulia Zuolo
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Adrian Zdjelar
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Radiology, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Chiara Dobrinja
- Department of General Surgery, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Nicolò De Manzini
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of General Surgery, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Fabrizio Zanconati
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Anatomical and Histo-pathology—Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Radiology, Ospedale di Cattinara, Azienda Sanitaria Giuliano-Isontina, Trieste, Trieste, Italy
| | - Fulvio Stacul
- Unit of Radiology, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
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Baratella E, Fiorese I, Marrocchio C, Salton F, Cova MA. Imaging Review of the Lung Parenchymal Complications in Patients with IPF. ACTA ACUST UNITED AC 2019; 55:medicina55100613. [PMID: 31547107 PMCID: PMC6844120 DOI: 10.3390/medicina55100613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 12/15/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, pulmonary-limited, interstitial lung disease with a poor prognosis. This condition is characterized by different clinical scenarios, ranging from the most typical slow and progressive deterioration of symptoms to a rapid and abrupt decline of lung function. Rapid worsening of clinical course is due to superimposed complications and comorbidities that can develop in IPF patients, with a higher incidence rate compared to the general population. These conditions may require a different management of the patient and a therapy adjustment, and thus it is fundamental to recognize them. High Resolution Computed Tomography (HRCT) is sensitive, but not specific, in detecting these complications, and can evaluate the presence of radiological variations when previous examinations are available; it recognizes ground glass opacities or consolidation that can be related to a large spectrum of comorbidities, such as infection, lung cancer, or acute exacerbation. To reach the final diagnosis, a multidisciplinary discussion is required, particularly when the clinical context is related to imaging findings.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), 34100 Trieste, Italy.
| | - Ilaria Fiorese
- Department of Radiology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), 34100 Trieste, Italy.
| | - Cristina Marrocchio
- Department of Radiology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), 34100 Trieste, Italy.
| | - Francesco Salton
- Department of Pneumology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), 34100 Trieste, Italy.
| | - Maria Assunta Cova
- Department of Radiology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), 34100 Trieste, Italy.
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Piai A, Contillo A, Arfelli F, Bonazza D, Brombal L, Assunta Cova M, Delogu P, Di Trapani V, Donato S, Golosio B, Mettivier G, Oliva P, Rigon L, Taibi A, Tonutti M, Tromba G, Zanconati F, Longo R. Quantitative characterization of breast tissues with dedicated CT imaging. Phys Med Biol 2019; 64:155011. [PMID: 31234148 DOI: 10.1088/1361-6560/ab2c29] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A quantitative characterization of the soft tissues composing the human breast is achieved by means of a monochromatic CT phase-contrast imaging system, through accurate measurements of their attenuation coefficients within the energy range of interest for breast CT clinical examinations. Quantitative measurements of linear attenuation coefficients are performed on tomographic reconstructions of surgical samples, using monochromatic x-ray beams from a synchrotron source and a free space propagation setup. An online calibration is performed on the obtained reconstructions, in order to reassess the validity of the standard calibration procedure of the CT scanner. Three types of healthy tissues (adipose, glandular, and skin) and malignant tumors, when present, are considered from each sample. The measured attenuation coefficients are in very good agreement with the outcomes of similar studies available in the literature, although they span an energy range that was mostly neglected in the previous studies. No globally significant differences are observed between healthy and malignant dense tissues, although the number of considered samples does not appear sufficient to address the issue of a quantitative differentiation of tumors. The study assesses the viability of the proposed methodology for the measurement of linear attenuation coefficients, and provides a denser sampling of attenuation data in the energy range useful to breast CT.
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Affiliation(s)
- Anna Piai
- Department of Physics, University of Trieste, Via Valerio 2, 34127 Trieste, Italy. INFN Division of Trieste, Via Valerio 2, 34127 Trieste, Italy. Present address: Department of Physics, University of Milan, Via G. Celoria 16, 20133 Milano, Italy
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Di Meo N, Conforti C, Gatti A, Nan K, Degrassi F, Cova MA, Stacul F, Zalaudek I. Ultrasound-guided electrochemotherapy for the treatment of skin metastases of breast cancer: a winning combination of techniques. J Eur Acad Dermatol Venereol 2019; 33:e432-e434. [PMID: 31222807 DOI: 10.1111/jdv.15753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N Di Meo
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - C Conforti
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - A Gatti
- Department of Dermatology, AULSS2 Marca Trevigiana, Hospital Ca' Foncello, Treviso, Italy
| | - K Nan
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
| | - F Degrassi
- Department of Radiology, University of Trieste, Trieste, Italy
| | - M A Cova
- Department of Radiology, University of Trieste, Trieste, Italy
| | - F Stacul
- Department of Radiology, University of Trieste, Trieste, Italy
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, Trieste, Italy
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Porcari A, Merlo M, Crosera L, Stolfo D, Cittar M, Della Paolera M, Barbati G, Pagnan L, Belgrano M, Cova MA, Gentile P, Aleksova A, Vitrella G, Sinagra G. 229Strain analysis reveals subtle systolic dysfunction in "confirmed" and "suspected" myocarditis with normal LVEF: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez113.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Porcari
- University Hospital Riuniti, Trieste, Italy
| | - M Merlo
- University Hospital Riuniti, Trieste, Italy
| | - L Crosera
- University Hospital Riuniti, Trieste, Italy
| | - D Stolfo
- University Hospital Riuniti, Trieste, Italy
| | - M Cittar
- University Hospital Riuniti, Trieste, Italy
| | | | - G Barbati
- University Hospital Riuniti, Biostatistics Unit, Department of Medical Sciences, Trieste, Italy
| | - L Pagnan
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - M Belgrano
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - M A Cova
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - P Gentile
- University Hospital Riuniti, Trieste, Italy
| | - A Aleksova
- University Hospital Riuniti, Trieste, Italy
| | - G Vitrella
- University Hospital Riuniti, Trieste, Italy
| | - G Sinagra
- University Hospital Riuniti, Trieste, Italy
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Muca M, Pagnan L, Belgrano MG, Giudici F, Vitrella G, Sinagra G, Cova MA. P448Correlation between native T1 and T2 mapping and MRI strain parameters in patients with myocarditis: a pilot study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Muca
- Integrated University Hospital of Trieste (ASUITS), Radiology department, Trieste, Italy
| | - L Pagnan
- Integrated University Hospital of Trieste (ASUITS), Radiology department, Trieste, Italy
| | - M G Belgrano
- Integrated University Hospital of Trieste (ASUITS), Radiology department, Trieste, Italy
| | - F Giudici
- Section of Biomedical Statistics, Department of Mathematics and Informatics, University of Trieste, Trieste, Italy
| | - G Vitrella
- Integrated University Hospital of Trieste (ASUITS), Integrated cardiovascular activity department, Trieste, Italy
| | - G Sinagra
- Integrated University Hospital of Trieste (ASUITS), Integrated cardiovascular activity department, Trieste, Italy
| | - M A Cova
- Integrated University Hospital of Trieste (ASUITS), Radiology department, Trieste, Italy
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Quaia E, Gennari AG, Cova MA. Early Predictors of the Long-term Response to Therapy in Patients With Crohn Disease Derived From a Time-Intensity Curve Analysis After Microbubble Contrast Agent Injection. J Ultrasound Med 2019; 38:947-958. [PMID: 30208230 DOI: 10.1002/jum.14778] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of this study was to identify early predictors of the long-term response to therapy in patients with Crohn disease (CD) from time-intensity curves obtained after microbubble injection. METHODS One hundred fifteen consecutive patients with a proven diagnosis of CD involving the terminal ileal loop who were scheduled to begin pharmacologic therapy with biologics (infliximab or adalimumab) were scanned after sulfur hexafluoride-filled microbubble injection before the beginning and at the end of the sixth week of treatment. The absolute value and percentage change of each semiquantitative kinetic parameter (peak enhancement, time to peak enhancement, rise time, mean transit time, wash-in and wash-out rates, area under the curve [AUC] for the whole time-intensity curve, AUC during wash-in, AUC during wash-out, and wash-in perfusion index) as measured on the terminal ileal tract and adjacent reactive mesenteric fat were calculated from time-intensity curves. Patients were followed for at least 24 months with redetermination of the Crohn Disease Activity Index and with at least 1 endoscopy within 18 weeks after the beginning of pharmacologic treatment. The absolute values and percentage changes of kinetic parameters were assessed as potential predictors of the therapeutic outcome by a logistic regression analysis. RESULTS The study group included 66 male and 49 female patients (mean age ± SD, 45.76 ± 11 years). The pretreatment values and percentage changes of the peak enhancement, AUC, AUC during wash-in, and AUC during wash-out were found to be predictors (P < .05) of the long-term therapeutic outcome. CONCLUSIONS The analysis of time-intensity curves obtained after microbubble contrast agent injection provides early predictors of the long-term therapeutic outcome in patients with CD.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, University of Padova, Via Giustiniani 2, 35128, Padova (Italy)
| | | | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
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Bertolotto M, Bucci S, Valentino M, Currò F, Sachs C, Cova MA. Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol 2018; 105:41-48. [PMID: 30017297 DOI: 10.1016/j.ejrad.2018.05.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 01/14/2018] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy.
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale Sant'Antonio Abate, Via Giobatta Morgagni 18, 33028 Tolmezzo, UD, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Camilla Sachs
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
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Abstract
Multiparametric US is increasingly recognized as a valuable problem-solving technique in scrotal pathologies. Compared to conventional Doppler modes, contrast-enhanced ultrasonography (CEUS) has higher sensitivity in assessing the presence or absence of flows, and to improve differentiation between poorly vascularized tumors and non-neoplastic, avascular lesions. Characterization of benign and malignant complex cysts is improved. In trauma patients, CEUS can help evaluating the viability of testicular parenchyma. In patients with severe epididymo-orchitis, it allows unequivocal assessment of post-inflammatory ischemic changes and abscess formation. CEUS does not add significantly to conventional Doppler modes in spermatic cord torsion. Attempt of differentiating benign and malignant tumors remains a research tool. In the clinical practice, elastography has a limited role for tumor characterization. The majority of malignant tumors are stiff at elastography, but they may display soft areas, or appear globally soft. A quantitative evaluation of testicular stiffness is feasible using shear-wave elastography. Potential clinical applications for elastographic modes could include work-up of infertile patients.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Matilda Muça
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Laurence Rocher
- Department of Radiology, Hôpital de Bicêtre, 78 Avenue du General Lecters, 94270, Paris, France
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
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Quaia E, Gennari AG, Cova MA, van Beek EJR. Differentiation of Inflammatory From Fibrotic Ileal Strictures among Patients with Crohn's Disease Based on Visual Analysis: Feasibility Study Combining Conventional B-Mode Ultrasound, Contrast-Enhanced Ultrasound and Strain Elastography. Ultrasound Med Biol 2018; 44:762-770. [PMID: 29331357 DOI: 10.1016/j.ultrasmedbio.2017.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 08/18/2017] [Revised: 09/29/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
The aim of this pilot study was to assess prospectively the feasibility of conventional B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) combined with real-time strain elastography (SE) in the differentiation of inflammatory from fibrotic ileal strictures among patients with Crohn's disease (CD) based on visual analysis. Twenty non-consecutive patients (15 male and 5 female; mean age ± standard deviation, 40.2 ± 10.22 y) with CD and stricture of the terminal ileal loop were scanned by conventional B-mode US and CEUS and, subsequently, by real-time SE. Two independent readers visually classified each bowel stricture as fibrotic or inflammatory based on conventional B-mode US, CEUS, SE, individually and then for all techniques combined. All techniques combined had a higher (p <0.05) sensitivity (reader 1, 9/20 [45%]; reader 2, 7/20 [35%]), specificity (reader 1, 5/20 [25%]; reader 2, 8/20 [40%]) and diagnostic accuracy (reader 1, 14/20 [70%]; reader 2, 15/20 [75%]) and higher (p <0.05) area under the receiver operating characteristic curve (reader 1, 0.953; reader 2, 0.921) than individual techniques. Inter-reader agreement was fair for conventional B-mode US (k = 0.46) and CEUS (k = 0.39), moderate for SE (k = 0.6) and fair for all techniques combined (k = 0.38). Conventional B-mode US and CEUS, in combination with SE, may improve differentiation of inflammatory from fibrotic ileal strictures among patients with CD based on visual analysis.
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Affiliation(s)
- Emilio Quaia
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | | | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Edwin J R van Beek
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Merlo M, Masè M, Vitrella G, Belgrano M, Faganello G, Gobbo M, Gigli M, Altinier A, Lesizza P, Barbati G, Ramani F, De Luca A, Morea G, Cova MA, Stolfo D, Sinagra G. COMPREHENSIVE STRUCTURAL AND FUNCTIONAL ASSESSMENT FOR PREDICTION OF LEFT VENTRICULAR REVERSE REMODELING IN NON-ISCHEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fedon C, Rigon L, Arfelli F, Dreossi D, Quai E, Tonutti M, Tromba G, Cova MA, Longo R. Dose and diagnostic performance comparison between phase-contrast mammography with synchrotron radiation and digital mammography: a clinical study report. J Med Imaging (Bellingham) 2018; 5:013503. [PMID: 29430473 DOI: 10.1117/1.jmi.5.1.013503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 08/18/2017] [Accepted: 01/04/2018] [Indexed: 12/31/2022] Open
Abstract
Two dosimetric quantities [mean glandular dose (MGD) and entrance surface air kerma (ESAK)] and the diagnostic performance of phase-contrast mammography with synchrotron radiation (MSR) are compared to conventional digital mammography (DM). Seventy-one patients (age range, 41 to 82 years) underwent MSR after a DM examination if questionable or suspicious breast abnormalities were not clarified by ultrasonography. The MGD and the ESAK delivered in both examinations were evaluated and compared. Two on-site radiologists rated the images in consensus according to the Breast Imaging Reporting and Data System assessment categories, which were then correlated with the final diagnoses by means of statistical generalized linear models (GLMs). Receiver operating characteristic curves were also used to assess the diagnostic performance by comparing the area under the curve (AUC). An important MGD and ESAK reduction was observed in MSR due to the monoenergetic beam. In particular, an average 43% reduction was observed for the MGD and a reduction of more than 50% for the ESAK. GLM showed higher diagnostic accuracy, especially in terms of specificity, for MSR, confirmed by AUC analysis ([Formula: see text]). The study design implied that the population was characterized by a high prevalence of disease and that the radiologists, who read the DM images before referring the patient to MSR, could have been influenced in their assessments. Within these limitations, the use of synchrotron radiation with the phase-contrast technique applied to mammography showed an important dose reduction and a higher diagnostic accuracy compared with DM. These results could further encourage research on the translation of x-ray phase-contrast imaging into the clinics.
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Affiliation(s)
- Christian Fedon
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Trieste, Italy.,Radboud University Medical Centre, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - Luigi Rigon
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Trieste, Italy.,University of Trieste, Department of Physics, Trieste, Italy
| | - Fulvia Arfelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Trieste, Italy.,University of Trieste, Department of Physics, Trieste, Italy
| | - Diego Dreossi
- Elettra-Sincrotrone Trieste S.C.p.A., Basovizza, Trieste, Italy
| | - Elisa Quai
- University of Trieste, Department of Physics, Trieste, Italy
| | - Maura Tonutti
- Azienda Sanitaria Universitaria Integrata di Trieste, Department of Radiology, Trieste, Italy
| | - Giuliana Tromba
- Elettra-Sincrotrone Trieste S.C.p.A., Basovizza, Trieste, Italy
| | - Maria Assunta Cova
- Azienda Sanitaria Universitaria Integrata di Trieste, Department of Radiology, Trieste, Italy.,University of Trieste, Department of Medical, Surgical and Health Sciences, Trieste, Italy
| | - Renata Longo
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Trieste, Italy.,University of Trieste, Department of Physics, Trieste, Italy
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Gatti G, Belgrano M, Cova MA, Sinagra G. Single coronary artery anomaly and chest pain. J Cardiovasc Med (Hagerstown) 2017; 18:983-984. [PMID: 29028782 DOI: 10.2459/jcm.0000000000000582] [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: 11/05/2022]
Affiliation(s)
- Giuseppe Gatti
- aCardiovascular DepartmentbDepartment of Radiology, University Hospital of Trieste, Trieste, Italy
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Ukmar M, Degrassi F, Pozzi Mucelli RA, Neri F, Mucelli FP, Cova MA. Perfusion CT in acute stroke: effectiveness of automatically-generated colour maps. Br J Radiol 2017; 90:20150472. [PMID: 28328241 DOI: 10.1259/bjr.20150472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of perfusion CT (pCT) in the definition of the infarcted core and the penumbra, comparing the data obtained from the evaluation of parametric maps [cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT)] with software-generated colour maps. METHODS A retrospective analysis was performed to identify patients with suspected acute ischaemic strokes and who had undergone unenhanced CT and pCT carried out within 4.5 h from the onset of the symptoms. A qualitative evaluation of the CBV, CBF and MTT maps was performed, followed by an analysis of the colour maps automatically generated by the software. RESULTS 26 patients were identified, but a direct CT follow-up was performed only on 19 patients after 24-48 h. In the qualitative analysis, 14 patients showed perfusion abnormalities. Specifically, 29 perfusion deficit areas were detected, of which 15 areas suggested the penumbra and the remaining 14 areas suggested the infarct. As for automatically software-generated maps, 12 patients showed perfusion abnormalities. 25 perfusion deficit areas were identified, 15 areas of which suggested the penumbra and the other 10 areas the infarct. The McNemar's test showed no statistically significant difference between the two methods of evaluation in highlighting infarcted areas proved later at CT follow-up. CONCLUSION We demonstrated how pCT provides good diagnostic accuracy in the identification of acute ischaemic lesions. The limits of identification of the lesions mainly lie at the pons level and in the basal ganglia area. Qualitative analysis has proven to be more efficient in identification of perfusion lesions in comparison with software-generated maps. However, software-generated maps have proven to be very useful in the emergency setting. Advances in knowledge: The use of CT perfusion is requested in increasingly more patients in order to optimize the treatment, thanks also to the technological evolution of CT, which now allows a whole-brain study. The need for performing CT perfusion study also in the emergency setting could represent a problem for physicians who are not used to interpreting the parametric maps (CBV, MTT etc.). The software-generated maps could be of value in these settings, helping the less expert physician in the differentiation between different areas.
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Affiliation(s)
- Maja Ukmar
- UCO di Radiologia Dipartimento di Scienze Mediche Chirurgiche e Tecnologiche, Università degli Studi di Trieste Ospedale di Cattinare (ASUITS), Trieste, Italy
| | - Ferruccio Degrassi
- UCO di Radiologia Dipartimento di Scienze Mediche Chirurgiche e Tecnologiche, Università degli Studi di Trieste Ospedale di Cattinare (ASUITS), Trieste, Italy
| | - Roberta Antea Pozzi Mucelli
- UCO di Radiologia Dipartimento di Scienze Mediche Chirurgiche e Tecnologiche, Università degli Studi di Trieste Ospedale di Cattinare (ASUITS), Trieste, Italy
| | - Francesca Neri
- UCO di Radiologia Dipartimento di Scienze Mediche Chirurgiche e Tecnologiche, Università degli Studi di Trieste Ospedale di Cattinare (ASUITS), Trieste, Italy
| | - Fabio Pozzi Mucelli
- UCO di Radiologia Dipartimento di Scienze Mediche Chirurgiche e Tecnologiche, Università degli Studi di Trieste Ospedale di Cattinare (ASUITS), Trieste, Italy
| | - Maria Assunta Cova
- UCO di Radiologia Dipartimento di Scienze Mediche Chirurgiche e Tecnologiche, Università degli Studi di Trieste Ospedale di Cattinare (ASUITS), Trieste, Italy
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Quaia E, Sozzi M, Angileri R, Gennari AG, Cova MA. Time-Intensity Curves Obtained after Microbubble Injection Can Be Used to Differentiate Responders from Nonresponders among Patients with Clinically Active Crohn Disease after 6 Weeks of Pharmacologic Treatment. Radiology 2016; 281:606-616. [DOI: 10.1148/radiol.2016152461] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Quaia E, Gennari AG, Ricciardi MC, Ulcigrai V, Angileri R, Cova MA. Value of percent change in tumoral volume measured at T 2 -weighted and diffusion-weighted MRI to identify responders after neoadjuvant chemoradiation therapy in patients with locally advanced rectal carcinoma. J Magn Reson Imaging 2016; 44:1415-1424. [PMID: 27219471 DOI: 10.1002/jmri.25310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate the percent change in tumoral volume measured at T2 -weighted magnetic resonance imaging (T2 WMRI) and diffusion-weighted (DWI) as a method to identify responders after chemo- and radiation therapy (CRT) in patients with locally advanced rectal carcinoma. MATERIALS AND METHODS Forty-five consecutive patients (mean age ± SD: 72 years ± 9.7; male/female = 24/21) with locally advanced rectal carcinoma underwent CRT followed by surgery. Each patient underwent T2 WMRI and DWI at 1.5T before and 6 weeks after the completion of CRT. The percent change in tumoral volume before and 6 weeks after CRT was compared in patients classified as responders and nonresponders according to rectal cancer regression grade. RESULTS Twenty-five patients were classified as responders with either partial (n = 20) or complete response (n = 5), while 20 patients were classified as nonresponders due to stable disease (n = 18) or disease progression (n = 2). Responders vs. nonresponders differed in the percent change of tumoral volume at T2 WMRI (-67% ± 26% vs. -29% ± 26%; P < 0.05) and DWI images (-72% ± 24% vs. -33% ± 28%; P < 0.05) with a cutoff ≤ -70% for T2 WMRI (sensitivity = 69%, 95% confidence interval [CI]: 48-85%; specificity = 100%, 95% CI 81-100%) and ≤66% for DWI (sensitivity = 73%, 95% CI: 52-88%; specificity = 100%, 95% CI 81-100%). CONCLUSION The percent change in tumoral volume at T2 WMRI and DWI images can differentiate responders from nonresponders in patients with locally advanced rectal carcinoma after neoadjuvant CRT. J. Magn. Reson. Imaging 2016;44:1415-1424.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | | | | | - Veronica Ulcigrai
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Roberta Angileri
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
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Tirelli G, Cova MA, Zanconati F, Makuc E, Bonazza D, Tofanelli M, Di Lenarda R, Gardenal N. Charcoal suspension tattoo: new tool for the localization of malignant laterocervical lymph nodes. Eur Arch Otorhinolaryngol 2016; 273:3973-3978. [PMID: 27142619 DOI: 10.1007/s00405-016-4075-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/13/2015] [Accepted: 04/27/2016] [Indexed: 02/03/2023]
Abstract
We present a retrospective study to evaluate safety and effectiveness of ultrasound (US)-guided tattooing with charcoal of suspicious laterocervical lymph nodes. When an open biopsy of a laterocervical lymph node is needed, the choice of the lymph node to excise and examine is fundamental to avoid rebiopsy. Surgeons tend to choose the most surgical approachable enlarged lymph node that does not always correspond to the one with worst echographic aspect. We present 16 cases of patients with laterocervical adenopathy with inconclusive or non-adequate results at fine needle aspiration cytology addressed to open biopsy. Those patients underwent US-guided preoperative injection of a charcoal suspension inside the lymph node to excise to mark it, and then excisional biopsy was performed. Sixteen marked lesions (100 %) were detected intraoperatively and dissected. The injected charcoal was detected intraoperatively in all cases. In 14 patients (87, 5 %) it was inside the lesion; in two cases (12, 5 %), the charcoal suspension was found in the tissues above the lesion. The procedure was well tolerated in all cases. No major procedure-related complications were encountered. US-guided charcoal tattooing is a new, safe, well-tolerated, and easy-to-perform technique for the marking of US suspicious laterocervical lymph nodes. This preliminary study shows a high technical success rate (76 %) and high percentage of intraoperative detection of marked lesions (100 %) with a low rate of complications.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - M A Cova
- Department of Radiology, University of Trieste, Trieste, Italy
| | - F Zanconati
- Clinical Unit of Pathological Anatomy and Histology, Department of Medical Science, University of Trieste, Trieste, Italy
| | - E Makuc
- Department of Radiology, University of Trieste, Trieste, Italy
| | - D Bonazza
- Clinical Unit of Pathological Anatomy and Histology, Department of Medical Science, University of Trieste, Trieste, Italy
| | - M Tofanelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - R Di Lenarda
- Division of Oral Medicine and Pathology, University of Trieste, Trieste, Italy
| | - N Gardenal
- Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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