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Bonaffini PA, Stanco F, Dulcetta L, Poli G, Brambilla P, Marra P, Valle C, Lorini FL, Mazzoleni M, Sonzogni B, Previdi F, Sironi S. Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak. Tomography 2023; 9:2211-2221. [PMID: 38133075 PMCID: PMC10748272 DOI: 10.3390/tomography9060171] [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: 09/10/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.
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Affiliation(s)
- Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Francesco Stanco
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Giancarla Poli
- Unit of Intensive Care and Anesthesia 2, Papa Giovanni XXIII Hospital, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Paolo Brambilla
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Ferdinando Luca Lorini
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
- Unit of Intensive Care and Anesthesia 2, Papa Giovanni XXIII Hospital, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Mirko Mazzoleni
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
| | - Beatrice Sonzogni
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
| | - Fabio Previdi
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio, 7/B, 24044 Dalmine, BG, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
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Alipour E, Pooyan A, Shomal Zadeh F, Darbandi AD, Bonaffini PA, Chalian M. Current Status and Future of Artificial Intelligence in MM Imaging: A Systematic Review. Diagnostics (Basel) 2023; 13:3372. [PMID: 37958267 PMCID: PMC10650900 DOI: 10.3390/diagnostics13213372] [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: 09/25/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Artificial intelligence (AI) has attracted increasing attention as a tool for the detection and management of several medical conditions. Multiple myeloma (MM), a malignancy characterized by uncontrolled proliferation of plasma cells, is one of the most common hematologic malignancies, which relies on imaging for diagnosis and management. We aimed to review the current literature and trends in AI research of MM imaging. This study was performed according to the PRISMA guidelines. Three main concepts were used in the search algorithm, including "artificial intelligence" in "radiologic examinations" of patients with "multiple myeloma". The algorithm was used to search the PubMed, Embase, and Web of Science databases. Articles were screened based on the inclusion and exclusion criteria. In the end, we used the checklist for Artificial Intelligence in Medical Imaging (CLAIM) criteria to evaluate the manuscripts. We provided the percentage of studies that were compliant with each criterion as a measure of the quality of AI research on MM. The initial search yielded 977 results. After reviewing them, 14 final studies were selected. The studies used a wide array of imaging modalities. Radiomics analysis and segmentation tasks were the most popular studies (10/14 studies). The common purposes of radiomics studies included the differentiation of MM bone lesions from other lesions and the prediction of relapse. The goal of the segmentation studies was to develop algorithms for the automatic segmentation of important structures in MM. Dice score was the most common assessment tool in segmentation studies, which ranged from 0.80 to 0.97. These studies show that imaging is a valuable data source for medical AI models and plays an even greater role in the management of MM.
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Affiliation(s)
- Ehsan Alipour
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98195, USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Atefe Pooyan
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98195, USA
| | - Firoozeh Shomal Zadeh
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98195, USA
| | - Azad Duke Darbandi
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine, University Milano Bicocca, 20126 Milan, Italy
| | - Majid Chalian
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98195, USA
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Bonaffini PA, De Bernardi E, Corsi A, Franco PN, Nicoletta D, Muglia R, Perugini G, Roscigno M, Occhipinti M, Da Pozzo LF, Sironi S. Towards the Definition of Radiomic Features and Clinical Indices to Enhance the Diagnosis of Clinically Significant Cancers in PI-RADS 4 and 5 Lesions. Cancers (Basel) 2023; 15:4963. [PMID: 37894330 PMCID: PMC10605400 DOI: 10.3390/cancers15204963] [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: 09/07/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Prostate cancer (PC) is the most frequently diagnosed cancer among adult men, and its incidence is increasing worldwide [...].
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Affiliation(s)
- Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Elisabetta De Bernardi
- Medicine and Surgery Department, Via Cadore, 48, 20900 Monza, MB, Italy
- Interdepartmental Research Centre Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, MB, Italy
| | - Andrea Corsi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Paolo Niccolò Franco
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Dario Nicoletta
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
| | - Giovanna Perugini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
| | - Marco Roscigno
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | | | - Luigi Filippo Da Pozzo
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS, 24127 Bergamo, BG, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, MI, Italy
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Ippolito D, Maino C, Vernuccio F, Cannella R, Inchingolo R, Dezio M, Faletti R, Bonaffini PA, Gatti M, Sironi S. Liver involvement in patients with COVID-19 infection: A comprehensive overview of diagnostic imaging features. World J Gastroenterol 2023; 29:834-850. [PMID: 36816623 PMCID: PMC9932422 DOI: 10.3748/wjg.v29.i5.834] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/06/2022] [Accepted: 01/20/2023] [Indexed: 02/06/2023] Open
Abstract
During the first wave of the pandemic, coronavirus disease 2019 (COVID-19) infection has been considered mainly as a pulmonary infection. However, different clinical and radiological manifestations were observed over time, including involvement of abdominal organs. Nowadays, the liver is considered one of the main affected abdominal organs. Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs. After clinical assessment, radiology plays a key role in the evaluation of liver involvement. Ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) may be used to evaluate liver involvement. US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection, in particular liver steatosis and portal-vein thrombosis. CT and MRI are used as second- and third-line techniques, respectively, considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization. This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.
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Affiliation(s)
- Davide Ippolito
- Milano Bicocca School of Medicine and Surgery, Milano 20126, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Cesare Maino
- Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Federica Vernuccio
- Institute of Radiology (DIMED), University Hospital of Padova, Padova 35128, Italy
| | - Roberto Cannella
- Section of Radiology-Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo 90127, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo 90127, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Michele Dezio
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Pietro Andrea Bonaffini
- Milano Bicocca School of Medicine and Surgery, Milano 20126, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Marco Gatti
- Department of Diagnostic Radiology, University of Turin, Turin 10126, Italy
| | - Sandro Sironi
- Milano Bicocca School of Medicine and Surgery, Milano 20126, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
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Muglia R, Marra P, Dulcetta L, Carbone FS, Bonaffini PA, Sironi S. US-guided percutaneous thrombin injection to treat non-femoral artery pseudoaneurysms: preliminary experience and review of the literature. Radiol Med 2023; 128:125-131. [PMID: 36525178 DOI: 10.1007/s11547-022-01576-4] [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: 04/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the clinical outcome of US-guided percutaneous thrombin injection in the treatment of non-femoral artery pseudoaneurysms (NFAP). MATERIALS AND METHODS Among all pseudoaneurysms treated in our institution, we retrospectively collected NFAP embolized with percutaneous thrombin injections from January 1, 2015, to December 31, 2021. The embolization was prompted for an ongoing antiaggregating/anticoagulation therapy, NFAP optimal US visibility, or high surgery-related risks. Causes, location, size and neck of NFAP, complications, number of repeated treatments, clinical success and patients clinical conditions at discharge were annotated. The endpoint for clinical success was the resolution of NFAP at postprocedural imaging, with no resort to surgery. RESULTS Eight consecutive patients (5 females, median age 73 years, range 46-84) underwent 16 procedures. Arterial damage was due to catheterization (3), CVC mispositioning (2), trauma, hemorrhagic diathesis and endoprosthesis endoleak. We treated humeral (2), subclavian (2), thyrocervical, anterior tibial, radial and pancreaticoduodenal arteries. Median pseudoaneurysm size was 530 mm2 (range 32-2400 mm2), with a thin (7/8) or non-visible (1/8) neck. No complications occurred. Clinical success was obtained in 7/8 patients (88%), with a single treatment in 4, multiple in 3 cases (4 embolizations, 3 and 2, respectively). One patient underwent surgical suture after the second failed attempt of percutaneous embolization. Seven patients were discharged in good clinical conditions; one died during hospitalization, due to the worsening of the underlying cardiac disease. CONCLUSIONS Percutaneous US-guided thrombin injection to treat NFAP is feasible in selected cases, with rare complications. Clinical success is often reached, also by repeated injections.
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Affiliation(s)
- Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy.
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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Marra P, Di Fazio B, Dulcetta L, Carbone FS, Muglia R, Bonaffini PA, Valle C, Corvino F, Giurazza F, Muscogiuri G, Venturini M, Sironi S. Embolization in Pediatric Patients: A Comprehensive Review of Indications, Procedures, and Clinical Outcomes. J Clin Med 2022; 11:jcm11226626. [PMID: 36431102 PMCID: PMC9696500 DOI: 10.3390/jcm11226626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
Embolization in pediatric patients encompasses a large spectrum of indications, ranging from the elective treatment of congenital diseases of the cardiovascular system to the urgent management of acute hemorrhagic conditions. In particular, the endovascular treatment of central and peripheral vascular malformations and hypervascular tumors represents a wide chapter for both congenital and acquired situations. Thanks to the progressive availability of low-profile endovascular devices and new embolic materials, the mini-invasive approach has gradually overtaken surgery. In this review, the main embolization procedures will be illustrated and discussed, with a focus on clinical indications and expected outcomes. The most recent mini-invasive techniques will be described, with hints on the cutting-edge devices and embolic materials.
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Affiliation(s)
- Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Barbaro Di Fazio
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Correspondence: ; Tel.: +39-347-516-5851 or +39-035-267-4359
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, 80131 Naples, Italy
| | - Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, 80131 Naples, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, Insubria University, 21100 Varese, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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Corsi A, De Bernardi E, Bonaffini PA, Franco PN, Nicoletta D, Simonini R, Ippolito D, Perugini G, Occhipinti M, Da Pozzo LF, Roscigno M, Sironi S. Radiomics in PI-RADS 3 Multiparametric MRI for Prostate Cancer Identification: Literature Models Re-Implementation and Proposal of a Clinical-Radiological Model. J Clin Med 2022; 11:6304. [PMID: 36362530 PMCID: PMC9656103 DOI: 10.3390/jcm11216304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 10/29/2023] Open
Abstract
PI-RADS 3 prostate lesions clinical management is still debated, with high variability among different centers. Identifying clinically significant tumors among PI-RADS 3 is crucial. Radiomics applied to multiparametric MR (mpMR) seems promising. Nevertheless, reproducibility assessment by external validation is required. We retrospectively included all patients with at least one PI-RADS 3 lesion (PI-RADS v2.1) detected on a 3T prostate MRI scan at our Institution (June 2016-March 2021). An MRI-targeted biopsy was used as ground truth. We assessed reproducible mpMRI radiomic features found in the literature. Then, we proposed a new model combining PSA density and two radiomic features (texture regularity (T2) and size zone heterogeneity (ADC)). All models were trained/assessed through 100-repetitions 5-fold cross-validation. Eighty patients were included (26 with GS ≥ 7). In total, 9/20 T2 features (Hector's model) and 1 T2 feature (Jin's model) significantly correlated to biopsy on our dataset. PSA density alone predicted clinically significant tumors (sensitivity: 66%; specificity: 71%). Our model obtained a sensitivity of 80% and a specificity of 76%. Standard-compliant works with detailed methodologies achieve comparable radiomic feature sets. Therefore, efforts to facilitate reproducibility are needed, while complex models and imaging protocols seem not, since our model combining PSA density and two radiomic features from routinely performed sequences appeared to differentiate clinically significant cancers.
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Affiliation(s)
- Andrea Corsi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Elisabetta De Bernardi
- Medicine and Surgery Department, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
- Interdepartmental Research Centre Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Paolo Niccolò Franco
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Dario Nicoletta
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Roberto Simonini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Department of Radiology, San Gerardo Hospital, Via G. B. Pergolesi 33, 20900 Monza, Italy
| | - Giovanna Perugini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | | | - Luigi Filippo Da Pozzo
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Marco Roscigno
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
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8
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Marra P, Carbone FS, Augello L, Dulcetta L, Muglia R, Bonaffini PA, Della Corte A, Steidler S, Gusmini S, Guazzarotti G, Palumbo D, Venturini M, De Cobelli F, Sironi S. Embolisation of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centres. CVIR Endovasc 2022; 5:48. [PMID: 36063253 PMCID: PMC9445138 DOI: 10.1186/s42155-022-00321-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Embolisation of the parenchymal tract is a key step after any other transhepatic or transplenic percutaneous portal vein catheterization since eventual venous bleeding is difficult to control and may require surgical management. Different techniques have been proposed to perform tract embolisation. The aim of this study is to compare the safety and efficacy of different techniques of haemostasis of the parenchymal tract.
Materials and methods
All the interventional procedures with percutaneous transhepatic or transplenic access to the portal vein (excluding ipsilateral portal vein embolisation) from January 2010 to July 2020, in two tertiary hospitals, were retrospectively analyzed. The following data were evaluated: access site, the technique of embolisation, technical success in terms of immediate thrombosis of the tract, safety and clinical efficacy in terms of the absence of hemorrhagic and thrombotic complications.
Results
One-hundred-sixty-one patients underwent 220 percutaneous transhepatic or transplenic portal vein catheterization procedures. The main indications were pancreatic islet transplantation, portal anastomotic stenosis after liver transplantation, and portal vein thrombosis recanalization. As embolic materials gelfoam was used in 105 cases, metallic micro-coils in 54 cases, and cyanoacrylic glue in 44 cases; in 17 cases the parenchymal tract was not embolized. Technical success was 98% without significant difference among groups (p-value = 0.22). Eighteen post-procedural abdominal bleedings occurred, all grade 3 and were managed conservatively; difference among groups was not significant (p-value = 0.25). We detected 12 intrahepatic portal branch thromboses not related to the embolisation technique; only one case of non-target embolisation was documented after liver tract embolisation with glue, without clinical consequences.
Conclusion
Embolisation of the parenchymal tract after percutaneous portal vein catheterization is technically safe and effective. No significant differences were found between coils, glue, and gelfoam in effectiveness and complications rate.
Level of evidence
Level 3, Cohort study.
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Bonaffini PA, Franco PN, Bonanomi A, Giaccherini C, Valle C, Marra P, Norsa L, Marchetti M, Falanga A, Sironi S. Ischemic and hemorrhagic abdominal complications in COVID-19 patients: experience from the first Italian wave. Eur J Med Res 2022; 27:165. [PMID: 36045452 PMCID: PMC9428880 DOI: 10.1186/s40001-022-00793-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/06/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To report ischemic and haemorrhagic abdominal complications in a series of COVID-19 patients. To correlate these complications with lung involvement, laboratory tests, comorbidities, and anticoagulant treatment. METHODS We retrospectively included 30 COVID-19 patients who undergone abdomen CECT for abdominal pain, between March 16 and May 19, 2020. Ischemic and haemorrhagic complications were compared with lung involvement (early, progressive, peak or absorption stage), blood coagulation values, anticoagulant therapy, comorbidities, and presence of pulmonary embolism (PE). RESULTS Ischemic complications were documented in 10 patients (7 receiving anticoagulant therapy, 70%): 6/10 small bowel ischemia (1 concomitant obstruction, 1 perforation) and 4/10 ischemic colitis. Main mesenteric vessels were patent except for 1 superior mesenteric vein thrombosis. Two ischemia cases also presented splenic infarctions. Bleeding complications were found in 20 patients (all receiving anticoagulant treatments), half with active bleeding: hematomas in soft tissues (15) and retroperitoneum (2) and gastro-intestinal bleeding (3). Platelet and lymphocyte were within the normal range. D-Dimer was significantly higher in ischemic cases (p < 0.001). Most of the patients had severe lung disease (45% peak, 29% absorption), two patients PE. CONCLUSIONS Ischemic and haemorrhagic abdominal complications may occur in COVID-19 patients, particularly associated to extended lung disease. CT plays a key role in the diagnosis of these potentially life- threatening conditions.
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Affiliation(s)
- Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy. .,School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy.
| | - Paolo Niccolò Franco
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy.,School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy
| | - Alice Bonanomi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy.,School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy
| | - Cinzia Giaccherini
- Unit of Immuno-Hematology and Transfusion Medicine and Center of Hemostasis and Thrombosis, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy.,School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy.,School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy
| | - Lorenzo Norsa
- Unit of Pediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy
| | - Marina Marchetti
- Unit of Immuno-Hematology and Transfusion Medicine and Center of Hemostasis and Thrombosis, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy
| | - Anna Falanga
- School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy.,Unit of Immuno-Hematology and Transfusion Medicine and Center of Hemostasis and Thrombosis, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy.,School of Medicine, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, MI, Italy
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10
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Raimondi F, Cazzaniga S, Annibali S, Novelli L, Brivio M, Pappacena S, Malandrino L, Bonaffini PA, Bianco I, Liggeri N, Gritti P, Lorini FL, Sironi S, Di Marco F. Extent and Distribution of Parenchymal Abnormalities in Baseline CT-Scans Do Not Predict Awake Prone Positioning Response in COVID-19 Related ARDS. Diagnostics (Basel) 2022; 12:diagnostics12081848. [PMID: 36010199 PMCID: PMC9406535 DOI: 10.3390/diagnostics12081848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/24/2022] [Accepted: 07/24/2022] [Indexed: 12/15/2022] Open
Abstract
Prone positioning is frequently used for non-intubated hypoxemic patients with COVID-19, although conclusive evidence is still lacking. The aim of the present study was to investigate whether baseline CT-scans could predict the improvement in oxygenation in COVID-19 related Acute respira-tory syndrome (ARDS) patients when pronated. Methods: A retrospective study of COVID-19 patients who underwent non-invasive ventilation (NIV) and prone positioning was conducted. Results: Forty-five patients were included. On average, 50% of the overall lung volume was affected by the disease, as observed in the CT-scans, with ground glass opacities (GGOs) and consolidations accounting for 44% and 4%, respectively. The abnormalities were mainly posterior, as demonstrated by posterior/anterior distribution ratios of 1.5 and 4.4 for GGO and consolidation, respectively. The median PaO2/FiO2 ratio during NIV in a supine position (SP1) was 140 [IQR 108–169], which improved by 67% (+98) during prone positioning, on average. Once supine positioning was resumed (SP2), the improvement in oxygenation was maintained in 28 patients (62% of the overall population, categorized as “responders”). We found no significant differences between responders and non-responders in terms of the extent (p = 0.92) and the distribution of parenchymal abnormalities seen in the baseline CT (p = 0.526). Conclusion: Despite the lack of a priori estimation of the sample size, considering the absence of any trends in the differences and correlations, we can reasonably conclude that the baseline chest CT-scan does not predict a gas-exchange response in awake prone-positioned patients with COVID-19 related ARDS. Physicians dealing with this category of patients should not rely on the imaging at presentation when evaluating whether to pronate patients.
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Affiliation(s)
- Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (F.R.); (L.N.); (S.P.); (L.M.)
| | - Sara Cazzaniga
- Department of Intensive Critical Care, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (M.B.); (P.G.); (F.L.L.)
| | - Simona Annibali
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.A.); (P.A.B.); (I.B.); (N.L.); (S.S.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (F.R.); (L.N.); (S.P.); (L.M.)
| | - Matteo Brivio
- Department of Intensive Critical Care, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (M.B.); (P.G.); (F.L.L.)
| | - Simone Pappacena
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (F.R.); (L.N.); (S.P.); (L.M.)
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| | - Luca Malandrino
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (F.R.); (L.N.); (S.P.); (L.M.)
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.A.); (P.A.B.); (I.B.); (N.L.); (S.S.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Ilaria Bianco
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.A.); (P.A.B.); (I.B.); (N.L.); (S.S.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Noemi Liggeri
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.A.); (P.A.B.); (I.B.); (N.L.); (S.S.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Paolo Gritti
- Department of Intensive Critical Care, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (M.B.); (P.G.); (F.L.L.)
| | - Ferdinando Luca Lorini
- Department of Intensive Critical Care, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.C.); (M.B.); (P.G.); (F.L.L.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (S.A.); (P.A.B.); (I.B.); (N.L.); (S.S.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (F.R.); (L.N.); (S.P.); (L.M.)
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-035-2673456
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11
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Marra P, Bonaffini PA, Ippolito D, Sironi S. Developments in diagnosis and management of post-liver transplantation biliary complications: the radiologist's perspective. Hepatobiliary Surg Nutr 2022; 11:457-461. [PMID: 35693400 PMCID: PMC9186186 DOI: 10.21037/hbsn-22-141] [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] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 08/30/2023]
Affiliation(s)
- Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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12
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Dulcetta L, Marra P, Carbone FS, Bonaffini PA, Sallemi C, Sansotta N, Colledan M, D'Antiga L, Sironi S. Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort. Pediatr Radiol 2022; 52:1061-1074. [PMID: 35107594 DOI: 10.1007/s00247-021-05278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population. OBJECTIVE The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images. MATERIALS AND METHODS This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18 years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data. RESULTS Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0 years (interquartile range [IQR] 8.2 years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups. CONCLUSION A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients are safe and effective, providing resolution or serving as a bridge to surgery, including re-transplantation.
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Affiliation(s)
- Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy. .,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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13
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Simonini R, Bonaffini PA, Porta M, Maino C, Carbone FS, Dulcetta L, Brambilla P, Marra P, Sironi S. Accuracy of Inflow Inversion Recovery (IFIR) for Upper Abdominal Arteries Evaluation: Comparison with Contrast-Enhanced MR and CTA. Diagnostics (Basel) 2022; 12:diagnostics12040825. [PMID: 35453873 PMCID: PMC9025362 DOI: 10.3390/diagnostics12040825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Inflow-sensitive inversion recovery (IFIR) is a recently introduced technique to perform unenhanced magnetic resonance angiography (MRA). The purpose of our study is to determine the accuracy of IFIR-MRA in the evaluation of upper abdominal arteries, compared to standard MRA and computed tomography angiography (CTA). Materials and Methods: Seventy patients undergoing upper abdomen Magnetic Resonance Imaging (MRI) in different clinical settings were enrolled. The MRI protocol included an IFIR-MRA sequence that was intra-individually compared by using a qualitative 4-point scale in the same patients who underwent concomitant or close MRA (n = 65) and/or CTA (n = 44). Celiac trunk (CA), common-proper-left-right hepatic artery (C-P-L-R-HA), left gastric artery (LGA), gastroduodenal artery (GDA), splenic artery (SA), renal arteries (RA) and superior mesenteric artery (SMA) were assessed. Results: IFIR-MRA images were better rated in comparison with MRA. Particularly, all arteries obtained a statistically significant higher qualitative rating value (all p < 0.05). IFIR-MRA and MRA exhibited acceptable intraclass correlation coefficients (ICC) values for CA, C-L-R-HA, and SMA (ICC 0.507, 0.591, 0.615, 0.570, 0.525). IFIR-MRA and CTA showed significant correlations in C-P-L-R-HA (τ = 0.362, 0.261, 0.308, 0.307, respectively; p < 0.05), and in RA (τ = 0.279, p < 0.05). Conclusions: Compared to MRA, IFIR-MRA demonstrated a higher image quality in the majority of upper abdomen arterial vessels assessment. LHA and RHA branches could be better visualized with IFIR sequences, when visualizable. Based on these findings, we suggest to routinely integrate IFIR sequences in upper abdomen MRI studies.
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Affiliation(s)
- Roberto Simonini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Marco Porta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
- Correspondence: ; Tel.: +39-338-704-8845
| | - Cesare Maino
- Department of Radiology, San Gerardo Hospital, Via G. B. Pergolesi 33, 20900 Monza, Italy;
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Paolo Brambilla
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
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14
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Mercanzin E, Bonaffini PA, Barletta A, Stanco F, Valle C, Marra P, Sironi S. Pneumonia-related pneumatoceles in infants: CT assessment and image-guided treatment. BJR Case Rep 2022; 8:20210191. [PMID: 36177270 PMCID: PMC9499427 DOI: 10.1259/bjrcr.20210191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/08/2021] [Indexed: 11/05/2022] Open
Abstract
Lung pneumatoceles represent a potential life-threatening complication of pneumonia in infants, especially when they do not spontaneously reabsorb. In this category of patients, scientific literature lacks and no consensus guidelines for management have been proposed. Imaging plays a key role in the diagnosis, characterization, and follow-up of pneumatoceles. Image-guided percutaneous drainage can be considered a safe and effective treatment in children, although it is not widely recognized in newborns and infants. The aim of this case series review is to describe the main CT features of complicated or persistent pneumatoceles in infants and to highlight the potential role of image-guided percutaneous drainage as an effective approach for their treatment. Successful management of four infants affected by pneumonia-related pneumatoceles with percutaneous drainage is presented.
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Affiliation(s)
- Elisa Mercanzin
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine University Milano Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine University Milano Bicocca, Milan, Italy
| | - Antonino Barletta
- Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Stanco
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine University Milano Bicocca, Milan, Italy
| | - Clarissa Valle
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine University Milano Bicocca, Milan, Italy
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine University Milano Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine University Milano Bicocca, Milan, Italy
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15
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Giannini F, Toselli M, Palmisano A, Cereda A, Vignale D, Leone R, Nicoletti V, Gnasso C, Monello A, Manfrini M, Khokhar A, Sticchi A, Biagi A, Turchio P, Tacchetti C, Landoni G, Boccia E, Campo G, Scoccia A, Ponticelli F, Danzi GB, Loffi M, Muri M, Pontone G, Andreini D, Mancini EM, Casella G, Iannopollo G, Nannini T, Ippolito D, Bellani G, Franzesi CT, Patelli G, Besana F, Costa C, Vignali L, Benatti G, Sverzellati N, Scarnecchia E, Lombardo FP, Anastasio F, Iannaccone M, Vaudano PG, Pacielli A, Baffoni L, Gardi I, Cesini E, Sperandio M, Micossi C, De Carlini CC, Spreafico C, Maggiolini S, Bonaffini PA, Iacovoni A, Sironi S, Senni M, Fominskiy E, De Cobelli F, Maggioni AP, Rapezzi C, Ferrari R, Colombo A, Esposito A. Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients. J Cardiovasc Comput Tomogr 2021; 15:421-430. [PMID: 33744175 PMCID: PMC7946543 DOI: 10.1016/j.jcct.2021.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. OBJECTIVES The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. METHODS 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes. RESULTS Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ± 570.92 vs 206.80 ± 424.13 mm2, p < 0.001); Volume (487.79 ± 565.34 vs 207.77 ± 406.81, p < 0.001)], aortic valve [Volume (322.45 ± 390.90 vs 98.27 ± 250.74 mm2, p < 0.001; Agatston 337.38 ± 414.97 vs 111.70 ± 282.15, p < 0.001)] and thoracic aorta [Volume (3786.71 ± 4225.57 vs 1487.63 ± 2973.19 mm2, p < 0.001); Agatston (4688.82 ± 5363.72 vs 1834.90 ± 3761.25, p < 0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046-1.637, p = 0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200-3.251, p = 0.007) resulted to be independent predictors of in-hospital mortality. CONCLUSION Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.
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Affiliation(s)
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Anna Palmisano
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Davide Vignale
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Riccardo Leone
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Valeria Nicoletti
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Chiara Gnasso
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | | | - Marco Manfrini
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Arif Khokhar
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | - Carlo Tacchetti
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Edda Boccia
- IRCCS San Raffaele Scientific Institute, Italy
| | - Gianluca Campo
- Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elisa Scarnecchia
- ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy
| | | | - Fabio Anastasio
- ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy
| | | | | | | | - Lucio Baffoni
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Casa di Cura Villa dei Pini, Civitanova Marche, Italy
| | - Iljia Gardi
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Francesco De Cobelli
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | | | - Claudio Rapezzi
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Roberto Ferrari
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Esposito
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
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Norsa L, Bonaffini PA, Caldato M, Bonifacio C, Sonzogni A, Indriolo A, Valle C, Furfaro F, Bonanomi A, Franco PN, Gori M, Smania V, Scaramella L, Forzenigo L, Vecchi M, Solbiati M, Costantino G, Danese S, D'Antiga L, Sironi S, Elli L. Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study. World J Gastroenterol 2021; 27:5448-5459. [PMID: 34539144 PMCID: PMC8409161 DOI: 10.3748/wjg.v27.i32.5448] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/11/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19).
AIM To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection.
METHODS A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1st and May 30th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed.
RESULTS Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%.
CONCLUSION Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.
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Affiliation(s)
- Lorenzo Norsa
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
| | - Maja Caldato
- Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Milano 20122, Italy
| | - Cristiana Bonifacio
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Italy
| | - Aurelio Sonzogni
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Amedeo Indriolo
- Department of Gastroenterology and Endoscopy, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Clarissa Valle
- Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
| | - Federica Furfaro
- IBD Center, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano 20089, Italy
| | - Alice Bonanomi
- Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
| | - Paolo Niccolò Franco
- Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Veronica Smania
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
| | - Lucia Scaramella
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
| | - Laura Forzenigo
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
| | - Maurizio Vecchi
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
| | - Monica Solbiati
- Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milano 20122, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milano 20122, Italy
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano 20089, Italy
| | - Lorenzo D'Antiga
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Sandro Sironi
- Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
- Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
| | - Luca Elli
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
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Scoccia A, Gallone G, Cereda A, Palmisano A, Vignale D, Leone R, Nicoletti V, Gnasso C, Monello A, Khokhar A, Sticchi A, Biagi A, Tacchetti C, Campo G, Rapezzi C, Ponticelli F, Danzi GB, Loffi M, Pontone G, Andreini D, Casella G, Iannopollo G, Ippolito D, Bellani G, Patelli G, Besana F, Costa C, Vignali L, Benatti G, Iannaccone M, Vaudano PG, Pacielli A, De Carlini CC, Maggiolini S, Bonaffini PA, Senni M, Scarnecchia E, Anastasio F, Colombo A, Ferrari R, Esposito A, Giannini F, Toselli M. Impact of clinical and subclinical coronary artery disease as assessed by coronary artery calcium in COVID-19. Atherosclerosis 2021; 328:136-143. [PMID: 33883086 PMCID: PMC8025539 DOI: 10.1016/j.atherosclerosis.2021.03.041] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The potential impact of coronary atherosclerosis, as detected by coronary artery calcium, on clinical outcomes in COVID-19 patients remains unsettled. We aimed to evaluate the prognostic impact of clinical and subclinical coronary artery disease (CAD), as assessed by coronary artery calcium score (CAC), in a large, unselected population of hospitalized COVID-19 patients undergoing non-gated chest computed tomography (CT) for clinical practice. METHODS SARS-CoV 2 positive patients from the multicenter (16 Italian hospitals), retrospective observational SCORE COVID-19 (calcium score for COVID-19 Risk Evaluation) registry were stratified in three groups: (a) "clinical CAD" (prior revascularization history), (b) "subclinical CAD" (CAC >0), (c) "No CAD" (CAC = 0). Primary endpoint was in-hospital mortality and the secondary endpoint was a composite of myocardial infarction and cerebrovascular accident (MI/CVA). RESULTS Amongst 1625 patients (male 67.2%, median age 69 [interquartile range 58-77] years), 31%, 57.8% and 11.1% had no, subclinical and clinical CAD, respectively. Increasing rates of in-hospital mortality (11.3% vs. 27.3% vs. 39.8%, p < 0.001) and MI/CVA events (2.3% vs. 3.8% vs. 11.9%, p < 0.001) were observed for patients with no CAD vs. subclinical CAD vs clinical CAD, respectively. The association with in-hospital mortality was independent of in-study outcome predictors (age, peripheral artery disease, active cancer, hemoglobin, C-reactive protein, LDH, aerated lung volume): subclinical CAD vs. No CAD: adjusted hazard ratio (adj-HR) 2.86 (95% confidence interval [CI] 1.14-7.17, p=0.025); clinical CAD vs. No CAD: adj-HR 3.74 (95% CI 1.21-11.60, p=0.022). Among patients with subclinical CAD, increasing CAC burden was associated with higher rates of in-hospital mortality (20.5% vs. 27.9% vs. 38.7% for patients with CAC score thresholds≤100, 101-400 and > 400, respectively, p < 0.001). The adj-HR per 50 points increase in CAC score 1.007 (95%CI 1.001-1.013, p=0.016). Cardiovascular risk factors were not independent predictors of in-hospital mortality when CAD presence and extent were taken into account. CONCLUSIONS The presence and extent of CAD are associated with in-hospital mortality and MI/CVA among hospitalized patients with COVID-19 disease and they appear to be a better prognostic gauge as compared to a clinical cardiovascular risk assessment.
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Affiliation(s)
| | - Guglielmo Gallone
- Division of Cardiology, Città Della Scienza e Della Salute, Dipartimento di Scienze Mediche University of Turin, Turin, Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | | | - Davide Vignale
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Riccardo Leone
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Valeria Nicoletti
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Chiara Gnasso
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | | | - Arif Khokhar
- GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | | | | | - Carlo Tacchetti
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Gianluca Campo
- Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elisa Scarnecchia
- ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy
| | - Fabio Anastasio
- ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy
| | | | | | - Antonio Esposito
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | | | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
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Ippolito D, Giandola T, Maino C, Gandola D, Ragusi M, Brambilla P, Bonaffini PA, Sironi S. Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients. Diagnostics (Basel) 2021; 11:diagnostics11061053. [PMID: 34201122 PMCID: PMC8226715 DOI: 10.3390/diagnostics11061053] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023] Open
Abstract
The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5-20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Correspondence:
| | - Teresa Giandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Cesare Maino
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Davide Gandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Paolo Brambilla
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
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Ippolito D, Giandola T, Maino C, Gandola D, Ragusi M, Bonaffini PA, Sironi S. Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma. Diagnostics (Basel) 2021; 11:diagnostics11050857. [PMID: 34064594 PMCID: PMC8150749 DOI: 10.3390/diagnostics11050857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023] Open
Abstract
Aim of the study is to compare the agreement between whole-body low-dose computed tomography (WBLDCT) and magnetic resonance imaging (WBMRI) in the evaluation of bone marrow involvement in patients with multiple myeloma (MM). Patients with biopsy-proven MM, who underwent both WBLDCT and WBMRI were retrospectively enrolled. After identifying the presence of focal bone involvement (focal infiltration pattern), the whole skeleton was divided into five anatomic districts (skull, spine, sternum and ribs, pelvis, and limbs). Patients were grouped according to the number and location of the lytic lesions (<5, 5-20, and >20) and Durie and Salmon staging system. The agreement between CT and MRI regarding focal pattern, staging, lesion number, and distribution was assessed using the Cohen Kappa statistics. The majority of patients showed focal involvement. According to the distribution of the focal lesions and Durie Salmon staging, the agreement between CT and MRI was substantial or almost perfect (all κ > 0.60). The agreement increased proportionally with the number of lesions in the pelvis and spine (κ = 0.373 to κ = 0.564, and κ = 0.469-0.624), while for the skull the agreement proportionally decreased without reaching a statistically significant difference (p > 0.05). In conclusion, WBLDCT showed an almost perfect agreement in the evaluation of focal involvement, staging, lesion number, and distribution of bone involvement in comparison with WBMRI.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Correspondence:
| | - Teresa Giandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Cesare Maino
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Davide Gandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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20
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Balbi M, Conti C, Imeri G, Caroli A, Surace A, Corsi A, Mercanzin E, Arrigoni A, Villa G, Di Marco F, Bonaffini PA, Sironi S. Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients. Eur J Radiol 2021; 138:109676. [PMID: 33798931 PMCID: PMC7980523 DOI: 10.1016/j.ejrad.2021.109676] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. METHODS COVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. RESULTS At a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11-23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. CONCLUSIONS Most severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.
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Affiliation(s)
- Maurizio Balbi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Post Graduate School of Diagnostic Radiology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, MI, 20126, Italy.
| | - Caterina Conti
- Respiratory Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy
| | - Gianluca Imeri
- Respiratory Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy
| | - Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Gian Battista Camozzi 3, Ranica, BG, 24020, Italy
| | - Alessandra Surace
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Post Graduate School of Diagnostic Radiology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, MI, 20126, Italy
| | - Andrea Corsi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Post Graduate School of Diagnostic Radiology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, MI, 20126, Italy
| | - Elisa Mercanzin
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Post Graduate School of Diagnostic Radiology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, MI, 20126, Italy
| | - Alberto Arrigoni
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio 3, Dalmine, BG, 24044, Italy
| | - Giulia Villa
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Gian Battista Camozzi 3, Ranica, BG, 24020, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Department of Health Sciences, University of Milan, Via di Rudinì 8, Milano, MI, 20146, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Post Graduate School of Diagnostic Radiology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, MI, 20126, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy; Post Graduate School of Diagnostic Radiology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, MI, 20126, Italy
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21
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Valle C, Bonaffini PA, Dal Corso M, Mercanzin E, Franco PN, Sonzogni A, Vacca G, Gianatti A, Sironi S. Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak. Eur J Radiol 2021; 137:109613. [PMID: 33657476 PMCID: PMC7903911 DOI: 10.1016/j.ejrad.2021.109613] [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: 10/11/2020] [Revised: 01/05/2021] [Accepted: 02/20/2021] [Indexed: 01/19/2023]
Abstract
Purpose Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis. Method COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned. Results A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted. Conclusions PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent.
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Affiliation(s)
- C Valle
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Post-Graduate School of Radiology, University of Milano-Bicocca, Monza, Italy
| | - P A Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Post-Graduate School of Radiology, University of Milano-Bicocca, Monza, Italy
| | - M Dal Corso
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - E Mercanzin
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Post-Graduate School of Radiology, University of Milano-Bicocca, Monza, Italy
| | - P N Franco
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Post-Graduate School of Radiology, University of Milano-Bicocca, Monza, Italy.
| | - A Sonzogni
- Department of Pathology and Laboratory Medicine, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - G Vacca
- Department of Economic Policy, University of Cattolica del Sacro Cuore, Milano, Italy
| | - A Gianatti
- Department of Pathology and Laboratory Medicine, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Post-Graduate School of Radiology, University of Milano-Bicocca, Monza, Italy
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Norsa L, Bonaffini PA, Indriolo A, Valle C, Sonzogni A, Sironi S. Poor Outcome of Intestinal Ischemic Manifestations of COVID-19. Gastroenterology 2020; 159:1595-1597.e1. [PMID: 32569772 PMCID: PMC7305715 DOI: 10.1053/j.gastro.2020.06.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Lorenzo Norsa
- Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Pietro Andrea Bonaffini
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy,Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
| | - Amedeo Indriolo
- Gastroenterology and Endoscopy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Clarissa Valle
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy,Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
| | - Aurelio Sonzogni
- Anatomic Pathology Department, Papa Giovanni XXIII, Hospital, Bergamo, Italy
| | - Sandro Sironi
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy,Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
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MESH Headings
- Betacoronavirus/genetics
- Betacoronavirus/metabolism
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/pathology
- Endarteritis/etiology
- Endarteritis/pathology
- Fatal Outcome
- Humans
- Infarction/diagnosis
- Infarction/etiology
- Infarction/pathology
- Infarction/surgery
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/virology
- Intestine, Small/blood supply
- Intestine, Small/metabolism
- Intestine, Small/surgery
- Male
- Mesenteric Ischemia/diagnosis
- Mesenteric Ischemia/etiology
- Mesenteric Ischemia/pathology
- Mesenteric Ischemia/surgery
- Middle Aged
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/pathology
- RNA, Messenger/metabolism
- SARS-CoV-2
- Shock, Septic/etiology
- Spike Glycoprotein, Coronavirus/genetics
- Thrombosis/etiology
- Thrombosis/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Lorenzo Norsa
- Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Clarissa Valle
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo; Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
| | - Denise Morotti
- Pathology Department, Papa Giovanni XXIII, Hospital, Bergamo, Italy; Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pietro Andrea Bonaffini
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo; Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
| | - Amedeo Indriolo
- Gastroenterology and Endoscopy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Aurelio Sonzogni
- Pathology Department, Papa Giovanni XXIII, Hospital, Bergamo, Italy
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Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging 2019; 100:619-634. [PMID: 31427216 DOI: 10.1016/j.diii.2019.07.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discussed. In order to help guide-imaging diagnosis, we provide an MRI-based diagnostic algorithm which takes into account morphological and functional features, both individually and in combination, in an attempt to optimize radiologic differentiation of leiomyomas from leiomyosarcomas.
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Affiliation(s)
- S Sun
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada.
| | - P A Bonaffini
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - S Nougaret
- Inserm, U1194, Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 34295 Montpellier, France
| | - L Fournier
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - A Dohan
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology A, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - J Chong
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - J Smith
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - H Addley
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - C Reinhold
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
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Upadhaya T, Vallieres M, Chatterjee A, Lucia F, Bonaffini PA, Masson I, Mervoyer A, Reinhold C, Schick U, Seuntjens J, Rest CCL, Visvikis D, Hatt M. Comparison of Radiomics Models Built Through Machine Learning in a Multicentric Context With Independent Testing: Identical Data, Similar Algorithms, Different Methodologies. IEEE Trans Radiat Plasma Med Sci 2019. [DOI: 10.1109/trpms.2018.2878934] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lucia F, Visvikis D, Vallières M, Desseroit MC, Miranda O, Robin P, Bonaffini PA, Alfieri J, Masson I, Mervoyer A, Reinhold C, Pradier O, Hatt M, Schick U. External validation of a combined PET and MRI radiomics model for prediction of recurrence in cervical cancer patients treated with chemoradiotherapy. Eur J Nucl Med Mol Imaging 2018; 46:864-877. [DOI: 10.1007/s00259-018-4231-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/27/2018] [Indexed: 12/22/2022]
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Ippolito D, Masetto A, Franzesi CT, Bonaffini PA, Sala A, Biondi A, Sironi S. Lower-limb MRI in the staging and re-staging of osteonecrosis in paediatric patients affected by acute lymphoblastic leukaemia after therapy. Skeletal Radiol 2016; 45:495-503. [PMID: 26782927 DOI: 10.1007/s00256-016-2329-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the diagnostic value of MRI examination in detecting and monitoring osteonecrotic lesions (ON) in childhood acute lymphoblastic leukaemia (ALL) after chemotherapy (CHT) and/or bone marrow transplantation (BMT). METHODS AND MATERIALS Seventy-three patients (37 males, mean age 12.4 years old) with ALL after treatment underwent a lower-limb MR examination between November 2006 and March 2012. In 47 there was clinical suspicion of ON, 26 were asymptomatic. Studies were performed with a 1 T and a 1.5 T scanner, acquiring short tau inversion recovery (STIR) and T1-weighted sequences in coronal plane from the hips to the ankles. The average acquisition time was 18 min. Considering baseline and follow-up examinations, the overall number of MRI studies was 195. RESULTS Fifty-four of 73 patients showed ON at MRI study, with an overall number of 323 ON (89 involving articular surface, 24 with joint deformity, JD). Twenty-five of 47 symptomatic patients showed subchondral ON lesions, 11 developed JD. Three of 26 asymptomatic patients showed subchondral bone ON at baseline examination but no JD at follow-up. Twenty-two of 28 BMT, 32/45 CHT patients developed ON. CONCLUSION Our MRI protocol proved to be feasible in evaluating ON in paediatric patients. Studies should be addressed only to symptomatic patients.
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Affiliation(s)
- D Ippolito
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy.
- Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy.
| | - A Masetto
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy
- Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy
| | - C Talei Franzesi
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy
- Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy
| | - P A Bonaffini
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy
- Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy
| | - A Sala
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy
- Department of Paediatric Haematology, H S. Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy
| | - A Biondi
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy
- Department of Paediatric Haematology, H S. Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy
| | - S Sironi
- School of Medicine, University of Milano-Bicocca Milan, Via Pergolesi 33, 20900, Monza (MB), Italy
- Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900, Monza (MB), Italy
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Ippolito D, Casiraghi AS, Talei Franzesi C, Bonaffini PA, Fior D, Sironi S. Intraobserver and Interobserver Agreement in the Evaluation of Tumor Vascularization With Computed Tomography Perfusion in Cirrhotic Patients With Hepatocellular Carcinoma. J Comput Assist Tomogr 2016; 40:152-9. [PMID: 26484957 DOI: 10.1097/rct.0000000000000331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate intrareader and inter-reader agreement in CT perfusion (Perf) measurements in cirrhotic patients with hepatocellular carcinoma (HCC) lesions. METHODS Sixteen patients with HCC (9 untreated, 5 recurrence/residual disease after transarterial chemoembolization, and 2 after radiofrequency ablation treatment) underwent standard CT examination and a Perf study; a quantitative map of arterial and portal Perf by means of a color scale was generated. With dedicated Perf software, the following parameters were calculated on untreated and treated HCC lesions and on cirrhotic parenchyma: hepatic Perf, tissue blood volume, hepatic perfusion index, arterial perfusion, and time to peak. Intraobserver and interobserver agreements were assessed for 2 readers with Bland-Altman plots, intraclass correlation coefficients (ICCs), coefficients of variation, and repeatability. RESULTS In HCC lesions, agreement analysis demonstrated higher intra-agreement values in comparison with interagreement (range of ICC values, 0.26-0.59 between readers and 0.67-0.94 between readings). Lower interagreement was found for treated HCC lesions in comparison with untreated lesions (range of ICC values, respectively, 0.12-0.54 and 0.31-0.89). CONCLUSIONS For all Perf parameters intra-agreement was higher than interagreement, even though a relatively wide range of 95% limits of agreement was found in both cases.
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Affiliation(s)
- Davide Ippolito
- From the Department of Diagnostic Radiology, "San Gerardo" Hospital; and School of Medicine, University of Milano-Bicocca, Monza, Milan, Italy
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29
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Ippolito D, Lombardi S, Trattenero C, Franzesi CT, Bonaffini PA, Sironi S. CT enterography: Diagnostic value of 4th generation iterative reconstruction algorithm in low dose studies in comparison with standard dose protocol for follow-up of patients with Crohn's disease. Eur J Radiol 2016; 85:268-273. [PMID: 26526900 DOI: 10.1016/j.ejrad.2015.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 07/01/2015] [Revised: 10/07/2015] [Accepted: 10/14/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare radiation dose, image quality and diagnostic performance of low dose CT enterography (CTE) protocol combined with iterative reconstruction algorithm (iDose(4)) with standard dose CTE in follow-up of patients with known Crohn's disease (CD). MATERIALS AND METHOD Thirty-six patients (12 females), with CD underwent a low-dose CTE scan during single venous phase on 256 MDCT scanner, with the following parameters: 120 kV, automated mAs dose-modulation, slice thickness 2mm and iDose(4) iterative reconstruction algorithm. A control group of thirty-seven patients underwent standard dose CTE examination on the same CT scanner. Two radiologists, blinded to clinical and pathological findings, independently evaluated in each scan, HU values in bowel wall and any presence of CD activity features and disease complications. Image noise and diagnostic quality were evaluated using a 4-point scale. Dose-length product (DLP) and CT-dose-index (CTDI) were recorded and data from both examinations were compared and statistically analyzed. RESULTS Low-dose CTE protocol showed high diagnostic quality in assessment of Crohn's disease obtaining significantly (p ≤ 0.001) lower values of DLP and CTDI (604.98 mGy*cm and 12.29 mGy) as compared to standard dose examinations (974.85 mGy*cm and 19.71 mGy), with an overall dose reduction of 37.6%. Noise resulted slightly higher in iDose(4) images (SD=15.97) than in standard dose ones (SD=13.61) but this difference was not statistically significant (p=0.064). CONCLUSION Low-dose CTE combined with iDose(4) reconstruction algorithm offers high quality images with significant reduction of radiation dose, and therefore can be considered a useful tool in the management of CD patients, considering their young age and the frequent imaging follow-up required.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy; Department of Diagnostic Radiology, H.S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy.
| | - Sophie Lombardi
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy; Department of Diagnostic Radiology, H.S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy
| | - Chiara Trattenero
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy; Department of Diagnostic Radiology, H.S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy; Department of Diagnostic Radiology, H.S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy; Department of Diagnostic Radiology, H.S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy; Department of Diagnostic Radiology, H.S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy
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Bonaffini PA, Ippolito D, Casiraghi A, Besostri V, Franzesi CT, Sironi S. Apparent diffusion coefficient maps integrated in whole-body MRI examination for the evaluation of tumor response to chemotherapy in patients with multiple myeloma. Acad Radiol 2015; 22:1163-71. [PMID: 26182979 DOI: 10.1016/j.acra.2015.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the diagnostic value of apparent diffusion coefficient (ADC) maps in the assessment of response to chemotherapy in patients with multiple myeloma (MM). MATERIALS AND METHODS Fourteen patients (seven women) with MM underwent whole-body magnetic resonance imaging (WB-MRI) study on a 1.5T scanner, before and after chemotherapy. DWI with background body signal suppression (DWIBS) sequences (b values: 0, 500, and 1000 mm(2)/sec) were qualitatively analyzed, along with T1 turbo spine echo and short tau inversion recovery T2-weighted images, to evaluate bone lesions. On ADC maps, regions of interest were manually drawn along contours of lesions. The ADC values percentage variation (ΔADC) before (MR1) and after (MR2) chemotherapy were calculated and compared between responders (11 of 14) and nonresponders (3 of 14). The percentage of plasma cells by the means of the bone marrow aspirate was evaluated as parameter for response to chemotherapy. RESULTS Twenty-four lesions, hyperintense on DWIBS as compared to normal bone marrow, were evaluated. In responder group, the mean ADC values were 0.63 ± 0.24 × 10(-3) mm(2)/s on MR1 and 1.04 ± 0.46 × 10(-3) mm(2)/s on MR2; partial or complete signal intensity decrease during follow-up on DWIBS was found along with a reduction of plasma cells infiltration in the bone marrow. The mean ADC values for nonresponders were 0.61 ± 0.05 × 10(-3) mm(2)/s on MR1 and 0.69 ± 0.09 × 10(-3) mm(2)/s on MR2. The mean variation of ΔADC in responders (Δ = 66%) was significantly different (P < .05) than in nonresponders (Δ = 15%). CONCLUSIONS WB-MRI with DWIBS sequences, by evaluating posttreatment changes of ADC values, might represent a complementary diagnostic tool in the assessment of response to chemotherapy in MM patients.
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Affiliation(s)
- Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy; Department of Health Sciences, Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy.
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Valeria Besostri
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; Department of Diagnostic Radiology, H. San Gerardo, Monza, Italy
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Ippolito D, Talei Franzesi C, Fior D, Bonaffini PA, Minutolo O, Sironi S. Low kV settings CT angiography (CTA) with low dose contrast medium volume protocol in the assessment of thoracic and abdominal aorta disease: a feasibility study. Br J Radiol 2015; 88:20140140. [PMID: 25784185 PMCID: PMC4628465 DOI: 10.1259/bjr.20140140] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the diagnostic quality of low dose (100 kV) CT angiography (CTA), by using ultra-low contrast medium volume (30 ml), for thoracic and abdominal aorta evaluation. METHODS 67 patients with thoracic or abdominal vascular disease underwent multidetector CT study using a 256 slice scanner, with low dose radiation protocol (automated tube current modulation, 100 kV) and low contrast medium volume (30 ml; 4 ml s(-1)). Density measurements were performed on ascending, arch, descending thoracic aorta, anonymous branch, abdominal aorta, and renal and common iliac arteries. Radiation dose exposure [dose-length product (DLP)] was calculated. A control group of 35 patients with thoracic or abdominal vascular disease were evaluated with standard CTA protocol (automated tube current modulation, 120 kV; contrast medium, 80 ml). RESULTS In all patients, we correctly visualized and evaluated main branches of the thoracic and abdominal aorta. No difference in density measurements was achieved between low tube voltage protocol (mean attenuation value of thoracic aorta, 304 HU; abdominal, 343 HU; renal arteries, 331 HU) and control group (mean attenuation value of thoracic aorta, 320 HU; abdominal, 339; renal arteries, 303 HU). Radiation dose exposure in low tube voltage protocol was significantly different between thoracic and abdominal low tube voltage studies (490 and 324 DLP, respectively) and the control group (thoracic DLP, 1032; abdomen, DLP 1078). CONCLUSION Low-tube-voltage protocol may provide a diagnostic performance comparable with that of the standard protocol, decreasing radiation dose exposure and contrast material volume amount. ADVANCES IN KNOWLEDGE Low-tube-voltage-setting protocol combined with ultra-low contrast agent volume (30 ml), by using new multidetector-row CT scanners, represents a feasible diagnostic tool to significantly reduce the radiation dose delivered to patients and to preserve renal function, while also maintaining adequate diagnostic quality images in assessment of aorta.
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Affiliation(s)
- D Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
- School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - C Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
- School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - D Fior
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
- School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - P A Bonaffini
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
- School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - O Minutolo
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
- School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - S Sironi
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
- School of Medicine, University of Milano-Bicocca, Monza, Italy
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Ippolito D, Colombo M, Trattenero C, Bonaffini PA, Talei Franzesi C, Fior D, Sironi S. Diagnostic Value of Semiquantitative Analysis of Dynamic Susceptibility Contrast Magnetic Resonance Imaging with GD-EOB-DTPA in Focal Liver Lesions Characterization: A Feasibility Study. Gastroenterol Res Pract 2015; 2015:630273. [PMID: 26064093 PMCID: PMC4438153 DOI: 10.1155/2015/630273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 04/20/2015] [Indexed: 02/08/2023] Open
Abstract
Purpose. To assess the diagnostic accuracy of dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSCE-MRI) in differentiation between benign and malignant liver lesions by assessment of tumoral perfusion parameters. Methods Materials. Seventy-three patients with known focal liver lesions, including 45 benign (16 FNH, 27 angiomas, and 2 abscesses) and 28 malignant ones (17 metastases, 9 HCCs, and 2 cholangiocarcinoma) underwent 1.5 T MRI upper abdominal study, with standard protocol that included dynamic contrast-enhanced sequences. On dedicated workstation, time-intensity curves were determined and the following perfusion parameters were calculated: relative arterial, venous and late enhancement (RAE, RVE, RLE), maximum enhancement (ME), relative enhancement (RE), and time to peak (TTP). Results. All diagnoses were established either by histopathology or imaging follow-up. Perfusion mean values calculated in benign lesions were RAE 33.8%, RVE 66.03%, RLE 80.63%, ME 776.00%, MRE 86.27%, and TTP 146.95 sec. Corresponding perfusion values calculated in malignant lesions were RAE 22.47%, RVE 40.54%, RLE 47.52%, ME 448.78%, MRE 49.85%, and TTP 183.79 sec. Statistical difference (p < 0.05) was achieved in all the perfusion parameters calculated, obtaining different cluster of perfusion kinetics between benign and malignant lesions. Conclusions. DSCE-MRI depicts kinetic differences in perfusion parameters among the different common liver lesions, related to tumour supply and microvascular characteristics.
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Affiliation(s)
- Davide Ippolito
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
- *Davide Ippolito:
| | - Maddalena Colombo
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
| | - Chiara Trattenero
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
| | - Pietro Andrea Bonaffini
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
| | - Cammillo Talei Franzesi
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
| | - Davide Fior
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
| | - Sandro Sironi
- 1School of Medicine, University of Milano-Bicocca, 20900 Milan, Italy
- 2Department of Diagnostic Radiology, H. S. Gerardo Monza, Milan, Italy
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Ippolito D, Fior D, Bonaffini PA, Capraro C, Leni D, Corso R, Sironi S. Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients. Eur J Radiol 2014; 83:1665-71. [PMID: 24962900 DOI: 10.1016/j.ejrad.2014.05.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 12/28/2013] [Revised: 05/11/2014] [Accepted: 05/23/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. MATERIALS AND METHODS Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50mL of non ionic contrast agent (350mg I/mL) at a flow rate of 6mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). RESULTS A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2±6.3; AP 10.4±7; BV 4.05±4.8; TTP 38.9±4.2; HPI 9.9±9.2, whereas in partially treated lesions were: HP 43.2±15.1mL/s/100g; AP 38.7±8.8mL/min; BV 20.7±9.5mL/100mg; TTP 24±3.7s; HPI 61.7±7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2±4; AP 12.3±3.4; BV 11.8±2.8; TTP 43.9±2.9; and HPI 17.1±9.8. A significant difference (P<0.001) was found for all parameters between residual viable tumor tissue (P<0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC. CONCLUSION According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
| | - Davide Fior
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Cristina Capraro
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Davide Leni
- Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Rocco Corso
- Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
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Ippolito D, Cadonici A, Bonaffini PA, Minutolo O, Casiraghi A, Perego P, Sironi S. Semiquantitative perfusion combined with diffusion-weighted MR imaging in pre-operative evaluation of endometrial carcinoma: results in a group of 57 patients. Magn Reson Imaging 2014; 32:464-72. [PMID: 24629513 DOI: 10.1016/j.mri.2014.01.009] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/15/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the semiquantitative DCE and quantitative DWI parameters in endometrial cancer, in order to assess the presence of neoplastic tissue and normal myometrium and to ascertain a potential relationship with tumor grade. METHODS AND MATERIALS A total of 57 patients with biopsy-proven endometrial adenocarcinoma who underwent MR imaging examination for staging purposes were retrospectively evaluated. Imaging protocol included multiplanar T1- and T2-weighted TSE, DCE T1-weighted (THRIVE; 0, 30, 90 and 120seconds after intravenous injection of gadolinium) and DWIBS sequences (b values=0 and 1000mm(2)/s). Color perfusion and ADC maps were automatically generated on dedicated software. Relative enhancement (RE, %), maximum enhancement (ME, %), maximum relative enhancement (MRE, %), time to peak (TTP, s) and mean apparent diffusion coefficient (ADC) were calculated by manually drawing a region of interest (ROI) both on the neoplastic tissue and the normal myometrium. Histopathology was used as reference standard. RESULTS Histopathological analysis confirmed the presence of endometrial carcinoma in all patients. Neoplastic tissue demonstrated significantly lower (P<0.001) values of RE (%) 63.92±35.68; ME (%) 864.91±429.54 and MRE (%) 75.97±38.26 as compared to normal myometrium (RE (%) 151.43±55.99; ME (%) 1800.73±721.32; MRE (%) 158.28±54.05). TTP was significantly higher (P<0.05) in tumor lesion (385.51±1630.27 vs 195.44±78.69). Mean ADC value of neoplastic tissue (775.09±?220.73×10(-3)mm(2)/s) was significantly lower (P<0.05) than in myometrium (1602.37±378.54×10(-3)mm(2)/s). The analysis of perfusion and diffusion parameters classified according to tumor grades, showed a statistically significant difference only for RE (P=0.043) and ME (P=0.007). CONCLUSIONS Perfusion parameters and mean ADC differ significantly between endometrial cancer and normal myometrium, potentially reflecting the different microscopical features of cellularity and vascularity; however a significant relationship with tumor grade was not found in our series.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy.
| | - Anna Cadonici
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy
| | - Orazio Minutolo
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy
| | | | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, H S.Gerardo Monza, Milan, Italy
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Ippolito D, Besostri V, Bonaffini PA, Rossini F, Di Lelio A, Sironi S. Diagnostic value of whole-body low-dose computed tomography (WBLDCT) in bone lesions detection in patients with multiple myeloma (MM). Eur J Radiol 2013; 82:2322-7. [PMID: 24074647 DOI: 10.1016/j.ejrad.2013.08.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/04/2013] [Accepted: 08/17/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). MATERIALS AND METHODS A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50-81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120 kV; tube current time product 40 mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2 mSv. Every patient gave personal informed consent, as required by our institution guidelines. RESULTS The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. CONCLUSION WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB), Italy; Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB), Italy.
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Ippolito D, Bonaffini PA, Capraro C, Leni D, Corso R, Sironi S. Viable residual tumor tissue after radiofrequency ablation treatment in hepatocellular carcinoma: evaluation with CT perfusion. Abdom Imaging 2013; 38:502-10. [PMID: 22743839 DOI: 10.1007/s00261-012-9924-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the role of CT perfusion technique in detection of blood flow changes related to the therapeutic effects in HCC lesion treated with RFA. METHODS 14 cirrhotic patients with known HCC underwent a perfusion study about 4 months (range 1-13 months) after RFA on a 16-slice MDCT scanner (Brilliance, Philips). Dynamic CT was performed acquiring 8 dynamic slice/scan, after injection of 50 mL of contrast media. In treated lesion, surrounding parenchyma and hypervascular tissue suspicious for residual disease/recurrence, the following perfusion parameters were analyzed: perfusion (P, mL/100 g min); arterial perfusion (AP, mL/min); blood volume (BV, mL/100 mg); hepatic perfusion index (HPI, %), and time to peak (TTP, s). Univariate Wilcoxon signed rank test was used for statistical analysis. RESULTS In patients with residual disease (8/14) values of perfusion parameters measured within tumor were: P, median = 45.2; AP, median = 48.2; BV, median = 18.9; HPI, median = 35.8; and TTP, median = 19.4. The values calculated in ablated area were: P, median = 10.9; AP, median = 9.6; BV, median = 5.5; HPI, median = 14.6; TTP, median = 39.6. The parameters calculated in the surrounding parenchyma were: P, median = 15.8; AP, median = 14.2; BV, median = 12.0; HPI, median = 17.9; TTP, median = 43.2. A significant difference (P < 0.05) was observed in mean values of P, AP, and HPI, calculated between treated lesions with residual tumor and those successfully treated. CONCLUSION Perfusion CT enables assessment of HCC vascularity after RFA treatment, by adding quantitative information about the presence of residual arterial vessels within the viable residual neoplastic tissue.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, Monza, MB, Italy.
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Ippolito D, Bonaffini PA, Ratti L, Antolini L, Corso R, Fazio F, Sironi S. Hepatocellular carcinoma treated with transarterial chemoembolization: Dynamic perfusion-CT in the assessment of residual tumor. World J Gastroenterol 2010; 16:5993-6000. [PMID: 21157976 PMCID: PMC3007114 DOI: 10.3748/wjg.v16.i47.5993] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To asses the value of computed tomography (CT)-perfusion in the detection of residual hepatocellular carcinoma (HCC) vascularization after transarterial chemoembolization (TACE).
METHODS: Thirty-two consecutive patients were prospectively included in this study. All patients had liver cirrhosis and a confirmed HCC lesion which was treated with TACE. One month after treatment, perfusion measurements of treated lesions were carried out. The CT-perfusion (CT-p) protocol was performed with 16 slice multidetector computed tomography which included the following parameters: 8 dynamic slices/scan per 40 scans after iv injection of 50 mL of iodinated contrast (350 mg/mL) at a flow rate of 6 mL/s. Treated lesions were evaluated using dedicated perfusion software, which generated a quantitative colour map of perfusion. The following parameters were considered: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), hepatic perfusion index (HPI), and time to peak (TTP). Perfusion parameters were described with quartile values of their distribution and statistically analyzed.
RESULTS: Perfusion parameters of the treated lesions could be quantitatively assessed using CT-p analysis. The presence of residual tumor tissue was observed in 13 of the 32 patients. The values of the perfusion parameters measured within the relapse tissue were: HP (mL/100 g per minute): median = 44.4 (1stqt = 31.3, 3rdqt = 55.8); BV (mL/100 g): median = 18.7 (1stqt = 11.5, 3rdqt = 22.5); AP (mL/min): median = 39.0 (1stqt = 36.5, 3rdqt = 61.3); HPI (%): median = 34.0 (1stqt = 30.4, 3rdqt = 38.9); TTP (s): median = 17.3 (1stqt = 15.8, 3rdqt = 26.5). With the use of the univariate paired Wilcoxon signed rank test, HP, AP and HPI were shown to be significantly higher (P < 0.001) in the relapse site than in the primary lesion. The BV and TTP parameters showed a tendency to be greater and lower, respectively, in the relapse site than in the primary lesion.
CONCLUSION: In patients with HCC treated with TACE, CT-p provides measurement of flow parameters related to residual arterial structures in viable tumor, thus helping in the assessment of therapeutic response.
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