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Monti CB, Palmisano A. Coronary sinus reducer: a new hope for refractory angina? Lancet 2024; 403:1514-1515. [PMID: 38604208 DOI: 10.1016/s0140-6736(24)00474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Caterina B Monti
- Postgraduation School in Radiodiagnostics, University of Milan, 20133 Milan, Italy.
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Folco G, Monti CB, Zanardo M, Silletta F, Capra D, Secchi F, Sardanelli F. MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis. Eur Radiol 2024; 34:2699-2710. [PMID: 37823922 PMCID: PMC10957707 DOI: 10.1007/s00330-023-10260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI-derived ECV as an early cardiotoxicity biomarker to guide timely intervention. MATERIALS AND METHODS In April 2022, we performed a systematic search on EMBASE and PubMed for articles on MRI-derived ECV as a biomarker of cancer therapy cardiotoxicity. Two blinded researchers screened the retrieved articles, including those reporting ECV values at least 3 months from cardiotoxic treatment. Data extraction was performed for each article, including clinical and technical data, and ECV values. Pooled ECV was calculated using the random effects model and compared among different treatment regimens and among those who did or did not experience overt cardiac dysfunction. Meta-regression analyses were conducted to appraise which clinical or technical variables yielded a significant impact on ECV. RESULTS Overall, 19 studies were included. Study populations ranged from 9 to 236 patients, for a total of 1123 individuals, with an average age ranging from 12.5 to 74 years. Most studies included patients with breast or esophageal cancer, treated with anthracyclines and chest radiotherapy. Pooled ECV was 28.44% (95% confidence interval, CI, 26.85-30.03%) among subjects who had undergone cardiotoxic cancer therapy, versus 25.23% (95%CI 23.31-27.14%) among those who had not (p = .003). CONCLUSION A higher ECV in patients who underwent cardiotoxic treatment could imply subclinical changes in the myocardium, present even before overt cardiac pathology is detectable. CLINICAL RELEVANCE STATEMENT The ability to detect subclinical changes in the myocardium displayed by ECV suggests its use as an early biomarker of cancer therapy-related cardiotoxicity. KEY POINTS • Cardiotoxicity is a common adverse effect of cancer therapy; therefore, its prompt detection could improve patient outcomes. • Pooled MRI-derived myocardial extracellular volume was higher in patients who underwent cardiotoxic cancer therapy than in those who did not (28.44% versus 25.23%, p = .003). • MRI-derived myocardial extracellular volume represents a potential early biomarker of cancer therapy cardiotoxicity.
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Affiliation(s)
- Gianluca Folco
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Caterina B Monti
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Silletta
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Davide Capra
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Sardanelli F, Monti CB. CT features of acute aortic syndromes: A groundwork for AI and the future of photon-counting technology. Int J Cardiol 2023:S0167-5273(23)00710-6. [PMID: 37201614 DOI: 10.1016/j.ijcard.2023.05.020] [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: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Caterina B Monti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
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Palmisano A, Campochiaro C, Vignale D, Tomelleri A, De Luca G, Bruno E, Monti CB, Cavalli G, Dagna L, Esposito A. Cardiovascular involvement in Erdheim-Chester diseases is associated with myocardial fibrosis and atrial dysfunction. Radiol Med 2023; 128:456-466. [PMID: 36947276 PMCID: PMC10119040 DOI: 10.1007/s11547-023-01616-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Erdheim-Chester disease (ECD) is a rare multisystem histiocytosis, whose cardiovascular involvement has not been systematically characterized so far. We aimed to systematically (qualitatively and quantitatively) describe the features of cardiovascular involvement in a large cohort of ECD patients and to evaluate its impact on myocardial fibrosis extension and cardiac function. MATERIAL AND METHODS Among 54 patients with biopsy-proven ECD, 29 patients (59 ± 12 years, 79% males) underwent 1.5-T CMR using a standardized protocol for qualitative and quantitative assessment of disease localization, evaluation of atrial and ventricular function, and assessment of non-dense and dense myocardial fibrosis. RESULTS The right atrioventricular (AV) groove was the most commonly affected cardiac site (76%) followed by the right atrial walls (63%), thoracic aorta (59%), and superior vena cava (38%). Right AV groove involvement, encasing the right ventricular artery, was associated with non-dense myocardial fibrosis in the infero-septal (20/26 patients) and the inferior (14/26 patients) mid-basal left ventricular (LV) wall. In two patients with right AV groove localization, LGE revealed myocardial infarction in the same myocardial segments. Three out of five patients with left AV groove involvement had non-dense LGE on the lateral LV mid-basal wall. Bulky right atrial pseudomass was associated with atrial dysfunction and superior and inferior vena cava stenosis. CONCLUSIONS In ECD patients, AV groove localization is associated with LV wall fibrosis in the downstream coronary territories, suggesting hemodynamic alterations due to coronary encasement. Conversely, atrial pseudomass ECD localizations impact on atrial contractility causing atrial dysfunction and are associated with atrio-caval junction stenosis.
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Affiliation(s)
- Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 58 - 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Corrado Campochiaro
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 58 - 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Tomelleri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo De Luca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Bruno
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Giulio Cavalli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 58 - 60, 20132, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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Magni V, Capra D, Cozzi A, Monti CB, Mobini N, Colarieti A, Sardanelli F. Mammography biomarkers of cardiovascular and musculoskeletal health: A review. Maturitas 2023; 167:75-81. [PMID: 36308974 DOI: 10.1016/j.maturitas.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Breast density (BD) and breast arterial calcifications (BAC) can expand the role of mammography. In premenopause, BD is related to body fat composition: breast adipose tissue and total volume are potential indicators of fat storage in visceral depots, associated with higher risk of cardiovascular disease (CVD). Women with fatty breast have an increased likelihood of hypercholesterolemia. Women without cardiometabolic diseases with higher BD have a lower risk of diabetes mellitus, hypertension, chest pain, and peripheral vascular disease, while those with lower BD are at increased risk of cardiometabolic diseases. BAC, the expression of Monckeberg sclerosis, are associated with CVD risk. Their prevalence, 13 % overall, rises after menopause and is reduced in women aged over 65 receiving hormonal replacement therapy. Due to their distinct pathogenesis, BAC are associated with hypertension but not with other cardiovascular risk factors. Women with BAC have an increased risk of acute myocardial infarction, ischemic stroke, and CVD death; furthermore, moderate to severe BAC load is associated with coronary artery disease. The clinical use of BAC assessment is limited by their time-consuming manual/visual quantification, an issue possibly solved by artificial intelligence-based approaches addressing BAC complex topology as well as their large spectrum of extent and x-ray attenuations. A link between BD, BAC, and osteoporosis has been reported, but data are still inconclusive. Systematic, standardised reporting of BD and BAC should be encouraged.
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Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Nazanin Mobini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Anna Colarieti
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
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Secchi F, Asteria C, Monti CB, Malavazos AE, Capra D, Alì M, Giassi CLA, Francesconi S, Basilico S, Giovanelli A, Morricone L, Sardanelli F. Quantification of epicardial adipose tissue in obese patients using an open-bore MR scanner. Eur Radiol Exp 2022; 6:25. [PMID: 35606555 PMCID: PMC9127004 DOI: 10.1186/s41747-022-00274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Our aim was to evaluate the reproducibility of epicardial adipose tissue (EAT) volume, measured on scans performed using an open-bore magnetic resonance scanner. Methods Consecutive patients referred for bariatric surgery, aged between 18 and 65 years who agreed to undergo cardiac imaging (MRI), were prospectively enrolled. All those with cardiac pathology or contraindications to MRI were excluded. MRI was performed on a 1.0-T open-bore scanner, and EAT was segmented on all scans at both systolic and diastolic phase by two independent readers (R1 with four years of experience and R2 with one year). Data were reported as median and interquartile range; agreement and differences were appraised with Bland-Altman analyses and Wilcoxon tests, respectively. Results Fourteen patients, 11 females (79%) aged 44 (41–50) years, underwent cardiac MRI. For the first and second readings, respectively, EAT volume was 86 (78–95) cm3 and 85 (79–91) cm3 at systole and 82 (74–95) cm3 and 81 (75–94) cm3 at diastole for R1, and 89 (79–99) cm3 and 93 (84–98) cm3 at systole and 92 (85–103) cm3 and 93 (82–94) cm3 at diastole for R2. R1 had the best reproducibility at diastole (bias 0.3 cm3, standard deviation of the differences (SD) 3.3 cm3). R2 had the worst reproducibility at diastole (bias 3.9 cm3, SD 12.1 cm3). The only significant difference between systole and diastole was at the first reading by R1 (p = 0.016). The greatest bias was that of inter-reader reproducibility at diastole (-9.4 cm3). Conclusions Reproducibility was within clinically acceptable limits in most instances.
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Affiliation(s)
- Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carmela Asteria
- National Institute for Obesity Cure (INCO), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Alexis Elias Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Marco Alì
- Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano S.p.A., Milan, Italy.,Bracco Imaging S.p.A., Via Caduti di Marcinelle 13, 20134, Milan, Italy
| | - Cecilia L A Giassi
- National Institute for Obesity Cure (INCO), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simona Francesconi
- National Institute for Obesity Cure (INCO), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Basilico
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Giovanelli
- National Institute for Obesity Cure (INCO), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lelio Morricone
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Monti CB, van Assen M, Stillman AE, Lee SJ, Hoelzer P, Fung GSK, Secchi F, Sardanelli F, De Cecco CN. Evaluating the Performance of a Convolutional Neural Network Algorithm for Measuring Thoracic Aortic Diameters in a Heterogeneous Population. Radiol Artif Intell 2022; 4:e210196. [PMID: 35391773 DOI: 10.1148/ryai.210196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
Abstract
The purpose of this work was to assess the performance of a convolutional neural network (CNN) for automatic thoracic aortic measurements in a heterogeneous population. From June 2018 to May 2019, this study retrospectively analyzed 250 chest CT scans with or without contrast enhancement and electrocardiographic gating from a heterogeneous population with or without aortic pathologic findings. Aortic diameters at nine locations and maximum aortic diameter were measured manually and with an algorithm (Artificial Intelligence Rad Companion Chest CT prototype, Siemens Healthineers) by using a CNN. A total of 233 examinations performed with 15 scanners from three vendors in 233 patients (median age, 65 years [IQR, 54-72 years]; 144 men) were analyzed: 68 (29%) without pathologic findings, 72 (31%) with aneurysm, 51 (22%) with dissection, and 42 (18%) with repair. No evidence of a difference was observed in maximum aortic diameter between manual and automatic measurements (P = .48). Overall measurements displayed a bias of -1.5 mm and a coefficient of repeatability of 8.0 mm at Bland-Altman analyses. Contrast enhancement, location, pathologic finding, and positioning inaccuracy negatively influenced reproducibility (P < .003). Sites with dissection or repair showed lower agreement than did sites without. The CNN performed well in measuring thoracic aortic diameters in a heterogeneous multivendor CT dataset. Keywords: CT, Vascular, Aorta © RSNA, 2022.
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Affiliation(s)
- Caterina B Monti
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Arthur E Stillman
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Scott J Lee
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Philipp Hoelzer
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - George S K Fung
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Francesco Secchi
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Francesco Sardanelli
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322 (C.B.M., M.v.A., A.E.S., S.J.L., C.N.D.C.); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M., F. Secchi, F. Sardanelli); Digital Health Imaging Decision Support, Siemens Healthineers, Princeton, NJ (P.H.); Computed Tomography, Siemens Healthineers, Malvern, Pa (G.S.K.F.); and Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Italy (F. Secchi, F. Sardanelli)
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Magni V, Interlenghi M, Cozzi A, Alì M, Salvatore C, Azzena AA, Capra D, Carriero S, Della Pepa G, Fazzini D, Granata G, Monti CB, Muscogiuri G, Pellegrino G, Schiaffino S, Castiglioni I, Papa S, Sardanelli F. Development and Validation of an AI-driven Mammographic Breast Density Classification Tool Based on Radiologist Consensus. Radiol Artif Intell 2022; 4:e210199. [PMID: 35391766 DOI: 10.1148/ryai.210199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/16/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
Mammographic breast density (BD) is commonly visually assessed using the Breast Imaging Reporting and Data System (BI-RADS) four-category scale. To overcome inter- and intraobserver variability of visual assessment, the authors retrospectively developed and externally validated a software for BD classification based on convolutional neural networks from mammograms obtained between 2017 and 2020. The tool was trained using the majority BD category determined by seven board-certified radiologists who independently visually assessed 760 mediolateral oblique (MLO) images in 380 women (mean age, 57 years ± 6 [SD]) from center 1; this process mimicked training from a consensus of several human readers. External validation of the model was performed by the three radiologists whose BD assessment was closest to the majority (consensus) of the initial seven on a dataset of 384 MLO images in 197 women (mean age, 56 years ± 13) obtained from center 2. The model achieved an accuracy of 89.3% in distinguishing BI-RADS a or b (nondense breasts) versus c or d (dense breasts) categories, with an agreement of 90.4% (178 of 197 mammograms) and a reliability of 0.807 (Cohen κ) compared with the mode of the three readers. This study demonstrates accuracy and reliability of a fully automated software for BD classification. Keywords: Mammography, Breast, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Matteo Interlenghi
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Marco Alì
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Christian Salvatore
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Alcide A Azzena
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Davide Capra
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Serena Carriero
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Gianmarco Della Pepa
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Deborah Fazzini
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Giuseppe Granata
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Caterina B Monti
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Giulia Muscogiuri
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Giuseppe Pellegrino
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Simone Schiaffino
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Isabella Castiglioni
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Sergio Papa
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health (V.M., A.C., D.C., C.B.M., F.S.) and Postgraduate School in Radiodiagnostics (A.A.A., S.C., G.D.P., G.G., G.M., G.P.), Università degli Studi di Milano, Milan, Italy; DeepTrace Technologies, Milan, Italy (M.I., C.S.); Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano, Milan, Italy (M.A., D.F., S.P.); Bracco Imaging, Milan, Italy (M.A.); Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Palazzo del Broletto, Piazza della Vittoria 15, 27100 Pavia, Italy (C.S.); Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.); Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy (I.C.); and Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy (I.C.)
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9
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Martin SS, van Assen M, Burchett P, Monti CB, Schoepf UJ, Ravenel J, Rieter WJ, Vogl TJ, Costello P, Gordon L, De Cecco CN. Prospective Evaluation of the First Integrated Positron Emission Tomography/Dual-Energy Computed Tomography System in Patients With Lung Cancer. J Thorac Imaging 2021; 36:382-388. [PMID: 34029282 DOI: 10.1097/rti.0000000000000597] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this pilot study was to prospectively evaluate the first integrated positron emission tomography (PET)/dual-energy computed tomography (DECT) system performance in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS In this single-center, prospective trial, consecutive patients with NSCLC referred for a PET study between May 2017 and June 2018 were enrolled. All patients received contrast-enhanced imaging on a clinical PET/DECT system. Data analysis included PET-based standard uptake values (SUVmax) and DECT-based iodine densities of tumor masses, lymph nodes, and distant metastases. Results were analyzed using correlation tests and receiver operating characteristics curves. RESULTS The study population was composed of 21 patients (median age 62 y, 14 male patients). A moderate positive correlation was found between iodine density values (2.2 mg/mL) and SUVmax (10.5) in tumor masses (ρ=0.53, P<0.01). Iodine density values (2.3 mg/mL) and SUVmax (5.4) of lymph node metastases showed a weak positive correlation (ρ=0.23, P=0.14). In addition, iodine quantification analysis provided no added value in differentiating between pathologic and nonpathologic lymph nodes with an area under the curve (AUC) of 0.55 using PET-based SUVmax as the reference standard. A weak positive correlation was observed between iodine density (2.2 mg/mL) and SUVmax in distant metastases (14.9, ρ=0.23, P=0.52). CONCLUSIONS The application of an integrated PET/DECT system in lung cancer might provide additional insights in the assessment of tumor masses. However, the added value of iodine density quantification for the evaluation of lymph nodes and distant metastases seems limited.
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Affiliation(s)
- Simon S Martin
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marly van Assen
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Emory University, Atlanta, GA
| | - Philip Burchett
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - James Ravenel
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - William J Rieter
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philip Costello
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Leonie Gordon
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Emory University, Atlanta, GA
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10
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Monti CB, Capra D, Zanardo M, Guarnieri G, Schiaffino S, Secchi F, Sardanelli F. CT-derived epicardial adipose tissue density: Systematic review and meta-analysis. Eur J Radiol 2021; 143:109902. [PMID: 34482178 DOI: 10.1016/j.ejrad.2021.109902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/22/2021] [Accepted: 08/05/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The aim of our work was to systematically review and meta-analyze epicardial adipose tissue (EAT) density values reported in literature, assessing potential correlations of EAT density with segmentation thresholds and other technical and clinical variables. METHOD A systematic search was performed, aiming for papers reporting global EAT density values in Hounsfield Units (HU) in patients undergoing chest CT for any clinical indication. After screening titles, abstract and full text of each retrieved work, studies reporting mean and standard deviation for EAT density were ultimately included. Technical, clinical and EAT data were extracted, and divided into subgroups according to clinical conditions of reported subjects. Pooled density analyses were performed both overall and for subgroups according to clinical conditions. Metaregression analyses were done to appraise the impact of clinical and technical variables on EAT volume. RESULTS Out of 152 initially retrieved works, 13 were ultimately included, totaling for 7683 subjects. EAT density showed an overall pooled value of -85.86 HU (95% confidence interval [95% CI] -91.84, -79.89 HU), being -86.40 HU (95% CI -112.69, -60.12 HU) in healthy subjects and -80.71 HU (95% CI -87.43, -73.99 HU) in patients with coronary artery disease. EAT volume and lower and higher segmentation thresholds were found to be significantly correlated with EAT density (p = 0.044, p < 0.001 and p< 0.001 respectively). CONCLUSIONS Patients with coronary artery disease appear to present with higher EAT density values, while the correlations observed at metaregression highlight the need for well-established, shared thresholds for EAT segmentation.
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Affiliation(s)
- Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Gianluca Guarnieri
- Postgraduation School in Cardiology, Università degli Studi di Milano, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
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11
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Salvatore C, Interlenghi M, Monti CB, Ippolito D, Capra D, Cozzi A, Schiaffino S, Polidori A, Gandola D, Alì M, Castiglioni I, Messa C, Sardanelli F. Artificial Intelligence Applied to Chest X-ray for Differential Diagnosis of COVID-19 Pneumonia. Diagnostics (Basel) 2021; 11:530. [PMID: 33809625 PMCID: PMC8000736 DOI: 10.3390/diagnostics11030530] [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: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/05/2023] Open
Abstract
We assessed the role of artificial intelligence applied to chest X-rays (CXRs) in supporting the diagnosis of COVID-19. We trained and cross-validated a model with an ensemble of 10 convolutional neural networks with CXRs of 98 COVID-19 patients, 88 community-acquired pneumonia (CAP) patients, and 98 subjects without either COVID-19 or CAP, collected in two Italian hospitals. The system was tested on two independent cohorts, namely, 148 patients (COVID-19, CAP, or negative) collected by one of the two hospitals (independent testing I) and 820 COVID-19 patients collected by a multicenter study (independent testing II). On the training and cross-validation dataset, sensitivity, specificity, and area under the curve (AUC) were 0.91, 0.87, and 0.93 for COVID-19 versus negative subjects, 0.85, 0.82, and 0.94 for COVID-19 versus CAP. On the independent testing I, sensitivity, specificity, and AUC were 0.98, 0.88, and 0.98 for COVID-19 versus negative subjects, 0.97, 0.96, and 0.98 for COVID-19 versus CAP. On the independent testing II, the system correctly diagnosed 652 COVID-19 patients versus negative subjects (0.80 sensitivity) and correctly differentiated 674 COVID-19 versus CAP patients (0.82 sensitivity). This system appears promising for the diagnosis and differential diagnosis of COVID-19, showing its potential as a second opinion tool in conditions of the variable prevalence of different types of infectious pneumonia.
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Affiliation(s)
- Christian Salvatore
- Department of Science, Technology, and Society, Scuola Universitaria IUSS, Istituto Universitario di Studi Superiori, Piazza della Vittoria 15, 27100 Pavia, Italy;
- DeepTrace Technologies S.R.L., via Conservatorio 17, 20122 Milano, Italy; (M.I.); (A.P.)
| | - Matteo Interlenghi
- DeepTrace Technologies S.R.L., via Conservatorio 17, 20122 Milano, Italy; (M.I.); (A.P.)
| | - Caterina B. Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; (C.B.M.); (D.C.); (A.C.); (F.S.)
| | - Davide Ippolito
- Department of Radiology, ASST Monza—Ospedale San Gerardo, Via Pergolesi 33, 20900 Monza, Italy; (D.I.); (D.G.)
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; (C.B.M.); (D.C.); (A.C.); (F.S.)
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; (C.B.M.); (D.C.); (A.C.); (F.S.)
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy;
| | - Annalisa Polidori
- DeepTrace Technologies S.R.L., via Conservatorio 17, 20122 Milano, Italy; (M.I.); (A.P.)
| | - Davide Gandola
- Department of Radiology, ASST Monza—Ospedale San Gerardo, Via Pergolesi 33, 20900 Monza, Italy; (D.I.); (D.G.)
| | - Marco Alì
- Department of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147 Milano, Italy;
| | - Isabella Castiglioni
- Department of Physics, Università degli Studi di Milano-Bicocca, Piazza della Scienza 3, 20126 Milano, Italy
- Institute of Biomedical Imaging and Physiology, Consiglio Nazionale delle Ricerche, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Cristina Messa
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy;
- Fondazione Tecnomed, Università degli Studi di Milano-Bicocca, Palazzina Ciclotrone—Via Pergolesi 33, 20900 Monza, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; (C.B.M.); (D.C.); (A.C.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy;
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Secchi F, Alì M, Monti CB, Greiser A, Pluchinotta FR, Carminati M, Sardanelli F. Right and left ventricle native T1 mapping in systolic phase in patients with congenital heart disease. Acta Radiol 2021; 62:334-340. [PMID: 32475124 DOI: 10.1177/0284185120924563] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND T1 mapping is emerging as a powerful tool in cardiac magnetic resonance (CMR) to evaluate diffuse fibrosis. However, right ventricular (RV) T1 mapping proves difficult due to the limited wall thickness in diastolic phase. Several studies focused on systolic T1 mapping, albeit only on the left ventricle (LV). PURPOSE To estimate intra- and inter-observer variability of native T1 (nT1) mapping of the RV, and its correlations with biventricular and pulmonary function in patients with congenital heart disease (CHD). MATERIAL AND METHODS In this retrospective, observational, cross-sectional study we evaluated 36 patients with CHD, having undergone CMR on a 1.5-T scanner. LV and RV functional evaluations were performed. A native modified look-locker inversion recovery short-axis sequence was acquired in the systolic phase. Intra- and inter-reader reproducibility were reported as complement to 100% of the ratio between coefficient of reproducibility and mean. Spearman ρ and Mann-Whitney U-test were used to compare distributions. RESULTS Intra- and inter-reader reproducibility was 84% and 82%, respectively. Median nT1 was 1022 ms (interquartile range [IQR] 1108-972) for the RV and 947 ms (IQR 986-914) for the LV. Median RV-nT1 was 1016 ms (IQR 1090-1016) in patients with EDVI ≤100 mL/m2 and 1100 ms (IQR 1113-1100) in patients with EDVI >100 mL/m2 (P = 0.049). A significant negative correlation was found between RV ejection fraction and RV-nT1 (ρ = -0.284, P = 0.046). CONCLUSION Systolic RV-nT1 showed a high reproducibility and a negative correlation with RV ejection fraction, potentially reflecting an adaptation of the RV myocardium to pulmonary valve/conduit (dys)-function.
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Affiliation(s)
- Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Alì
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Mario Carminati
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Zanardo M, Sardanelli F, Rainford L, Monti CB, Murray JG, Secchi F, Cradock A. Technique and protocols for cardiothoracic time-resolved contrast-enhanced magnetic resonance angiography sequences: a systematic review. Clin Radiol 2020; 76:156.e9-156.e18. [PMID: 33008622 DOI: 10.1016/j.crad.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
AIM To review contrast medium administration protocols used for cardiothoracic applications of time-resolved, contrast-enhanced magnetic resonance angiography (MRA) sequences. MATERIALS AND METHODS A systematic search of the literature (Medline/EMBASE) was performed to identify articles utilising time-resolved MRA sequences, focusing on type of sequence, adopted technical parameters, contrast agent (CA) issues, and acquisition workflow. Study design, year of publication, population, magnetic field strength, type, dose, and injection parameters of CA, as well as technical parameters of time-resolved MRA sequences were extracted. RESULTS Of 117 retrieved articles, 16 matched the inclusion criteria. The study design was prospective in 9/16 (56%) articles, and study population ranged from 5 to 185 patients, for a total of 506 patients who underwent cardiothoracic time-resolved MRA. Magnetic field strength was 1.5 T in 13/16 (81%), and 3 T in 3/16 (19%) articles. The administered CA was gadobutrol (Gadovist) in 6/16 (37%) articles, gadopentetate dimeglumine (Magnevist) in 5/16 (31%), gadobenate dimeglumine (MultiHance) in 2/16 (13%), gadodiamide (Omniscan) in 2/16 (13%), gadofosveset trisodium (Ablavar, previously Vasovist) in 1/16 (6%). CA showed highly variable doses among studies: fixed amount or based on patient body weight (0.02-0.2 mmol/kg) and was injected with a flow rate ranging 1-5 ml/s. Sequences were TWIST in 13/16 (81%), TRICKS in 2/16 (13%), and CENTRA 1/16 articles (6%). CONCLUSION Time-resolved MRA sequences were adopted in different clinical settings with a large spectrum of technical approaches, mostly in association with different CA dose, type, and injection method. Further studies in relation to specific clinical indications are warranted to provide a common standardised acquisition protocol.
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Affiliation(s)
- M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
| | - F Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - C B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - J G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - F Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - A Cradock
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Spagnolo P, Giglio M, Di Marco D, Cannaò PM, Agricola E, Della Bella PE, Monti CB, Sardanelli F. Diagnosis of left atrial appendage thrombus in patients with atrial fibrillation: delayed contrast-enhanced cardiac CT. Eur Radiol 2020; 31:1236-1244. [PMID: 32886202 PMCID: PMC7880950 DOI: 10.1007/s00330-020-07172-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
Objectives The current reference standard for diagnosing LAA thrombi is transesophageal echocardiography (TEE), a semi-invasive technique. We aimed to devise an optimal protocol for cardiac computed tomography (CCT) in diagnosing left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF), using TEE as reference standard. Methods Two hundred sixty consecutive patients referred for radiofrequency ablation for AF were prospectively enrolled. All patients underwent CCT and TEE within 2 hours. The CCT protocol included one standard angiographic phase and three delayed acquisitions at 1-, 3-, and 6-min after contrast injection. Thrombi were defined as persisting defects at 6-min delayed acquisition. Results TEE demonstrated spontaneous contrast in 52 (20%) patients and thrombus in 10 (4%). In 63 patients (24%), CCT demonstrated LAA early filling defects at angiographic phase. Among them, 15 (6%) had a persistent defect at 1-min, 12 (5%) at 3-min, and 10 (4%) at 6-min. All 10 thrombi diagnosed on TEE were correctly identified by delayed CCT, without any false positives. For all phases, sensitivity and negative predictive were 100%. Specificity increased from 79% for the angiographic phase to 100% at 6-min. Positive predictive value increased from 16% to 100%. Estimated radiation exposure was 2.08 ± 0.76 mSv (mean ± standard deviation) for the angiographic phase and 0.45 ± 0.23 mSv for each delayed phase. Conclusion A CCT protocol adding a 6-min delayed phase to the angiographic phase can be considered optimized for the diagnosis of LAA thrombi, with a low radiation dose. Key Points • In patients with persistent atrial fibrillation referred for ablation procedures, a cardiac CT examination comprising an angiographic-phase acquisition and, in case of filling defects, a 6-min delayed phase may help reduce the need for transesophageal echocardiography. • Cardiac CT would provide morphological and volumetric data, along with the potential to exclude the presence of thrombi in the left atrial appendage.
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Affiliation(s)
- Pietro Spagnolo
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Manuela Giglio
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Daniela Di Marco
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola M Cannaò
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Eustachio Agricola
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo E Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, Department of Cardiology and Cardiothoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Francesco Sardanelli
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Zanardo M, Martini C, Monti CB, Cattaneo F, Ciaralli C, Cornacchione P, Durante S. Management of patients with suspected or confirmed COVID-19, in the radiology department. Radiography (Lond) 2020; 26:264-268. [PMID: 32340912 PMCID: PMC7167552 DOI: 10.1016/j.radi.2020.04.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES From December 2019, a novel coronavirus disease named COVID-19 was reported in China. Within 3 months, the World Health Organization defined COVID-19 as a pandemic, with more than 370,000 cases and 16,000 deaths worldwide. In consideration of the crucial role of diagnostic testing during COVID-19, the aim of this technical note was to provide a complete synthesis of approaches implemented for the management of suspected or confirmed COVID-19 patients. KEY FINDINGS The planning of a robust plan to prevent the transmission of the virus to patients and department staff members should be fundamental in each radiology service. Moreover, the speed of spread and the incidence of the pandemic make it necessary to optimize the use of personal protective devices and dedicated COVID-19 equipment, given the limited availability of supplies. CONCLUSION In the management of radiographic and CT imaging, staff should take special precautions to limit contamination between patients and other patients or professionals. IMPLICATIONS FOR PRACTICE An isolated imaging room should be dedicated to suspected or confirmed COVID-19 cases, including radiography and CT scanners. This paper will provide guidance concerning disposable protective gear to be utilized, as well as on the cleaning and sanitation of radiology room and equipment.
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Affiliation(s)
- M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy; FASTeR, Italian Federation of Scientific Radiographers Societies, Italy.
| | - C Martini
- FASTeR, Italian Federation of Scientific Radiographers Societies, Italy; Department of Health Professions, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - C B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - F Cattaneo
- Department of Neuroscience, Centre of Sleep Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - C Ciaralli
- UOS Professioni Sanitarie Tecniche, INMI Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - P Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - S Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Affiliation(s)
- Carlo N De Cecco
- From the Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Suite EG45, Atlanta, GA 30322 (C.N.D.C., C.B.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M.)
| | - Caterina B Monti
- From the Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Suite EG45, Atlanta, GA 30322 (C.N.D.C., C.B.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (C.B.M.)
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Monti CB, Codari M, De Cecco CN, Secchi F, Sardanelli F, Stillman AE. Novel imaging biomarkers: epicardial adipose tissue evaluation. Br J Radiol 2019; 93:20190770. [PMID: 31782934 DOI: 10.1259/bjr.20190770] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Epicardial adipose tissue (EAT) is a metabolically activated beige adipose tissue, non-homogeneously surrounding the myocardium. Physiologically, EAT regulates toxic fatty acids, protects the coronary arteries against mechanical strain, regulates proinflammatory cytokines, stimulates the production of nitric oxide, reduces oxidative stress, and works as a thermogenic source against hypothermia. Conversely, EAT has pathologic paracrine interactions with the surrounded vessels, and might favour the onset of atrial fibrillation. In addition, initial atherosclerotic lesions can promote inflammation and trigger the EAT production of cytokines increasing vascular inflammation, which, in turn, may help the development of collateral vessels but also of self-stimulating, dysregulated inflammatory process, increasing coronary artery disease severity. Variations in EAT were also linked to metabolic syndrome. Echocardiography first estimated EAT measuring its thickness on the free wall of the right ventricle but does not allow accurate volumetric EAT estimates. Cardiac CT (CCT) and cardiac MR (CMR) allow for three-dimensional EAT estimates, the former showing higher spatial resolution and reproducibility but being limited by radiation exposure and long segmentation times, the latter being radiation-free but limited by lower spatial resolution and reproducibility, higher cost, and difficulties for obese patients. EAT radiodensity at CCT could to be related to underlying metabolic processes. The correlation between EAT and response to certain pharmacological therapies has also been investigated, showing promising results. In the future, semi-automatic or fully automatic techniques, machine/deep-learning methods, if validated, will facilitate research for various EAT measures and may find a place in CCT/CMR reporting.
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Affiliation(s)
- Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Marina Codari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Carlo Nicola De Cecco
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Arthur E Stillman
- Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
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