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Damiani Ferretti M, Rimondi MR, Zompatori M. When Emphysema Meets Fibrosis: A Pictorial Essay. J Thorac Imaging 2024; 39:W5-W10. [PMID: 37423612 DOI: 10.1097/rti.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Many lung diseases, first, tumors, are smoking-related, and it is very likely to find more than one pattern in the same patient. Airspace enlargement with fibrosis (AEF) is one of them, but it has not been deeply understood or studied yet. In fact, we think that it might still be wrongly assimilated with other conditions that have different radiological features altogether and different prognoses. This pictorial essay is aimed at pointing out AEF so that radiologists and pulmonologists get acquainted with it and use the proper terminology, as AEF might not be that rare.
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Affiliation(s)
| | - Maria Rita Rimondi
- Cardio-Thoracic Radiology Unit, University Hospital Sant'Orsola, Malpighi, Italy
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Poerio A, Carlicchi E, Zompatori M. Diagnosis of interstitial lung disease (ILD) secondary to systemic sclerosis (SSc) and rheumatoid arthritis (RA) and identification of 'progressive pulmonary fibrosis' using chest CT: a narrative review. Clin Exp Med 2023; 23:4721-4728. [PMID: 37803100 DOI: 10.1007/s10238-023-01202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
Interstitial lung disease (ILD) is a frequent manifestation of connective tissue diseases (CTDs), with incidence and prevalence variously assessed in the literature but reported in up to 30% of patients, with higher frequency in rheumatoid arthritis (RA) and systemic sclerosis (SSc). Recent years have seen a growing interest in the pulmonary manifestations of ILD-CTDs, mainly due to the widening of the use of anti-fibrotic drugs initially introduced exclusively for IPF, and radiologists play a key role because the lung biopsy is very rarely used in these patients where the morphological assessment is essentially left to imaging and especially HRCT. In this narrative review we will discuss, from the radiologist's point of view, the most recent findings in the field of ILD secondary to SSc and RA, with a special focus about the progression of disease and in particular about the 'progressive pulmonary fibrosis' (PPF) phenotype, and we will try to address two main issues: How to predict a possible evolution and therefore a worse prognosis when diagnosing a new case of ILD-CTDs and how to assess the progression of an already diagnosed ILD-CTDs.
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Affiliation(s)
- Antonio Poerio
- Radiology Unit - S. Maria della Scaletta Hospital, Imola, Italy.
| | | | - Maurizio Zompatori
- Department of Radiology - Villa Erbosa, Gruppo San Donato, Bologna, Italy
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Poerio A, Carlicchi E, Zompatori M. Correction to: Diagnosis of interstitial lung disease (ILD) secondary to systemic sclerosis (SSc) and rheumatoid arthritis (RA) and identification of 'progressive pulmonary fibrosis' using chest CT: a narrative review. Clin Exp Med 2023; 23:4729. [PMID: 37985534 DOI: 10.1007/s10238-023-01250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Antonio Poerio
- Radiology Unit - S. Maria della Scaletta Hospital, Imola, Italy.
| | | | - Maurizio Zompatori
- Department of Radiology - Villa Erbosa, Gruppo San Donato, Bologna, Italy
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Caminati A, Zompatori M, Fuccillo N, Sonaglioni A, Elia D, Cassandro R, Trevisan R, Rispoli A, Pelosi G, Harari S. Coronary artery calcium score is a prognostic factor for mortality in idiopathic pulmonary fibrosis. Minerva Med 2023; 114:815-824. [PMID: 35671002 DOI: 10.23736/s0026-4806.22.08018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiovascular diseases are frequent in idiopathic pulmonary fibrosis (IPF) and impact on survival. We investigated the association of coronary artery calcium (CAC) score at IPF diagnosis and during mid-term follow-up, with adverse cardiovascular events and all-cause mortality. METHODS Consecutive patients with IPF were retrospectively analyzed. Demographic data, smoking history, comorbidities and pulmonary function tests (PFTs) were recorded. All patients had at least two chest high resolution computed tomography (HRCT) performed 2 years apart. The total CAC score and visual fibrotic score were calculated, and all clinically significant cardiovascular events and deaths were reported. RESULTS The population consisted of 79 patients (57 males, mean age: 74.4±7.6 years); 67% of patients had a history of smoking, 48% of hypertension, 37% of dyslipidemia and 22.8% of diabetes. The visual score was 21.28±7.99% at T0 and 26.54±9.34% at T1, respectively (T1-T0 5.26±6.13%, P<0.001). CAC score at T0 and at T1 was 537.93±839.94 and 759.98±1027.6, respectively (T1-T0 224.66±406.87, P<0.001). Mean follow-up time was 2.47±1.1 years. On multivariate analysis, male sex (HR=3.58, 95% CI: 1.14-11.2) and CAC score at T0 (HR=1.04, 95% CI: 1.01-1.07) correlated with mortality and cardiovascular events. CAC score at T0≥405 showed 82% sensitivity and 100% specificity for predicting mortality and adverse cardiovascular events. CONCLUSIONS IPF patients with a CAC score at diagnosis ≥405 have a poor prognosis over a mid-term follow-up. A higher CAC score is associated with mortality and cardiovascular events.
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Affiliation(s)
- Antonella Caminati
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy -
| | - Maurizio Zompatori
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
- DIMES Department, University of Bologna, Bologna, Italy
| | - Nicoletta Fuccillo
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | | | - Davide Elia
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | - Roberto Cassandro
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
| | - Roberta Trevisan
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
| | - Anna Rispoli
- Department of Diagnostic Imaging, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Pelosi
- Intercompany Service of Pathological Anatomy, Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy
| | - Sergio Harari
- Unit of Pneumology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, IRCCS MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Caminati A, Awad I, Elia D, Cassandro R, Mozzanica F, Pelosi G, Zompatori M, Harari S. Significant functional improvement in IPF patient treated with antifibrotic drugs: preliminary results and clinical outcome. Minerva Med 2023; 114:736-738. [PMID: 37310710 DOI: 10.23736/s0026-4806.23.08720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Antonella Caminati
- Unit of Pulmonology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, MultiMedica IRCCS, Milan, Italy -
| | - Inas Awad
- Unit of Pulmonology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, MultiMedica IRCCS, Milan, Italy
| | - Davide Elia
- Unit of Pulmonology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, MultiMedica IRCCS, Milan, Italy
| | - Roberto Cassandro
- Unit of Pulmonology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, MultiMedica IRCCS, Milan, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IRCCS MultiMedica, Milan, Italy
| | | | - Sergio Harari
- Unit of Pulmonology and Semi-Intensive Respiratory Therapy, Section of Respiratory Pathophysiology and Pulmonary Hemodynamics, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Sonaglioni A, Caminati A, Elia D, Trevisan R, Zompatori M, Grasso E, Lombardo M, Harari S. Comparison of clinical scoring to predict mortality risk in mild-to-moderate idiopathic pulmonary fibrosis. Minerva Med 2023; 114:608-619. [PMID: 37204783 DOI: 10.23736/s0026-4806.23.08585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND During the last decade, a number of clinical scores, such as Gender-Age-Physiology (GAP) Index, TORVAN Score and Charlson Comorbidity Index (CCI), have been separately used to measure comorbidity burden in idiopathic pulmonary fibrosis (IPF). However, no previous study compared the prognostic value of these scores to assess mortality risk stratification in IPF patients with mild-to-moderate disease. METHODS All consecutive patients with mild-to-moderate IPF who underwent high-resolution computed tomography, spirometry, transthoracic echocardiography and carotid ultrasonography at our Institution, between January 2016 and December 2018, were retrospectively analyzed. GAP Index, TORVAN Score and CCI were calculated in all patients. Primary endpoint was all-cause mortality, whereas secondary endpoint was the composite of all-cause mortality and rehospitalizations for all-causes, over medium-term follow-up. RESULTS Seventy IPF patients (70.2±7.4 yrs, 74.3% males) were examined. At baseline, GAP Index, TORVAN Score and CCI were 3.4±1.1, 14.7±4.1 and 5.3±2.4, respectively. A strong correlation between coronary artery calcification (CAC) and common carotid artery (CCA) intima-media thickness (IMT) (r=0.88), CCI and CAC (r=0.80), CCI and CCA-IMT (r=0.81), was demonstrated in the study group. Follow-up period was 3.5±1.2 years. During follow-up, 19 patients died and 32 rehospitalizations were detected. CCI (HR 2.39, 95% CI: 1.31-4.35) and heart rate (HR 1.10, 95% CI: 1.04-1.17) were independently associated with primary endpoint. CCI (HR 1.54, 95% CI: 1.15-2.06) predicted secondary endpoint, also. A CCI ≥6 was the optimal cut-off for predicting both outcomes. CONCLUSIONS Due to the increased atherosclerotic and comorbidity burden, IPF patients with CCI ≥6 at an early-stage disease have poor outcome over medium-term follow-up.
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Affiliation(s)
| | - Antonella Caminati
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy -
| | - Davide Elia
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy
| | | | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Sergio Harari
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Sonaglioni A, Caminati A, Re M, Elia D, Trevisan R, Granato A, Zompatori M, Lombardo M, Harari S. Prognostic role of CHA 2DS 2-VASc score for mortality risk assessment in non-advanced idiopathic pulmonary fibrosis: a preliminary observation. Intern Emerg Med 2023; 18:755-767. [PMID: 36966265 PMCID: PMC10039767 DOI: 10.1007/s11739-023-03219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 03/27/2023]
Abstract
During the last decade, the CHA2DS2-VASc score has been used for stratifying the mortality risk in both atrial fibrillation (AF) and non-AF patients. However, no previous study considered this score as a prognostic indicator in non-AF patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF). All consecutive non-AF patients with mild-to-moderate IPF, diagnosed between January 2016 and December 2018 at our Institution, entered this study. All patients underwent physical examination, blood tests, spirometry, high-resolution computed tomography and transthoracic echocardiography. CHA2DS2-VASc score, Gender-Age-Physiology (GAP) index and Charlson Comorbidity Index (CCI) were determined in all patients. Primary endpoint was all-cause mortality, while the secondary endpoint was the composite of all-cause mortality and rehospitalizations for all causes over mid-term follow-up. 103 consecutive IPF patients (70.7 ± 7.3 yrs, 79.6% males) were retrospectively analyzed. At the basal evaluation, CHA2DS2-VASc score, GAP index and CCI were 3.7 ± 1.6, 3.6 ± 1.2 and 5.5 ± 2.3, respectively. Mean follow-up was 3.5 ± 1.3 yrs. During the follow-up period, 29 patients died and 43 were re-hospitalized (44.2% due to cardiopulmonary causes). On multivariate Cox regression analysis, CHA2DS2-VASc score (HR 2.15, 95% CI 1.59-2.91) and left ventricular ejection fraction (LVEF) (HR 0.91, 95% CI 0.86-0.97) were independently associated with all-cause mortality in IPF patients. CHA2DS2-VASc score (HR 1.66, 95% CI 1.39-1.99) and LVEF (HR 0.94, 95% CI 0.90-0.98) also predicted the secondary endpoint in the same study group. CHA2DS2-VASc score > 4 was the optimal cut-off for predicting both outcomes. At mid-term follow-up, a CHA2DS2-VASc score > 4 predicts an increased risk of all-cause mortality and rehospitalizations for all causes in non-AF patients with mild-to-moderate IPF.
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Affiliation(s)
| | - Antonella Caminati
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy.
| | - Margherita Re
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
| | - Davide Elia
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
| | | | - Alberto Granato
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | | | | | - Sergio Harari
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
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Sonaglioni A, Nicolosi GL, Trevisan R, Granato A, Zompatori M, Lombardo M. Modified Haller index validation and correlation with left ventricular strain in a cohort of subjects with obesity and without overt heart disease. Intern Emerg Med 2022; 17:1907-1919. [PMID: 35753022 DOI: 10.1007/s11739-022-03026-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/04/2022] [Indexed: 12/29/2022]
Abstract
The present study was primarily designed to validate the modified Haller index (MHI), the ratio of chest transverse diameter over the distance between sternum and spine, measured by a ruler and transthoracic echocardiography (TTE), respectively, in a cohort of subjects with obesity, but otherwise healthy, by comparing the results to the conventional Haller index (HI) measured on chest X-ray (CXR). 100 consecutive subjects with body mass index (BMI) ≥ 30 kg/m2 and 60 matched controls with BMI < 30 kg/m2, who underwent a two-plane CXR for any clinical indication, were prospectively examined over a 6-month period. All participants underwent MHI assessment, TTE and speckle-tracking analysis of left ventricular (LV) global longitudinal strain (GLS). Bland-Altman analysis was used to compare the radiological and nonradiological techniques. Second, independent predictors of subclinical myocardial dysfunction, defined as LV-GLS less negative than - 20%, were evaluated. Bland-Altman analysis revealed a bias of - 4.91 cm for latero-lateral thoracic diameter, of - 0.74 cm for antero-posterior (A-P) thoracic diameter and of - 0.22 for HI assessment, suggesting a systematic overestimation of the nonradiological methodology in comparison to that radiological. Despite normal LV systolic function on TTE, LV-GLS resulted impaired in 76% of subjects with obesity. Waist circumference (OR 1.13, 95%CI 1.04-1.22) and nonradiological A-P thoracic diameter (OR 0.51, 95%CI 0.28-0.93) were the main independent predictors of subclinical myocardial dysfunction in subjects with obesity. The impairment in LV myocardial strain detected in subjects with obesity appears to be primarily related to extrinsic abdominal and thoracic compressive phenomena, rather than intrinsic myocardial dysfunction.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | | | - Roberta Trevisan
- Division of Radiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Alberto Granato
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini 2, Grugliasco, 10095, Turin, Italy
| | - Maurizio Zompatori
- Division of Radiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
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Elia D, Mozzanica F, Caminati A, Giana I, Carli L, Ambrogi F, Zompatori M, Harari S. Prognostic value of radiological index and clinical data in patients with COVID-19 infection. Intern Emerg Med 2022; 17:1679-1687. [PMID: 35596103 PMCID: PMC9122253 DOI: 10.1007/s11739-022-02985-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/05/2022] [Indexed: 01/08/2023]
Abstract
During the Coronavirus-19 pandemic, chest X-ray scoring system have been validated by Al-Smadi and Toussie in this group of patients and even RALE score, previously designed for ARDS, have been used to estimate correlation with mortality. The aim of this study was to evaluate the prognostic value of As-Smadi, Tuossie and RALE scores in predicting death in the same population of patients when associated to clinical data. In this retrospective clinical study, data of patients with COVID-19, admitted to our hospital from 1st October 2020 to 31st December 2020 were collected. CXR images of each patient were analyzed with the three different scores above mentioned. 144 patients (male 96 aged 68.5 years) were included in the study. 93 patients reported a least 1 comorbidity and 36 died. The association with increasing age, presence of comorbidities, and lower hemoglobin was significantly associated with risk of death for all the regression models. When considering the radiological score, a significant effect was found for the Al Smadi and RALE scores, while no evidence of association was found for the Toussie score. The fraction of new information is 16.7% for the Al Smadi score, 12.9% for the RALE and 5.1% for the Toussie score. The improvement in the prognostic usefulness with respect to the base model is particularly interesting for the Al Smadi score. The highest c-index was also obtained by the model with the Al Smadi score.
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Affiliation(s)
- Davide Elia
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - Antonella Caminati
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy.
| | - Ilaria Giana
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Leonardo Carli
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Federico Ambrogi
- Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - Maurizio Zompatori
- U.O. Di Radiologia Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Sergio Harari
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Mura M, Rellini C, Taha N, Sbordone FP, Rufi F, Montesanto F, Floris R, Zompatori M, Sergiacomi G. Radiographic Progression and Survival of the Different HRCT Patterns of Idiopathic Pulmonary Fibrosis. Sarcoidosis Vasc Diffuse Lung Dis 2022; 39:e2022021. [PMID: 36118536 PMCID: PMC9437754 DOI: 10.36141/svdld.v39i2.12534] [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] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a chronic disease with a peculiar (typical) HRCT pattern, but biopsy can demonstrate usual interstitial pneumonia in patients with atypical patterns. It is unknown how progression pattern varies among different radiographic presentations of IPF. We sought to investigate the longitudinal radiographic evolution and survival of typical and non-typical patterns. MATERIALS AND METHODS One-hundred-twenty-three patients diagnosed with IPF in 2 tertiary referral hospitals were included in the study. Longitudinal evolution of non-typical patterns was considered. The HRCT visual fibrosis score was used as a reliable evaluation tool of disease progression. HRCTs were scored by 2 senior chest radiologists with ILD expertise. The primary endpoint was the evolution of the presentation pattern to probable or typical. The secondary endpoint was lung transplant (LTx)-free survival from the time of diagnosis. RESULTS Average interval between HRCTs was 16±5 months; average follow-up after the 2nd HRCT was 17±11 months. Four out of 45 (8.9%) patients with probable pattern "evolved" to a typical pattern of IPF, while 5 out of 31 (16.1%) with indeterminate/alternative pattern "evolved" to probable pattern. An average HRCT fibrosis score increase of 9±11% was observed with typical (n=49), 6±5% with probable (n=43) and 7±8% (n=31) with indeterminate/alternative presentation pattern. LTx-free survival and lung function declines did not show any difference related to presentation HRCT patterns. CONCLUSIONS The evolution of a non-typical UIP pattern to a typical one is infrequent. All presentation HRCT patterns of IPF evolve in similar way and are associated with comparable survival time.[/sc].
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Affiliation(s)
- Marco Mura
- Division of Respirology, Western University, London, Ontario, Canada
| | - Carlotta Rellini
- Diagnostica per immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
| | - Nada Taha
- Division of Respirology, Western University, London, Ontario, Canada
| | - Francesco Paolo Sbordone
- Diagnostica per immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
| | - Flavia Rufi
- Diagnostica per immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
| | - Francesca Montesanto
- Diagnostica per immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
| | - Roberto Floris
- Diagnostica per immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
| | | | - Gianluigi Sergiacomi
- Diagnostica per immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
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Keow J, Cecchini MJ, Jayawardena N, Zompatori M, Joseph MG, Mura M. Digital quantification of p16-positive foci in fibrotic interstitial lung disease is associated with a phenotype of idiopathic pulmonary fibrosis with reduced survival. Respir Res 2022; 23:147. [PMID: 35672770 PMCID: PMC9175499 DOI: 10.1186/s12931-022-02067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is associated with increased expression of cyclin-dependent kinase inhibitors such as p16 and p21, and subsequent induction of cell cycle arrest, cellular senescence, and pro-fibrotic gene expression. We sought to link p16-expression with a diagnosis of IPF or other fibrotic interstitial lung diseases (ILDs), radiographic pattern, senescent foci-specific gene expression, antifibrotic therapy response, and lung transplant (LTx)-free survival. METHODS Eighty-six cases of fibrosing ILD were identified with surgical lung biopsy. Immunohistochemistry for p16 was performed on sections with the most active fibrosis. p16-positive foci (loose collection of p16-positive fibroblasts with overlying p16-positive epithelium) were identified on digital slides and quantified. Cases were scored as p16-low (≤ 2.1 foci per 100 mm2) or p16-high (> 2.1 foci per 100 mm2). Twenty-four areas including senescent foci, fibrotic and normal areas were characterized using in situ RNA expression analysis with digital spatial profiling (DSP) in selected cases. RESULTS The presence of p16-positive foci was specific for the diagnosis of IPF, where 50% of cases expressed any level of p16 and 26% were p16-high. There was no relationship between radiographic pattern and p16 expression. However, there was increased expression of cyclin-dependent kinase inhibitors, collagens and matrix remodeling genes within p16-positive foci, and cases with high p16 expression had shorter LTx-free survival. On the other hand, antifibrotic therapy was significantly protective. DSP demonstrated that fibroblastic foci exhibit transcriptional features clearly distinct from that of normal-looking and even fibrotic areas. CONCLUSIONS We demonstrated the potential clinical applicability of a standardized quantification of p16-positive fibroblastic foci. This method identifies an IPF phenotype associated with foci-specific upregulation of senescence-associated and matrix remodeling gene expression. While these patients have reduced LTx-free survival, good response to antifibrotic therapies was observed in those who were treated.
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Affiliation(s)
- Jonathan Keow
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Nathashi Jayawardena
- Interstitial Lung Disease Research Laboratory, Lawson Research Institute, Western University, London, ON, Canada
| | | | - Mariamma G Joseph
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Marco Mura
- Interstitial Lung Disease Research Laboratory, Lawson Research Institute, Western University, London, ON, Canada. .,Division of Respirology, Department of Medicine, Western University, London, ON, Canada.
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12
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Schifino G, Vega ML, Pisani L, Prediletto I, Catalanotti V, Comellini V, Bassi I, Zompatori M, Ranieri MV, Nava S. Effects of non-invasive respiratory supports on inspiratory effort in moderate-severe COVID-19 patients. A randomized physiological study. Eur J Intern Med 2022; 100:110-118. [PMID: 35483993 PMCID: PMC9023341 DOI: 10.1016/j.ejim.2022.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVE Various forms of Non-invasive respiratory support (NRS) have been used during COVID-19, to treat Hypoxemic Acute Respiratory Failure (HARF), but it has been suggested that the occurrence of strenuous inspiratory efforts may cause Self Induced Lung Injury(P-SILI). The aim of this investigation was to record esophageal pressure, when starting NRS application, so as to better understand the potential risk of the patients in terms of P-SILI and ventilator induced lung injury (VILI). METHODS AND MEASUREMENTS 21 patients with early de-novo respiratory failure due to COVID-19, underwent three 30 min trials applied in random order: high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV). After each trial, standard oxygen therapy was reinstituted using a Venturi mask (VM). 15 patients accepted a nasogastric tube placement. Esophageal Pressure (ΔPes) and dynamic transpulmonary driving pressure (ΔPLDyn), together with the breathing pattern using a bioelectrical impedance monitor were recorded. Arterial blood gases were collected in all patients. MAIN RESULTS No statistically significant differences in breathing pattern and PaCO2 were found. PaO2/FiO2 ratio improved significantly during NIV and CPAP vs VM. NIV was the only NRS to reduce significantly ΔPes vs. VM (-10,2 ±5 cmH20 vs -3,9 ±3,4). No differences were found in ΔPLDyn between NRS (10,2±5; 9,9±3,8; 7,6±4,3; 8,8±3,6 during VM, HFNC, CPAP and NIV respectively). Minute ventilation (Ve) was directly dependent on the patient's inspiratory effort, irrespective of the NRS applied. 14% of patients were intubated, none of them showing a reduction in ΔPes during NRS. CONCLUSIONS In the early phase of HARF due to COVID-19, the inspiratory effort may not be markedly elevated and the application of NIV and CPAP ameliorates oxygenation vs VM. NIV was superior in reducing ΔPes, maintaining ΔPLDyn within a range of potential safety.
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Affiliation(s)
- Gioacchino Schifino
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Maria L Vega
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Lara Pisani
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Irene Prediletto
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Vito Catalanotti
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Vittoria Comellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Ilaria Bassi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Maurizio Zompatori
- IRCCS MultiMedica, Division of Radiology Sesto, San Giovanni, Lombardia, Italy
| | - Marco Vito Ranieri
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Stefano Nava
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy.
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13
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Poellinger A, Berezowska S, Myers JL, Huber A, Funke-Chambour M, Guler S, Geiser T, Harari S, Caminati A, Zompatori M, Sverzellati N. The Octopus Sign—A New HRCT Sign in Pulmonary Langerhans Cell Histiocytosis. Diagnostics (Basel) 2022; 12:diagnostics12040937. [PMID: 35453983 PMCID: PMC9025181 DOI: 10.3390/diagnostics12040937] [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: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Fibrosis in pulmonary Langerhans cell histiocytosis (PLCH) histologically comprises a central scar with septal strands and associated airspace enlargement that produce an octopus-like appearance. The purpose of this study was to identify the octopus sign on high-resolution computed tomography (HRCT) images to determine its frequency and distribution across stages of the disease. Methods: Fifty-seven patients with confirmed PLCH were included. Two experienced chest radiologists assessed disease stages as early, intermediate, or late, as well as the lung parenchyma for nodular, cystic, or fibrotic changes and for the presence of the octopus sign. Statistical analysis included Cohen’s kappa for interrater agreement and Fisher’s exact test for the frequency of the octopus sign. Results: Interobserver agreement was substantial for the octopus sign (kappa = 0.747). Significant differences in distribution of the octopus sign between stages 2 and 3 were found with more frequent octopus signs in stage 2 and fewer in stage 3. In addition, we only found the octopus sign in cases of nodular und cystic lung disease. Conclusions: The octopus sign in PLCH can be identified not only on histological images, but also on HRCT images. Its radiological presence seems to depend on the stage of PLCH.
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Affiliation(s)
- Alexander Poellinger
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-(0)-31-63-2-24-35
| | - Sabina Berezowska
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 25, 1011 Lausanne, Switzerland;
| | - Jeffrey Leon Myers
- Department of Pathology, University of Michigan Hospital, Ann Arbor, MI 48109, USA;
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland;
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland; (M.F.-C.); (S.G.); (T.G.)
| | - Sabina Guler
- Department of Pulmonary Medicine, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland; (M.F.-C.); (S.G.); (T.G.)
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland; (M.F.-C.); (S.G.); (T.G.)
| | - Sergio Harari
- Department of Medicine, Division of Internal Medicine, Ospedale San Giuseppe MultiMedica IRCCS, University of Milan, 20133 Milan, Italy; (S.H.); (M.Z.)
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria e Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, University of Milan, 20133 Milan, Italy;
| | - Maurizio Zompatori
- Department of Medicine, Division of Internal Medicine, Ospedale San Giuseppe MultiMedica IRCCS, University of Milan, 20133 Milan, Italy; (S.H.); (M.Z.)
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, Padiglione Barbieri, University of Parma, V. Gramsci 14, 43124 Parma, Italy;
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14
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Faverio P, Luppi F, Rebora P, D'Andrea G, Stainer A, Busnelli S, Catalano M, Modafferi G, Franco G, Monzani A, Galimberti S, Scarpazza P, Oggionni E, Betti M, Oggionni T, De Giacomi F, Bini F, Bodini BD, Parati M, Bilucaglia L, Ceruti P, Modina D, Harari S, Caminati A, Intotero M, Sergio P, Monzillo G, Leati G, Borghesi A, Zompatori M, Corso R, Valsecchi MG, Bellani G, Foti G, Pesci A. One-year pulmonary impairment after severe COVID-19: a prospective, multicenter follow-up study. Respir Res 2022; 23:65. [PMID: 35313890 PMCID: PMC8934910 DOI: 10.1186/s12931-022-01994-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 10/27/2021] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
Background Long-term pulmonary sequelae following hospitalization for SARS-CoV-2 pneumonia is largely unclear. The aim of this study was to identify and characterise pulmonary sequelae caused by SARS-CoV-2 pneumonia at 12-month from discharge. Methods In this multicentre, prospective, observational study, patients hospitalised for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support (“oxygen only”, “continuous positive airway pressure (CPAP)” and “invasive mechanical ventilation (IMV)”) and followed up at 12 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6 min walking test, high resolution CT (HRCT) scan, and modified Medical Research Council (mMRC) dyspnea scale were collected. Results Out of 287 patients hospitalized with SARS-CoV-2 pneumonia and followed up at 1 year, DLCO impairment, mainly of mild entity and improved with respect to the 6-month follow-up, was observed more frequently in the “oxygen only” and “IMV” group (53% and 49% of patients, respectively), compared to 29% in the “CPAP” group. Abnormalities at chest HRCT were found in 46%, 65% and 80% of cases in the “oxygen only”, “CPAP” and “IMV” group, respectively. Non-fibrotic interstitial lung abnormalities, in particular reticulations and ground-glass attenuation, were the main finding, while honeycombing was found only in 1% of cases. Older patients and those requiring IMV were at higher risk of developing radiological pulmonary sequelae. Dyspnea evaluated through mMRC scale was reported by 35% of patients with no differences between groups, compared to 29% at 6-month follow-up. Conclusion DLCO alteration and non-fibrotic interstitial lung abnormalities are common after 1 year from hospitalization due to SARS-CoV-2 pneumonia, particularly in older patients requiring higher ventilatory support. Studies with longer follow-ups are needed.
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Affiliation(s)
- Paola Faverio
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy.
| | - Fabrizio Luppi
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy
| | | | - Anna Stainer
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.,IRCCS Humanitas Research Hospital, Respiratory Unit, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Sara Busnelli
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Martina Catalano
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Giuseppe Modafferi
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Giovanni Franco
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Anna Monzani
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy
| | - Paolo Scarpazza
- Division of Pulmonary Medicine, Civile Hospital, Vimercate, MB, Italy
| | - Elisa Oggionni
- Division of Pulmonary Medicine, Civile Hospital, Vimercate, MB, Italy
| | - Monia Betti
- Division of Pulmonary Medicine, Cremona Hospital, ASST Cremona, Cremona, Italy
| | - Tiberio Oggionni
- Division of Pulmonary Medicine, Cremona Hospital, ASST Cremona, Cremona, Italy
| | - Federica De Giacomi
- Division of Pulmonary Medicine, Cremona Hospital, ASST Cremona, Cremona, Italy
| | - Francesco Bini
- UOC Pulmonology, Department of Internal Medicine, Ospedale G. Salvini, ASST-Rhodense, Garbagnate Milanese, MI, Italy
| | - Bruno Dino Bodini
- UOC Pulmonology, Department of Internal Medicine, Ospedale G. Salvini, ASST-Rhodense, Garbagnate Milanese, MI, Italy
| | - Mara Parati
- Department of Pulmonology and Respiratory High-Dependency Unit, Ospedale Maggiore, Crema, Italy
| | - Luca Bilucaglia
- Department of Pulmonology and Respiratory High-Dependency Unit, Ospedale Maggiore, Crema, Italy
| | - Paolo Ceruti
- U.O. Pneumologia e Fisiopatologia Respiratoria-ASST Spedali Civili di Brescia, Brescia, Italy
| | - Denise Modina
- U.O. Pneumologia e Fisiopatologia Respiratoria-ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sergio Harari
- Department of Medical Sciences, San Giuseppe Hospital, MultiMedica IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123, Milan, MI, Italy
| | | | - Pietro Sergio
- U.O. Radiodiagnostica, Cremona Hospital, ASST Cremona, Cremona, Italy
| | - Giuseppe Monzillo
- U.O.C. Radiodiagnostica, Ospedale G. Salvini, ASST-Rhodense, Garbagnate Milanese, MI, Italy
| | | | - Andrea Borghesi
- U.O. Radiologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Zompatori
- Dipartimento di Radiologia, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Rocco Corso
- Radiology Unit, Gerardo Hospital, ASST Monza, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Alberto Pesci
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy
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15
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Poerio A, Carlicchi E, Lotrecchiano L, Praticò C, Mistè G, Scavello S, Morsiani M, Zompatori M, Ferrari R. Evolution of COVID-19 Pulmonary Fibrosis-Like Residual Changes Over Time - Longitudinal Chest CT up to 9 Months After Disease Onset: a Single-Center Case Series. SN Compr Clin Med 2022; 4:57. [PMID: 35194572 PMCID: PMC8852861 DOI: 10.1007/s42399-022-01140-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 01/13/2023]
Abstract
The aim of the study was to evaluate the temporal evolution of fibrotic-like pulmonary interstitial abnormalities secondary to Sars-CoV-2 virus (COVID-19) pneumonia detected on chest-CTs of patients hospitalized for COVID-19 infection. We retrospectively reviewed chest-CTs obtained up to 9 months after disease onset in a group of patients with COVID-19 pneumonia and CT features suggestive of lung fibrosis at the first follow-up after hospital discharge. We observed a complete and unexpected resolution of all interstitial abnormalities, including reticulations and bronchial dilatation, in a period of about 6-9 months after discharge. Interstitial fibrotic-like changes detectable in the first months after COVID-19 pneumonia could be slowly or very slowly resolving but still completely reversible and probably secondary to an organizing pneumonia reaction.
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Affiliation(s)
- Antonio Poerio
- Radiology Unit, S. Maria Della Scaletta Hospital, via Montericco 4, 40026 Imola, BO Italy
| | - Eleonora Carlicchi
- Postgraduate School in Radiodiagnostics, Università Degli Studi Di Milano, Milan, Italy
| | - Ludovica Lotrecchiano
- Department of Radiology, IRCCS Ospedale San Raffaele Turro, via Stamira d’Ancona 20, 20127 Milan, Italy
| | - Chiara Praticò
- Emergency Care Unit, S. Maria Della Scaletta Hospital, via Montericco 4, 40026 Imola, BO Italy
| | - Giacomo Mistè
- Internal Medicine Unit, S. Maria Della Scaletta Hospital, via Montericco 4, 40026 Imola, BO Italy
| | - Saverio Scavello
- Internal Medicine Unit, S. Maria Della Scaletta Hospital, via Montericco 4, 40026 Imola, BO Italy
| | - Miria Morsiani
- Radiology Unit, S. Maria Della Scaletta Hospital, via Montericco 4, 40026 Imola, BO Italy
| | - Maurizio Zompatori
- Department of Radiology, Multimedica IRCCS, San Giuseppe Hospital, Milano, Italy
| | - Rodolfo Ferrari
- Emergency Care Unit, S. Maria Della Scaletta Hospital, via Montericco 4, 40026 Imola, BO Italy
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16
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Manzetti GM, Hosein K, Cecchini MJ, Kwan K, Abdelrazek M, Zompatori M, Rogliani P, Mura M. Validation of the risk stratification score in idiopathic pulmonary fibrosis: study protocol of a prospective, multi-centre, observational, 3-year clinical trial. BMC Pulm Med 2021; 21:396. [PMID: 34863146 PMCID: PMC8645123 DOI: 10.1186/s12890-021-01753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is characterized by a poor prognosis, with a progressive decline in lung function and considerable variability in the disease's natural history. Besides lung transplantation (LTx), the only available treatments are anti-fibrosing drugs, which have shown to slow down the disease course. Therefore, predicting the prognosis is of pivotal importance to avoid treatment delays, which may be fatal for patients with a high risk of progression. Previous studies showed that a multi-dimensional approach is practical and effective in the development of a reliable prognostic score for IPF. In the RIsk Stratification scorE (RISE), physiological parameters, an objective measure of patient-reported dyspnea and exercise capacity are combined to capture different domains of the complex pathophysiology of IPF. METHODS This is an observational, multi-centre, prospective cohort study, designed to reflect common clinical practice in IPF. A development cohort and a validation cohort will be included. Patients newly diagnosed with IPF based on the ATS/ERS criteria and multi-disciplinary discussion will be included in the study. A panel of chest radiologists and lung pathologists will further assess eligibility. At the first visit (time of diagnosis), and every 4-months, MRC dyspnea score, pulmonary function tests (FEV1, FVC and DLCO), and 6-min walking distance will be recorded. Patients will be prospectively followed for 3 years. Comorbidities will be considered. The radiographic extent of fibrosis on HRCT will be recalculated at a 2-year interval. RISE, Gender-Age-Physiology, CPI and Mortality Risk Scoring System will be calculated at 4-month intervals. Longitudinal changes of each variable considered will be assessed. The primary endpoint is 3-year LTx-free survival from the time of diagnosis. Secondary endpoints include several, clinically-relevant information to ensure reproducibility of results across a wide range of disease severity and in concomitance of associated pulmonary hypertension or emphysema. DISCUSSION The objective of this study is to validate RISE as a simple, straightforward, inexpensive and reproducible tool to guide clinical decision making in IPF, and potentially as an endpoint for future clinical trials. TRIAL REGISTRATION U.S National Library of Medicine Clinicaltrials.gov, trial n. NCT02632123 "Validation of the risk stratification score in idiopathic pulmonary fibrosis". Date of registration: December 16th, 2015.
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Affiliation(s)
- Gian Marco Manzetti
- Malattie Apparato Respiratorio, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Karishma Hosein
- Division of Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | | | - Maurizio Zompatori
- Radiologia, MultiMedica Group, I.R.C.C.S. San Giuseppe Hospital, Milan, Italy
| | - Paola Rogliani
- Malattie Apparato Respiratorio, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Mura
- Division of Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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17
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Mascalchi M, Zompatori M. Mediastinal Lymphadenopathy in Lung Cancer Screening: A Red Flag. Radiology 2021; 302:695-696. [PMID: 34812678 DOI: 10.1148/radiol.212501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mario Mascalchi
- From the Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, Florence, 50139, Italy (M.M.); Department of Clinical and Experimental Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy (M.M.); and Department of Radiology, S. Giuseppe Hospital, Multimedica IRCCS, Milan, Italy (M.Z.)
| | - Maurizio Zompatori
- From the Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), via Cosimo il Vecchio 2, Florence, 50139, Italy (M.M.); Department of Clinical and Experimental Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy (M.M.); and Department of Radiology, S. Giuseppe Hospital, Multimedica IRCCS, Milan, Italy (M.Z.)
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18
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Sonaglioni A, Lombardo M, Rigamonti E, Nicolosi GL, Trevisan R, Zompatori M, Anzà C. An unusual case of painless type A aortic dissection. J Clin Ultrasound 2021; 49:682-685. [PMID: 33433015 DOI: 10.1002/jcu.22974] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/15/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
The pathogenesis of acute aortic dissection (AAD) is not fully elucidated yet, but it was recently shown that inflammation contributes to the occurrence and development of both Stanford type A and type B AAD. We describe a rare case of a painless type A aortic dissection that occurred in an 85-year-old male, with moderate calcified aortic stenosis and a moderately dilated ascending aorta in 6-month clinical and echocardiographic follow-up. A chronic calculous cholecystitis with neutrophilic leukocytosis and severely increased C reactive protein was diagnosed in the last 3 months. In this patient, a chronic systemic inflammatory state might have contributed to generate the intimal entry tear in the aortic root. In particular, a neutrophil mobilization might have played a causative role in aortic rupture.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | | | | | - Roberta Trevisan
- Department of Radiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | - Maurizio Zompatori
- Department of Radiology, Ospedale San Giuseppe MultiMedica, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Milan, Italy
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19
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Abstract
Coronavirus disease 2019 (COVID-19) emerged in early December 2019 in China, as an acute lower respiratory tract infection and spread rapidly worldwide being declared a pandemic in March 2020. Chest-computed tomography (CT) has been utilized in different clinical settings of COVID-19 patients; however, COVID-19 imaging appearance is highly variable and nonspecific. Indeed, many pulmonary infections and non-infectious diseases can show similar CT findings and mimic COVID-19 pneumonia. In this review, we discuss clinical conditions that share a similar imaging appearance with COVID-19 pneumonia, in order to identify imaging and clinical characteristics useful in the differential diagnosis.
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Affiliation(s)
- Eleonora Carlicchi
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy.
| | - Pietro Gemma
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy
| | - Antonio Poerio
- Radiology Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Antonella Caminati
- Respiratory Medicine and Semi-Intensive Therapy Unit, Respiratory Physiopathology and Pulmonary Haemodynamics Services, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Angelo Vanzulli
- Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Oncology and Hemato-Oncology Unit, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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20
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Harari S, Torre O, Elia D, Caminati A, Pelosi G, Specchia C, Zompatori M, Cassandro R. Improving Survival in Lymphangioleio-myomatosis: A 16-Year Observational Study in a Large Cohort of Patients. Respiration 2021; 100:989-999. [PMID: 34044410 DOI: 10.1159/000516330] [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: 09/22/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the last 2 decades, great progress has been made in the understanding of the clinical aspects and pathogenesis of lymphangioleiomyomatosis (LAM), leading to publication of guidelines and approval of an effective therapy. OBJECTIVES Aim of our study was to describe how the management and the natural history of this rare disease have changed after the publication of the ERS and American Thoracic Society/Japanese Respiratory Society guidelines and the introduction of sirolimus. METHODS We examined 162 LAM patients followed at our center between 2001 and 2017, reporting clinical characteristics and diagnostic approach. Response to sirolimus in patients undergoing long-term treatment and mortality risk, estimated in terms of cumulative incidence taking into account organ transplantation as a competing cause of the event, were evaluated. The difference in the cumulative incidence between the patients admitted to the observation before 2011 and after 2011, year of the publication of the MILES trial for the efficacy of sirolimus, has also been estimated. RESULTS Sixty-one patients had a histological diagnosis (22 from 2010 onward). 101 patients received a radiological diagnosis according to the guidelines criteria. Pulmonary function tests remained stable over a 3-year treatment period in patients who received sirolimus for over 12 months. The cumulative incidence of mortality after 10 years in the whole population was 25.5%. The cumulative incidence of mortality after 5 years was significantly lower in patients who entered the study since 2011 (after publication of the MILES trial) than in patients who entered the study before. CONCLUSIONS We provide the data supporting the long-term efficacy of sirolimus therapy in a large cohort of patients with functional impairment and other manifestations of the disease. Our results also suggest that the advent of sirolimus and the publication of international guidelines changed the natural history of the disease lowering the mortality and reducing the need of invasive diagnostic techniques.
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Affiliation(s)
- Sergio Harari
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy.,Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Olga Torre
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Davide Elia
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Antonella Caminati
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Giuseppe Pelosi
- Servizio di Anatomia Patologica, Polo Scientifico e Tecnologico, Multimedica Srl, IRCCS, Milan, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Maurizio Zompatori
- U.O. di Radiologia Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
| | - Roberto Cassandro
- Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
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21
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Grecuccio S, Sverzellati N, Uslenghi E, Caminati A, Pedrazzi G, Zompatori M. Prognostic value of mediastinal lymph node enlargement in chronic interstitial lung disease. ACTA ACUST UNITED AC 2021; 27:329-335. [PMID: 34003121 DOI: 10.5152/dir.2021.19585] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Mediastinal lymph node (MLN) enlargement detected on chest computed tomography (CT) is frequent in patients with interstitial lung disease (ILD) and is shown in approximately 70% of cases of idiopathic pulmonary fibrosis (IPF). We hypothesized that enlarged MLNs might be a predictor of poor prognosis, associated with lower survival and stronger disease severity. METHODS This study included patients with idiopathic pulmonary fibrosis (IPF) or nonspecific interstitial pneumonia (NSIP) from January 2009 to December 2018. Baseline chest CT scan and one-year follow-up scan of the patients were reviewed for the extent of lung fibrosis and MLNs. Two radiologists independently assessed MLN diameter and location. Patients with drug toxicity-related ILD, sarcoidosis, chronic hypersensitivity pneumonitis and other rare idiopathic interstitial pneumonias were excluded. The primary endpoint was survival. Secondary endpoints included number of hospitalizations for respiratory causes, lung function evaluated by forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), and lung fibrosis score determined by CT scan. RESULTS We retrospectively reviewed the medical registries of 110 patients with chronic pulmonary fibrosis (mean age 71 years, 60.4% male). Nine participants were excluded because the CT scans were of poor diagnostic quality for the evaluation of the mediastinum or unavailable for review. The analysis of 101 patients showed that enlarged MLNs (short axis diameter ≥10 mm) were present in 50.5% (n=51) and strongly predicted survival (HR= 2.11, 95% CI 1.12-3.96, p = 0.020). Patients with MLN enlargement experienced greater number of hospitalizations for respiratory causes (mean 2.5 vs. 1.8, p = 0.010) and had significantly worse lung function parameters (FVC, 71% vs. 81%, p = 0.018 and DLCO, 40% vs. 50%, p = 0.001) and a higher lung fibrosis score (50% vs. 39%, p = 0.001). CONCLUSION In patients with IPF and NSIP, enlarged MLNs predict survival, are associated with increased number of hospitalizations, and show signs of poorer lung function and more severe fibrosis.
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Affiliation(s)
| | - Nicola Sverzellati
- Division of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy
| | - Elisabetta Uslenghi
- Department of Diagnostic Imaging and U.O. of Multi Medical Radiology IRCCS, Milan, Italy
| | - Antonella Caminati
- U.O. of Pneumology and Semi-Intensive Respiratory Therapy, Service of Respiratory Pathophysiology and Pulmonary Hemodynamics, San Giuseppe Multimedica Hospital, Milan, Italy
| | - Giueseppe Pedrazzi
- Department of Medicine and Surgery, Unit of Neuroscience and Robust Statistics Academy, University of Parma, Parma, Italy
| | - Maurizio Zompatori
- Department of Diagnostic Imaging and U.O. of Multi Medical Radiology IRCCS, Milan, Italy
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22
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Carlicchi E, Caminati A, Fughelli P, Pelosi G, Harari S, Zompatori M. High-resolution CT in smoking-related interstitial lung diseases. Int J Tuberc Lung Dis 2021; 25:106-112. [PMID: 33656421 DOI: 10.5588/ijtld.20.0622] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In addition to chronic obstructive pulmonary disease (COPD) and bronchogenic carcinoma, smoking can also cause interstitial lung diseases (ILDs) such as respiratory bronchiolitis (RB), RB with ILD (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell granulomatosis (LCG) and idiopathic pulmonary fibrosis-usual interstitial pneumonia (IPF-UIP). However, smoking seems to have a protective effect against hypersensitivity pneumonitis (HP), sarcoidosis and organising pneumonia (OP). High-resolution computed tomography (HRCT) has a pivotal role in the differential diagnosis. RB is extremely frequent in smokers, and is considered a marker for smoking exposure. It has no clinical relevance in itself since most patients with RB are asymptomatic. It is frequent to observe the association of RB with other smoking-related diseases, such as LCG or pulmonary neoplasms. In RB-ILD, HRCT features are more conspicuous and diffuse than in RB, but there is no definite cut-off between the two entities and any distinction can only be made by integrating imaging and clinical data. RB, RB-ILD and DIP may represent different degrees of the same pathological process, consisting in a bronchiolar and alveolar inflammatory reaction to smoking. Smoking is also a well-known risk factor for pulmonary fibrosis. Multidisciplinary discussion and follow-up can generally solve even the most difficult cases.
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Affiliation(s)
- E Carlicchi
- Postgraduated School in Radiodiagnostic, Università degli Studi di Milano, Milan
| | - A Caminati
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe, MultiMedica Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Milan
| | - P Fughelli
- Alma Mater Studiorum, Università di Bologna, Bologna
| | - G Pelosi
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Milan, Dipartimento di Oncologia ed Onco-ematologia, Università degli Studi di Milano, Milan
| | - S Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe, MultiMedica Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Milan, Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS and Community Health, Università degli Studi di Milano, Milan
| | - M Zompatori
- Diagnostica per Immagini, Ospedale San Giuseppe, IRCCS Multimedica, Milan, Italy
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23
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Carlicchi E, Harari S, Caminati A, Fughelli P, Zompatori M. Radiological diagnosis of fibrosing interstitial lung diseases: innovations and controversies. Int J Tuberc Lung Dis 2020; 24:1156-1164. [PMID: 33172523 DOI: 10.5588/ijtld.19.0743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following the introduction of new effective antifibrotic drugs, interest in fibrosing interstitial lung diseases (FILD) has been renewed. In this context, radiological evaluation of FILD plays a cardinal role. Radiological diagnosis is possible in about 50% of the cases, which allows the initiation of effective therapy, thereby avoiding invasive procedures such as surgical lung biopsy. Usual interstitial pneumonia (UIP) pattern may be diagnosed based on clinical, radiological, and pathological data. High-resolution computed tomography features of UIP have been widely described in literature; however, interpreting them remains challenging, even with specific expertise on the subject. Diagnostic difficulties are understandable given the continuous evolution of FILD classifications and their complexity. Both early-stage diseases and advanced or combined patterns are not easily classifiable, and many end up being labelled 'indeterminate´ or 'unclassifiable´. Especially in these cases, optimal patient management involves collaboration and communication between different specialists. Here, we discuss the most critical aspects of radiological interpretation in FILD diagnosis based on the most recent classifications. We believe that the clinicians´ awareness of radiological diagnostic issues of FILD would improve comprehension and dialogue between physicians and radiologists, leading to better clinical practice.
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Affiliation(s)
- E Carlicchi
- Postgraduated School in Radiodiagnostic, Università degli Studi di Milano, Milan
| | - S Harari
- Pneumologia, Ospedale San Giuseppe, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, Milan
| | - A Caminati
- Pneumologia, Ospedale San Giuseppe, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, Milan
| | - P Fughelli
- Alma Mater Studiorum, Università di Bologna, Bologna
| | - M Zompatori
- Diagnostica per Immagini, Ospedale San Giuseppe, IRCCS Multimedica, Milan, Italy
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24
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Parisi C, Lamberti G, Zompatori M, Gelsomino F, Salvagni S, Sperandi F, Ardizzoni A. Evolution of cystic airspaces lung lesions on immune checkpoint inhibition in non-small cell lung cancer. J Immunother Cancer 2020; 8:jitc-2019-000502. [PMID: 33004540 PMCID: PMC7534725 DOI: 10.1136/jitc-2019-000502] [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] [Accepted: 04/18/2020] [Indexed: 11/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) can be associated with pulmonary cystic airspaces (pCAs). pCAs are radiologically classified into four types based on whether the nodule or mass extrudes the wall of the pCAs. In most cases, response evaluation of these lesions by Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1 is challenging. Based on the observation of a case of morphological evolution of pCAs associated with NSCLC in a patient receiving immune checkpoint inhibitor (ICI), we reviewed retrospectively imaging scans of 92 consecutive advanced patients with NSCLC treated at our institution. Overall, three cases of pCAs associated with NSCLC obtained a remarkable change following ICI. Of note, these changes were not always seen in the context of a clear radiological objective response. The morphological changes observed may reflect a novel pattern of response to immunotherapy agents that clinicians should be aware of. This pattern of response, not reported before, warrants further investigation and, if confirmed, we believe that it should be considered in future version of immune RECIST.
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Affiliation(s)
- Claudia Parisi
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Giuseppe Lamberti
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Maurizio Zompatori
- Radiology Department, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Francesco Gelsomino
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Stefania Salvagni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Francesca Sperandi
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Andrea Ardizzoni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
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25
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Grasselli G, Tonetti T, Protti A, Langer T, Girardis M, Bellani G, Laffey J, Carrafiello G, Carsana L, Rizzuto C, Zanella A, Scaravilli V, Pizzilli G, Grieco DL, Di Meglio L, de Pascale G, Lanza E, Monteduro F, Zompatori M, Filippini C, Locatelli F, Cecconi M, Fumagalli R, Nava S, Vincent JL, Antonelli M, Slutsky AS, Pesenti A, Ranieri VM. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med 2020; 8:1201-1208. [PMID: 32861276 PMCID: PMC7834127 DOI: 10.1016/s2213-2600(20)30370-2] [Citation(s) in RCA: 437] [Impact Index Per Article: 109.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the functional and morphological features of COVID-19-associated ARDS and to compare these with the characteristics of ARDS unrelated to COVID-19. Methods This prospective observational study was done at seven hospitals in Italy. We enrolled consecutive, mechanically ventilated patients with laboratory-confirmed COVID-19 and who met Berlin criteria for ARDS, who were admitted to the intensive care unit (ICU) between March 9 and March 22, 2020. All patients were sedated, paralysed, and ventilated in volume-control mode with standard ICU ventilators. Static respiratory system compliance, the ratio of partial pressure of arterial oxygen to fractional concentration of oxygen in inspired air, ventilatory ratio (a surrogate of dead space), and D-dimer concentrations were measured within 24 h of ICU admission. Lung CT scans and CT angiograms were done when clinically indicated. A dataset for ARDS unrelated to COVID-19 was created from previous ARDS studies. Survival to day 28 was assessed. Findings Between March 9 and March 22, 2020, 301 patients with COVID-19 met the Berlin criteria for ARDS at participating hospitals. Median static compliance was 41 mL/cm H2O (33–52), which was 28% higher than in the cohort of patients with ARDS unrelated to COVID-19 (32 mL/cm H2O [25–43]; p<0·0001). 17 (6%) of 297 patients with COVID-19-associated ARDS had compliances greater than the 95th percentile of the classical ARDS cohort. Total lung weight did not differ between the two cohorts. CT pulmonary angiograms (obtained in 23 [8%] patients with COVID-19-related ARDS) showed that 15 (94%) of 16 patients with D-dimer concentrations greater than the median had bilateral areas of hypoperfusion, consistent with thromboembolic disease. Patients with D-dimer concentrations equal to or less than the median had ventilatory ratios lower than those of patients with D-dimer concentrations greater than the median (1·66 [1·32–1·95] vs 1·90 [1·50–2·33]; p=0·0001). Patients with static compliance equal to or less than the median and D-dimer concentrations greater than the median had markedly increased 28-day mortality compared with other patient subgroups (40 [56%] of 71 with high D-dimers and low compliance vs 18 [27%] of 67 with low D-dimers and high compliance, 13 [22%] of 60 with low D-dimers and low compliance, and 22 [35%] of 63 with high D-dimers and high compliance, all p=0·0001). Interpretation Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to COVID-19. Notably, patients with COVID-19-related ARDS who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates. Funding None.
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Affiliation(s)
- Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Alessandro Protti
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, ASST Monza-Ospedale San Gerardo, Monza, Italy
| | - John Laffey
- Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland; Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gianpaolo Carrafiello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Luca Carsana
- Department of Anatomy and Histopathology, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Rizzuto
- Department of Anesthesia and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy
| | - Alberto Zanella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Vittorio Scaravilli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giacinto Pizzilli
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Letizia Di Meglio
- Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Gennaro de Pascale
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Ezio Lanza
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Francesco Monteduro
- Dipartimento di Radiologia, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Maurizio Zompatori
- Dipartimento di Radiologia, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Claudia Filippini
- Dipartimento di Scienze Chirurgiche, Università di Torino, Torino, Italy
| | - Franco Locatelli
- Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine, Respiratory and Critical Care Unit, S Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Antonio Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
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Poerio A, Sartoni M, Lazzari G, Valli M, Morsiani M, Zompatori M. Halo, Reversed Halo, or Both? Atypical Computed Tomography Manifestations of Coronavirus Disease (COVID-19) Pneumonia: The "Double Halo Sign". Korean J Radiol 2020; 21:1161-1164. [PMID: 32729264 PMCID: PMC7458858 DOI: 10.3348/kjr.2020.0687] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
The epidemic of 2019 novel coronavirus, later named as coronavirus disease (COVID-19), began in Wuhan, China in December 2019 and has spread rapidly worldwide. Early diagnosis is crucial for the management of the patients with COVID-19, but the gold standard diagnostic test for this infection, the reverse transcriptase polymerase chain reaction, has a low sensitivity and an increased turnaround time. In this scenario, chest computed tomography (CT) could play a key role for an early diagnosis of COVID-19 pneumonia. Here, we have reported a confirmed case of COVID-19 with an atypical CT presentation showing a “double halo sign,” which we believe represents the pathological spectrum of this viral pneumonia.
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Affiliation(s)
- Antonio Poerio
- Radiology Unit, S. Maria della Scaletta Hospital, Imola, Italy.
| | - Matilde Sartoni
- Radiology Unit, S. Maria della Scaletta Hospital, Imola, Italy
| | | | - Michele Valli
- Internal Medicine Unit, S. Maria della Scaletta Hospital, Imola, Italy
| | - Miria Morsiani
- Radiology Unit, S. Maria della Scaletta Hospital, Imola, Italy
| | - Maurizio Zompatori
- Department of Radiology, Multimedica IRCCS, San Giuseppe Hospital, Milano, Italy
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Taha N, D'Amato D, Hosein K, Ranalli T, Sergiacomi G, Zompatori M, Mura M. Longitudinal functional changes with clinically significant radiographic progression in idiopathic pulmonary fibrosis: are we following the right parameters? Respir Res 2020; 21:119. [PMID: 32429952 PMCID: PMC7238541 DOI: 10.1186/s12931-020-01371-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023] Open
Abstract
Background Progression of the disease in idiopathic pulmonary fibrosis (IPF) is difficult to predict, due to its variable and heterogenous course. The relationship between radiographic progression and functional decline in IPF is unclear. We sought to confirm that a simple HRCT fibrosis visual score is a reliable predictor of mortality in IPF, when longitudinally followed; and to ascertain which pulmonary functional variables best reflect clinically significant radiographic progression. Methods One-hundred-twenty-three consecutive patients with IPF from 2 centers were followed for an average of 3 years. Longitudinal changes of HRCT fibrosis scores, forced vital capacity (FVC), total lung capacity and diffusing lung capacity for carbon monoxide were considered. HRCTs were scored by 2 chest radiologists. The primary outcome was lung transplant (LTx)-free survival after the follow-up HRCT. Results During the follow-up period, 43 deaths and 11 LTx occurred. On average, the HRCT fibrosis score increased significantly, and a longitudinal increase > 7% predicted LTx-free survival significantly, with good specificity, but limited sensitivity. The correlation between radiographic and functional progression was moderately significant. HRCT progression and FVC decline predicted LTx-free survival independently and significantly, with better sensitivity, but worse specificity for a ≥ 5% decline of FVC. However, the area under the curve towards LTx-survival were only 0.61 and 0.62, respectively. Conclusions The HRCT fibrosis visual score is a reliable and responsive tool to detect clinically meaningful disease progression. Although no individual pulmonary function test closely reflects radiographic progression, a longitudinal FVC decline improves sensitivity in the detection of clinically significant disease progression. However, the accuracy of these methods remains limited, and better prognostication models need to be found.
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Affiliation(s)
- Nada Taha
- Division of Respirology, Western University, London, Ontario, Canada
| | - Dejanira D'Amato
- Diagnostica per Immagini e Radiologia Interventistica, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Karishma Hosein
- Division of Respirology, Western University, London, Ontario, Canada
| | - Tiziana Ranalli
- Diagnostica per Immagini e Radiologia Interventistica, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Gianluigi Sergiacomi
- Diagnostica per Immagini e Radiologia Interventistica, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Maurizio Zompatori
- Radiologia, MultiMedica Group, I.R.C.C.S. San Giuseppe Hospital, Milan, Italy
| | - Marco Mura
- Division of Respirology, Western University, London, Ontario, Canada. .,London Health Science Centre, Victoria Hospital, 800 Commissioners Road East Room E6-203, London, Ontario, N6A 5W9, Canada.
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Zanasi A, Morselli-Labate AM, Mazzolini M, Mastroroberto M, Dal Negro RW, Poliacek I, Morice AH, Maio S, Viegi G, Koufman J, Torresan F, Ioannou A, Mandolesi D, Liverani E, Montale A, Bazzoli F, Baldi F, Zompatori M, Fontana GA, Kantar A, Dicpinigaitis P, Page C, Birring SS, Tursi F. XII AIST 2018 Conference: “The thousand faces of cough: clinical and therapeutic updates”. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2018.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper summarizes the presentations submitted for publication of the 12th AIST National Congress (Associazione Italiana Studio Tosse/Italian Association for Cough Study) entitled “The thousand facets of cough. A clinical and therapeutic update”, which occurred last February 2nd-3rd, 2018 in Bologna (Italy). It summarizes the contributions from leading experts of the sector, who, as in the previous editions, also this year have analyzed a problem too often underestimated which still has many dark sides as regards both the diagnosis and the therapy of cough. The Scientific Committee has chosen topics that had less space in previous editions and these are topical subjects representing a concrete opportunity for learning and comparison of opinions, as well as indispensable elements for the correct management of the symptoms. Hereby we report the abstracts of the works submitted for publication in this Meeting report. The main topics have covered Cough relationship with nerve vagus, ATP, air pollution, GERD, imaging, COPD, pediatric and therapy. Of particular interest it is the preliminary data on cough hydration ratio that shows a highly significant correlation between dehydration and cough.
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Pelosi G, Sabella G, Cannone M, Balladore E, Papanikolaou N, Incarbone M, Zompatori M, Harari S, Bedini AV. Parietal Pleura-Based Malignant Perivascular Epithelioid Cell Neoplasm Protruding Into Serous Cavity: A Hitherto Unrecognized Occurrence. J Thorac Oncol 2019; 15:462-466. [PMID: 31812753 DOI: 10.1016/j.jtho.2019.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/20/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Interhospital Pathology Division, IRCCS MultiMedica, Milan, Italy.
| | - Giovanna Sabella
- Interhospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | - Maria Cannone
- Interhospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | | | | | | | - Maurizio Zompatori
- Department of Radiology, San Giuseppe Hospital, IRCCS MultiMedica, Milan, Italy
| | - Sergio Harari
- Department of Medical Sciences and Division of Pneumology, San Giuseppe Hospital, IRCCS MultiMedica, Milan, Italy
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Hosein KS, Sergiacomi G, Zompatori M, Mura M. The CALIPER-Revised Version of the Composite Physiologic Index is a Better Predictor of Survival in IPF than the Original Version. Lung 2019; 198:169-172. [DOI: 10.1007/s00408-019-00295-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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31
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Sonaglioni A, Lombardo M, Rigamonti E, Vincenti A, Nicolosi GL, Trevisan R, Zompatori M, Cassandro R, Harari S, Anzà C. Unusual presentation of acute pulmonary hypertension in a patient with bilateral pneumonia and hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2019; 20:853-856. [DOI: 10.2459/jcm.0000000000000848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rasciti E, Cancellieri A, Romagnoli M, Dell'Amore A, Zompatori M. Suspected pleuroparenchymal fibroelastosis relapse after lung transplantation: a case report and literature review. BJR Case Rep 2019; 5:20190040. [PMID: 31938568 PMCID: PMC6945250 DOI: 10.1259/bjrcr.20190040] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a very rare lung disease characterized by dense fibrous thickening of the visceral pleura and intraalveolar fibrosis containing prominent elastosis, with typical upper lobe predominance. PPFE usually shows progressive restrictive ventilatory impairment refractory to medical treatment; bilateral lung transplantation currently remains the only available therapeutic option. In this report, we describe a case of suspected PPFE relapse after lung transplantation that, to our knowledge, has never been described in the medical literature. A 48-year-old male with idiopathic pleuroparenchymal fibroelastosis underwent a bilateral lung transplant in our department. 8 months later, he presented with progressively worsening clinical condition, his respiratory state gradually deteriorated. High-resolution CT again showed bilateral diffused parenchymal consolidations, with prevalence in the upper lobes and subpleural regions. A PPFE relapse was therefore suspected, so he was listed for lung retransplantation, which was performed ten months after the first transplant. Histopathological analysis of the second explanted lung again confirmed the diagnosis of PPFE. The case highlights the possibility of PPFE relapse after lung transplantation, that may add to the increasing evidence of an underlying auto-immune mechanism contributing to its pathogenesis.
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Affiliation(s)
- Edoardo Rasciti
- Department of Radiology, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - Alessandra Cancellieri
- Department of Pathology, S. Orsola Malpighi University Hospital and Maggiore Hospital, Bologna, Italy
| | | | - Andrea Dell'Amore
- Department of Cardio-Thoracic Surgery, S. Orsola Malpighi University Hospital, Bologna, Italy
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Pelosi G, Nesa F, Taietti D, Servillo SP, Papanikolaou N, Zompatori M, Meroni A, Harari S, Incarbone M. Spread of hyperplastic pulmonary neuroendocrine cells into air spaces (S.H.I.P.M.E.N.T.S): A proof for artifact. Lung Cancer 2019; 137:43-47. [DOI: 10.1016/j.lungcan.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
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Elia D, Caminati A, Zompatori M, Cassandro R, Lonati C, Luisi F, Pelosi G, Provencher S, Harari S. Pulmonary hypertension and chronic lung disease: where are we headed? Eur Respir Rev 2019; 28:28/153/190065. [DOI: 10.1183/16000617.0065-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/22/2019] [Indexed: 12/26/2022] Open
Abstract
Pulmonary hypertension related to chronic lung disease, mainly represented by COPD and idiopathic pulmonary fibrosis, is associated with a worse outcome when compared with patients only affected by parenchymal lung disease. At present, no therapies are available to reverse or slow down the pathological process of this condition and most of the clinical trials conducted to date have had no clinically significant impact. Nevertheless, the importance of chronic lung diseases is always more widely recognised and, along with its increasing incidence, associated pulmonary hypertension is also expected to be growing in frequency and as a health burden worldwide. Therefore, it is desirable to develop useful and reliable tools to obtain an early diagnosis and to monitor and follow-up this condition, while new insights in the therapeutic approach are explored.
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Caminati A, Lonati C, Cassandro R, Elia D, Pelosi G, Torre O, Zompatori M, Uslenghi E, Harari S. Comorbidities in idiopathic pulmonary fibrosis: an underestimated issue. Eur Respir Rev 2019; 28:28/153/190044. [PMID: 31578211 DOI: 10.1183/16000617.0044-2019] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/16/2019] [Indexed: 12/25/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive and fibrosing lung disease with a poor prognosis. Between 60% and 70% of IPF patients die of IPF; the remaining causes of death may be due to comorbidities occurring in this ageing population. Interest in the role played by comorbidities in IPF has increased in the past few years. The optimal clinical management of IPF is multifaceted and not only involves antifibrotic treatment, but also vaccinations, oxygen supplementation, evaluation of nutritional status as well as psychological support and patient education. Symptom management, pulmonary rehabilitation, palliative care and treatment of comorbidities represent further areas of clinical intervention. This review analyses the major comorbidities observed in IPF, focusing on those that have the greatest impact on mortality and quality of life (QoL). The identification and treatment of comorbidities may help to improve patients' health-related QoL (i.e. sleep apnoea and depression), while some comorbidities (i.e. lung cancer, cardiovascular diseases and pulmonary hypertension) influence survival. It has been outlined that gathering comorbidities data improves the prediction of survival beyond the clinical and physiological parameters of IPF.
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Affiliation(s)
- Antonella Caminati
- UO di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
| | - Chiara Lonati
- UO di Medicina Generale, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
| | - Roberto Cassandro
- UO di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
| | - Davide Elia
- UO di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
| | - Giuseppe Pelosi
- Dipartimento di Oncologia ed Onco-ematologia, Università degli Studi di Milano, Milan, Italy.,Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, MultiMedica IRCCS, Milan, Italy
| | - Olga Torre
- UO di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
| | - Maurizio Zompatori
- Dipartimento di Diagnostica per Immagini e UO di Radiologia, MultiMedica IRCCS, Milan, Italy.,Dipartimento Universitario DIMES, Università di Bologna, Bologna, Italy
| | - Elisabetta Uslenghi
- Dipartimento di Diagnostica per Immagini e UO di Radiologia, MultiMedica IRCCS, Milan, Italy
| | - Sergio Harari
- UO di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy.,UO di Medicina Generale, Ospedale San Giuseppe - MultiMedica IRCCS, Milan, Italy
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36
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Harari S, Cereda F, Pane F, Cavazza A, Papanikolaou N, Pelosi G, Scarioni M, Uslenghi E, Zompatori M, Caminati A. Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure. ACTA ACUST UNITED AC 2019; 55:medicina55090606. [PMID: 31546869 PMCID: PMC6780159 DOI: 10.3390/medicina55090606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/31/2022]
Abstract
Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.
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Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
- U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
| | - Francesca Cereda
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
| | - Federico Pane
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
| | - Alberto Cavazza
- U.O. di Anatomia Patologica Azienda USL/IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.
| | - Nikolaos Papanikolaou
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Via Gaudenzio Fantoli 16/15, 20138 Milan, Italy.
| | - Giuseppe Pelosi
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Via Gaudenzio Fantoli 16/15, 20138 Milan, Italy.
- Dipartimento di Oncologia ed Onco-ematologia, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Monica Scarioni
- U.O. di Anestesia e Rianimazione, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
| | - Elisabetta Uslenghi
- Dipartimento di Diagnostica per Immagini e U.O. di Radiologia MultiMedica IRCCS, 20123 Milan, Italy.
| | - Maurizio Zompatori
- Dipartimento di Diagnostica per Immagini e U.O. di Radiologia MultiMedica IRCCS, 20123 Milan, Italy.
- Dipartimento Universitario DIMES, Università di Bologna, 40126 Bologna, Italy.
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
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Chiumello D, Sferrazza Papa GF, Artigas A, Bouhemad B, Grgic A, Heunks L, Markstaller K, Pellegrino GM, Pisani L, Rigau D, Schultz MJ, Sotgiu G, Spieth P, Zompatori M, Navalesi P. ERS statement on chest imaging in acute respiratory failure. Eur Respir J 2019; 54:13993003.00435-2019. [PMID: 31248958 DOI: 10.1183/13993003.00435-2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
Chest imaging in patients with acute respiratory failure plays an important role in diagnosing, monitoring and assessing the underlying disease. The available modalities range from plain chest X-ray to computed tomography, lung ultrasound, electrical impedance tomography and positron emission tomography. Surprisingly, there are presently no clear-cut recommendations for critical care physicians regarding indications for and limitations of these different techniques.The purpose of the present European Respiratory Society (ERS) statement is to provide physicians with a comprehensive clinical review of chest imaging techniques for the assessment of patients with acute respiratory failure, based on the scientific evidence as identified by systematic searches. For each of these imaging techniques, the panel evaluated the following items: possible indications, technical aspects, qualitative and quantitative analysis of lung morphology and the potential interplay with mechanical ventilation. A systematic search of the literature was performed from inception to September 2018. A first search provided 1833 references. After evaluating the full text and discussion among the committee, 135 references were used to prepare the current statement.These chest imaging techniques allow a better assessment and understanding of the pathogenesis and pathophysiology of patients with acute respiratory failure, but have different indications and can provide additional information to each other.
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Affiliation(s)
- Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | | | - Antonio Artigas
- Corporacion Sanitaria, Universitaria Parc Tauli, CIBER de Enfermedades Respiratorias Autonomous University of Barcelona, Sabadell, Spain.,Intensive Care Dept, University Hospitals Sagrado Corazon - General de Cataluna, Quiron Salud, Barcelona-Sant Cugat del Valles, Spain
| | - Belaid Bouhemad
- Service d'Anesthésie - Réanimation, Université Bourgogne - Franche Comtè, lncumr 866L, Dijon, France
| | - Aleksandar Grgic
- Dept of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Leo Heunks
- Dept of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Klaus Markstaller
- Dept of Anesthesia, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Giulia M Pellegrino
- Dipartimento di Scienze della Salute, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy.,Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, Alma Mater Studiorum, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Peter Spieth
- Dept of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | | | - Paolo Navalesi
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy
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Violante FS, Zompatori M, Lovreglio P, Apostoli P, Marinelli F, Bonfiglioli R. Is age more than manual material handling associated with lumbar vertebral body and disc changes? A cross-sectional multicentre MRI study. BMJ Open 2019; 9:e029657. [PMID: 31537567 PMCID: PMC6756319 DOI: 10.1136/bmjopen-2019-029657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Conflicting evidence exists to what extent manual material handling (MMH) causes lumbar disc disease, lack of evidence exist that this effect takes place especially at L5-S1 level, where the greatest moment occurs. The aim was to assess if lumbar vertebral body and disc changes are more common in people whose job involves significant MMH and, if so, to evaluate if lumbar vertebral body and disc changes are more prevalent in the lower part of the lumbar spine (L4-L5 and L5-S1). DESIGN Observational, cross-sectional, with quasi-random recruitment. SETTING Outpatient radiology units of three large hospitals in northern (Bologna and Brescia) and southern (Bari) Italy. PARTICIPANTS 183 consecutive adult subjects (89 males, 94 females) aged 20-70 years referred by the general practitioner or a specialist for MRI of the lumbar spine. PRIMARY AND SECONDARY OUTCOME MEASURES Neuroradiologists (blind to clinical assessment) evaluated the prevalence of intervertebral disc and vertebral body changes in standardised MRI examinations. History of personal and family musculoskeletal diseases and injuries, current and previous MMH at work and during leisure time were assessed by interview and self-administered questionnaire. RESULTS Participants were classified according their occupational exposure to MMH. No association was found between MMH and vertebral body and intervertebral disc changes, whereas age over 45 years was consistently associated with more disc extension beyond the interspace changes, Pfirrmann changes, osteophytes and Modic changes: the association was statistically significant at the conventional 5% level. CONCLUSIONS Age, and not MMH, seems to primarily affect the presence of intervertebral disc changes; prospective studies are needed to better explore the relationship between MMH and the possible presence (and level) of lumbar vertebral body and/or disc changes.
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Affiliation(s)
- Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maurizio Zompatori
- Department of Radiology, Ospedale San Giuseppe MultiMedica, Milan, Milan, Italy
| | - Piero Lovreglio
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Pietro Apostoli
- Department of Medical and Surgical Sciences, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Marinelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Chiocchini ALC, Sportoletti C, Comai G, Brocchi S, Capelli I, Baraldi O, Bruno P, Conti F, Serra C, Meola M, Zompatori M, La Manna G. Correlation Between Renal Cortical Stiffness and Histological Determinants by Point Shear-Wave Elastography in Patients With Kidney Transplantation. Prog Transplant 2019; 27:346-353. [PMID: 29187134 DOI: 10.1177/1526924817731882] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/20/2022]
Abstract
INTRODUCTION Renal allograft biopsy is the gold standard for the detection of histological lesions of chronic allograft dysfunction. The identification of a noninvasive routine test would be desirable. Elastosonography is used to assess tissue stiffness according to viscosity, and no data are available on the use of point quantification shear-wave elastography (ElastPQ) for the evaluation of renal chronic lesions. RESEARCH QUESTION To evaluate the feasibility of ElastPQ to assess cortical allograft stiffness and to determine the correlation of clinical, biological, and pathological factors with the diagnostic accuracy of kidney stiffness values in patients with histological lesions. DESIGN Forty-two patients underwent kidney transplant biopsy and 10 valid measurements of ElastPQ, blindly performed by 2 operators. The interobserver reproducibility was assessed according to intraclass correlation coefficient. The ElastPQ measurements and the clinical data were compared using the Spearman correlation analysis. RESULTS 97.6% reliable measurements were obtained using ElastPQ, with an excellent interobserver agreement. The kidney stiffness was significantly higher in the patients with a time since transplantation >12 months and was correlated with chronic lesions (interstitial fibrosis, tubular atrophy transplant glomerulopathy, and mesangial matrix), with the interstitial fibrosis/tubular atrophy, score and with the sum of the scores of the chronic lesions. Mesangial matrix increase is the only independent determinant of kidney stiffness. DISCUSSION ElastPQ is a noninvasive, reproducible, and sensitive diagnostic tool able to detect moderate/severe chronic lesions. Its routine use during follow-up can identify patients eligible for biopsy, which remains the gold standard exam for detecting chronic allograft dysfunction.
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Affiliation(s)
- A L Croci Chiocchini
- 1 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) - Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - C Sportoletti
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES)-Radiology Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - G Comai
- 1 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) - Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - S Brocchi
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES)-Radiology Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - I Capelli
- 1 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) - Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - O Baraldi
- 1 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) - Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - P Bruno
- 1 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) - Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - F Conti
- 3 Department of Surgical and Medical Sciences, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - C Serra
- 4 Department of Organ Dysfunction and Transplants-Internal Medicine, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - M Meola
- 5 Nephrology Division, Department of Internal and Experimental Medicine, University of Pisa, S. Anna School of Advanced Studies, Pisa, Italy
| | - M Zompatori
- 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES)-Radiology Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - G La Manna
- 1 Department of Experimental, Diagnostic and Specialty Medicine (DIMES) - Nephrology, Dialysis and Transplantation Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
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Romagnoli M, Colby TV, Berthet JP, Gamez AS, Mallet JP, Serre I, Cancellieri A, Cavazza A, Solovei L, Dell’Amore A, Dolci G, Guerrieri A, Reynaud P, Bommart S, Zompatori M, Dalpiaz G, Nava S, Trisolini R, Suehs CM, Vachier I, Molinari N, Bourdin A. Poor Concordance between Sequential Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy in the Diagnosis of Diffuse Interstitial Lung Diseases. Am J Respir Crit Care Med 2019; 199:1249-1256. [DOI: 10.1164/rccm.201810-1947oc] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Micaela Romagnoli
- Department of Respiratory Diseases
- Department of Interventional Pulmonology
| | - Thomas V. Colby
- Emeritus, Department of Laboratory Medicine Pathology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | | | | | - Alberto Cavazza
- Department of Pathology, Azienda USL–IRCCS, Reggio Emilia, Italy; and
| | | | | | | | | | | | - Sébastien Bommart
- Department of Radiology
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale, and
| | - Maurizio Zompatori
- Department of Radiology, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | | | | | | | - Nicolas Molinari
- L’Institut Montpelliérain Alexander Grothendieck, CNRS, Centre Hospitalier Universitaire de Montpellier, University of Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale, and
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41
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Gelsomino F, Fiorentino M, Zompatori M, Poerio A, Melotti B, Sperandi F, Gargiulo M, Borghi C, Ardizzoni A. Programmed death-1 inhibition and atherosclerosis: can nivolumab vanish complicated atheromatous plaques? Ann Oncol 2019; 29:284-286. [PMID: 29106493 DOI: 10.1093/annonc/mdx718] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- F Gelsomino
- Medical Oncology, University Hospital of Parma, Parma, Italy.,Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - M Fiorentino
- Laboratory of Molecular Pathology, Addarii Institute of Oncology, Bologna, Italy
| | - M Zompatori
- Unit of Radiology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - A Poerio
- Unit of Radiology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - B Melotti
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Sperandi
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - M Gargiulo
- Unit of Vascular Surgery, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - C Borghi
- Unit of Internal Medicine, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - A Ardizzoni
- Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy.,Unit of Medical Oncology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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42
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Sonaglioni A, Binda G, Rigamonti E, Vincenti A, Trevisan R, Nicolosi GL, Zompatori M, Lombardo M, Anzà C. A rare case of native pulmonary valve infective endocarditis complicated by septic pulmonary embolism. J Cardiovasc Med (Hagerstown) 2019; 20:152-155. [DOI: 10.2459/jcm.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Zanasi A, Morselli-Labate AM, Mazzolini M, Mastroroberto M, Dal Negro RW, Poliacek I, Morice AH, Maio S, Viegi G, Koufman J, Torresan F, Ioannou A, Mandolesi D, Liverani E, Montale A, Bazzoli F, Baldi F, Zompatori M, Fontana GA, Kantar A, Dicpinigaitis P, Page C, Birring SS, Tursi F. XII AIST 2018 Conference: “The thousand faces of cough: clinical and therapeutic updates”. Multidiscip Respir Med 2018. [PMCID: PMC6027558 DOI: 10.1186/s40248-018-0130-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper summarizes the presentations submitted for publication of the 12th AIST National Congress (Associazione Italiana Studio Tosse/Italian Association for Cough Study) entitled “The thousand facets of cough. A clinical and therapeutic update”, which occurred last February 2nd-3rd, 2018 in Bologna (Italy). It summarizes the contributions from leading experts of the sector, who, as in the previous editions, also this year have analyzed a problem too often underestimated which still has many dark sides as regards both the diagnosis and the therapy of cough. The Scientific Committee has chosen topics that had less space in previous editions and these are topical subjects representing a concrete opportunity for learning and comparison of opinions, as well as indispensable elements for the correct management of the symptoms. Hereby we report the abstracts of the works submitted for publication in this Meeting report. The main topics have covered Cough relationship with nerve vagus, ATP, air pollution, GERD, imaging, COPD, pediatric and therapy. Of particular interest it is the preliminary data on cough hydration ratio that shows a highly significant correlation between dehydration and cough.
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44
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Yoo D, Zompatori M, Barrile A, Rossi G, D’Amato D, Sergiacomi G, Rogliani P, Mura M. Associated Pulmonary Hypertension Is an Independent Contributor to Exercise Intolerance in Chronic Fibrosing Interstitial Pneumonias. Respiration 2018; 96:543-551. [DOI: 10.1159/000491095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022] Open
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45
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Nannini M, Dondi G, Santini D, De Leo A, Dei Tos AP, Zamagni C, Saponara M, Gatto L, Nigro C, Bertaccini P, Zompatori M, De Iaco P, Perrone AM, Perrone MA, Pantaleo MA. A Single-Centre Experience on the Management of Adenosarcoma: A Successful Report of an Integrated Medical and Surgical Approach. Clin Med Insights Oncol 2018; 12:1179554918782477. [PMID: 29977120 PMCID: PMC6024524 DOI: 10.1177/1179554918782477] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/22/2018] [Indexed: 12/13/2022]
Abstract
Adenosarcomas are the rarest form of uterine sarcomas, and clinical experience with their management is still limited. Here, we reported 7 patients with uterine adenosarcoma referred to our institution, focusing on main pathologic features, their medical history, and long-term follow-up. Among these patients, we provided a detailed description of the medical history of a 49-year-old woman with advanced uterine adenosarcoma with sarcomatous overgrowth who presented a brilliant radiologic and pathologic response after 3 cycles of epirubicin and ifosfamide, ultimately achieving an extraordinary long-term outcome through an integrated surgical and medical approach. Our single-centre experience would suggest that aggressive uterine adenosarcomas with sarcomatous overgrowth are sensitive to standard epirubicin and ifosfamide and that an integrated approach, both medical and surgical, could be considered in clinical practice, again emphasizing the relevant role of multidisciplinary management for this extremely rare disease.
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Affiliation(s)
- Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Dondi
- Gynecologic Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Antonio De Leo
- Pathology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.,Department of Medicine, School of Medicine, University of Padua, Padua, Italy
| | - Claudio Zamagni
- SSD Oncologia Medica "Addarii," S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lidia Gatto
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Concetta Nigro
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paola Bertaccini
- Radiology Unit, Cardio-Thoracic-Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maurizio Zompatori
- Radiology Unit, Cardio-Thoracic-Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,"Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
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46
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Pasquali M, Sciascia N, D'Arcangelo Liviano G, La Manna G, Zompatori M. Pancake kidney: when it is not a problem. BJR Case Rep 2018; 4:20170117. [PMID: 31489215 PMCID: PMC6711276 DOI: 10.1259/bjrcr.20170117] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
Pancake kidney is a very rare congenital anomaly involving complete fusion of
medial renal parenchyma. The interface is devoid of any intervening septum. As
described, the kidneys form a single lobulated mass in pelvic location. However,
dual collecting systems are retained, and the shortened, anteriorly seated
ureters enter the bladder normally. This condition is usually discovered
incidentally but may confer a heightened susceptibility to recurrent urinary
tract infections or stone formation, given the likelihood of anomalous
collecting system rotation and the potential for ureteral stasis or obstruction.
Excretory urography, the customary method of detection, has been replaced by
ultrasonography, CT, MRI, and radionucleotide scanning. Herein, we present a
male patient with a pelvic pancake kidney, never symptomatic. A conservative
approach of regular follow up visits and laboratory testing was elected, thus
avoiding any unnecessary investigations or extensive surgery.
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Affiliation(s)
- Milena Pasquali
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology, Policlinico Sant Orsola-Malpighi, Bologna, Italy
| | - Nicola Sciascia
- Department of Radiology Cardiothoracic section, Policlinico Sant Orsola-Malpighi, Bologna, Italy
| | - Giovanni D'Arcangelo Liviano
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, Policlinico Sant Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental, Diagnostic and Specialty Medicine, Nephrology, Dialysis and Transplantation Unit, Policlinico Sant Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Maurizio Zompatori
- Department of Radiology, San Giuseppe Hospital - MultMedica IRCCS, Milano, Italy
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47
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Comito F, Grassi E, Poerio A, Freier E, Calculli L, Zompatori M, Ricci C, Casadei R, Di Marco M. Organizing pneumonia after pancreatic cancer treatment with nab-paclitaxel and gemcitabine: a case report. BJR Case Rep 2018; 4:20170086. [PMID: 30363157 PMCID: PMC6159108 DOI: 10.1259/bjrcr.20170086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/27/2017] [Accepted: 01/04/2018] [Indexed: 01/05/2023] Open
Abstract
The incidence of pancreatic cancer is increasing. Most patients have advanced disease at diagnosis, and therapeutics is limited in this setting. Gemcitabine and nab-paclitaxel combination is indicated as first-line treatment in patients with metastatic cancer of pancreas. The most common adverse events of Grade 3 or higher gemcitabine and nab-paclitaxel combination are neutropenia, fatigue and neuropathy. In this report, we describe a rare case of organizing pneumonia associated with the use of nab-paclitaxel and gemcitabine in metastatic pancreatic cancer. A 68-year-old female underwent total splenopancreatectomy for ductal adenocarcinoma of the neck of the pancreas, followed by adjuvant chemoradiation therapy. Afterwards she relapsed and received first-line chemotherapy with gemcitabine plus nab-paclitaxel combination for 12 cycles. Following the administration of the 12th cycle of gemcitabine plus nab-paclitaxel, the patient experienced low-grade pyrexia, effort dyspnoea, persistent non-productive cough and malaise. High-resolution CT scan of chest revealed new-onset bilateral peripheral ground-glass opacities, smooth interlobular septal thickening and patchy subpleural consolidation areas, findings consistent with organizing pneumonia. A thorough microbiological workup was negative. Treatment with steroids resulted in prompt clinical and radiological improvement. Organizing pneumonia closely mimics infection or progressive disease and can be difficult to diagnose in the setting of malignancy. Correct diagnosis is of primary importance since delay in treatment can result in significantly adverse patient outcomes.
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Affiliation(s)
- Francesca Comito
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Grassi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonio Poerio
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Eva Freier
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Lucia Calculli
- Department of Radiology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Maurizio Zompatori
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Ricci
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Riccardo Casadei
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariacristina Di Marco
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
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Mascalchi M, Comin CE, Bertelli E, Sali L, Maddau C, Zuccherelli S, Picozzi G, Carrozzi L, Grazzini M, Fontanini G, Voltolini L, Vella A, Castiglione F, Carozzi F, Paci E, Zompatori M, Lopes Pegna A, Falaschi F. Screen-detected multiple primary lung cancers in the ITALUNG trial. J Thorac Dis 2018; 10:1058-1066. [PMID: 29607181 DOI: 10.21037/jtd.2018.01.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Occurrence of multiple primary lung cancers (MPLC) in individuals undergoing low-dose computed tomography (LDCT) screening has not been thoroughly addressed. We investigated MPLC in subjects recruited in the ITALUNG randomized clinical trial. Cases of cytologically/histologically proven MPLC detected at screening LDCT or follow-up CT were selected and pathologically re-evaluated according to the WHO 2015 classification. Overall 16 MPLC were diagnosed at screening LDCT (n=14, all present at baseline) or follow-up CT (n=2) in six subjects (4 in one subject, 3 in two and 2 in three subjects), representing 0.43% of the 1,406 screenees and 15.8% of the 38 subjects with at least one screen-detected primary lung cancer. MPLC included 9 adenocarcinomas in three subjects and a combination of 7 different tumour histotypes in three subjects. MPLC, mostly adenocarcinomas, are not uncommon in smokers and ex-smokers with at least one LDCT screen detected primary lung cancer.
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Affiliation(s)
- Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Camilla E Comin
- Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Elena Bertelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Lapo Sali
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Cristina Maddau
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Stefania Zuccherelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Picozzi
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Laura Carrozzi
- Cardiopulmonary Department, Pisa University Hospital, Pisa, Italy
| | | | | | - Luca Voltolini
- Division of Thoracic Surgery, Careggi University Hospital, Florence, Italy
| | | | - Francesca Castiglione
- Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Francesca Carozzi
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Eugenio Paci
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Maurizio Zompatori
- Radiology Department, Multimedica Group, IRCCS, Sesto San Giovanni, Italy
| | - Andrea Lopes Pegna
- Pulmonology, Cardio-Thoracic-Vascular Department, Careggi Hospital, Florence, Italy
| | - Fabio Falaschi
- 2nd Radiology Unit, University Hospital of Pisa, Pisa, Italy
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49
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Sverzellati N, Odone A, Silva M, Polverosi R, Florio C, Cardinale L, Cortese G, Addonisio G, Zompatori M, Dalpiaz G, Piciucchi S, Larici AR. Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist. Radiol Med 2017; 123:245-253. [PMID: 29230680 PMCID: PMC5849634 DOI: 10.1007/s11547-017-0835-6] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/06/2017] [Indexed: 12/11/2022]
Abstract
Objectives To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD). Methods The writing committee selected the HRCT criteria—the Delphi items—for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as “essential”, “optional”, or “not relevant”. The items rated “essential” by < 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP. Results A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated “essential” by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated “essential” by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting. Conclusions This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists. Electronic supplementary material The online version of this article (10.1007/s11547-017-0835-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.
| | - Anna Odone
- Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mario Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Roberta Polverosi
- Department of Radiology, Ospedali di San Donà di Piave e Jesolo, Padua, Italy
| | - Carlo Florio
- Department of Radiology, Istituto Tumori "Giovanni Paolo II" di Bari, Bari, Italy
| | | | | | - Giancarlo Addonisio
- Department of Radiology, Ospedali di San Donà di Piave e Jesolo, Padua, Italy
| | - Maurizio Zompatori
- Radiology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Giorgia Dalpiaz
- Department of Radiology, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | - Sara Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì, Italy
| | - Anna Rita Larici
- Department of Radiological Sciences, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
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50
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Frakulli R, Salvi F, Balestrini D, Palombarini M, Akshija I, Cammelli S, Morganti AG, Zompatori M, Frezza G. Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC). Transl Lung Cancer Res 2017; 6:S1-S7. [PMID: 29299403 DOI: 10.21037/tlcr.2017.10.01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Parenchymal changes after stereotactic body radiation therapy (SBRT) make differential diagnosis between treatment outcomes and disease recurrence often difficult. The purpose of our study was to identify the radiographic features detectable at computed tomography (CT) scan [high-risk features (HRFs)] that allow enough specificity and sensitivity for early detection of recurrence. Methods We retrospectively evaluated patients who underwent SBRT for inoperable early stage non-small cell lung cancer (NSCLC). The median delivered dose performed was 50 Gy in 5 fractions prescribed to 80% isodose. All patients underwent chest CT scan before SBRT and at 3, 6, 12, 18, 24 months after, and then annually. Each CT scan was evaluated and benign and HRFs were recorded. 18F-fluorodeoxyglucose-CT was not used routinely. Results Forty-five patients were included (34 males, 11 females; median age: 77 years; stage IA: 77.8%, stage IB: 22.2%; median follow-up: 21.7 months). Two year and actuarial local control was 77%. HRFs were identified in 20 patients. The most significant predictor of relapse was an enlarging opacity at 12 months (P<0.001) with 84.6% sensitivity and 71.8% specificity. The presence of ≥2 HRFs demonstrated a high sensibility (92.3%) and specificity (71.9%) (P<0.0001). Conclusions Detection of HRFs is predictive of relapse with a sensibility that increases with the number of HRFs observed. This observation may allow to better define the diagnostic follow algorithm up suggesting to performing further exams only in patients with >2 HRFs.
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Affiliation(s)
- Rezarta Frakulli
- Radiation Oncology Centre, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Fabrizio Salvi
- Radiation Oncology Unit, Bellaria Hospital, Bologna, Italy
| | | | | | - Ilir Akshija
- Department of Biomedical Sciences, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Silvia Cammelli
- Radiation Oncology Centre, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Centre, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Maurizio Zompatori
- Radiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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