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Gagliardo C, Martines F, Bencivinni F, La Tona G, Lo Casto A, Midiri M. Intratumoral haemorrhage causing an unusual clinical presentation of a vestibular schwannoma. Neuroradiol J 2013; 26:30-4. [PMID: 23859164 DOI: 10.1177/197140091302600105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/26/2013] [Indexed: 12/18/2022] Open
Abstract
We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibular schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves.
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Agnello F, Roy C, Bazille G, Galia M, Midiri M, Charles T, Lang H. Small solid renal masses: characterization by diffusion-weighted MRI at 3 T. Clin Radiol 2013; 68:e301-8. [PMID: 23452876 DOI: 10.1016/j.crad.2013.01.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/23/2012] [Accepted: 01/02/2013] [Indexed: 02/06/2023]
Abstract
AIM To describe the appearance of small solid renal lesions (≤3 cm) on diffusion-weighted magnetic resonance imaging (MRI) and to determine whether ADC measurements may help to differentiate benign from malignant small solid renal masses. METHODS AND MATERIALS Thirty-five patients with 47 small renal masses (23 malignant, 24 benign) who underwent 3 T MRI of the kidney using diffusion-weighted sequences (b values of 0 and 1000 s/mm(2)) were retrospectively evaluated. Qualitative and quantitative analysis of diffusion-weighted images was performed. RESULTS Most lesions were hyperintense to kidney on high b-value diffusion-weighted images and hypointense on apparent diffusion coefficient (ADC) map. The mean ADC of the lesions was significantly lower than that of kidney (1.22 ± 0.3 versus 1.85 ± 0.12 mm(2)/s; p < 0.005). The mean ADC was significantly different between renal cell carcinomas (1.2 ± 0.01 mm(2)/s), metastases (1.25 ± 0.04 mm(2)/s), angiomyolipoma (1.07 ± 0.3 mm(2)/s) and oncocytomas (1.56 ± 0.08 mm(2)/s; p < 0.05). The mean ADC of clear cell renal cell carcinomas was significantly different from that of non-clear cell renal cell carcinomas (1.38 ± 0.34 versus 0.83 ± 0.34 mm(2)/s; p < 0.005). No significant difference was found between mean ADC of fat containing and minimal fat angiomyolipomas (1.06 ± 0.48 versus 1.11 ± 0.33 mm(2)/s). CONCLUSION Small solid renal masses are hyperintense on high b value and have different ADC values.
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La Grutta L, Galia M, Gentile G, Lo Re G, Grassedonio E, Coppolino F, Maffei E, Maresi E, Lo Casto A, Cademartiri F, Midiri M. Comparison of iodinated contrast media for the assessment of atherosclerotic plaque attenuation values by CT coronary angiography: observations in an ex vivo model. Br J Radiol 2013; 86:20120238. [PMID: 23255542 DOI: 10.1259/bjr.20120238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the influence of different iodinated contrast media with several dilutions on plaque attenuation in an ex vivo coronary model studied by multislice CT coronary angiography. METHODS In six ex vivo left anterior descending coronary arteries immersed in oil, CT (slices/collimation 64×0.625 mm, temporal resolution 210 ms, pitch 0.2) was performed after intracoronary injection of a saline solution, and solutions of a dimeric isosmolar contrast medium (Iodixanol 320 mgI ml(-1)) and a monomeric high-iodinated contrast medium (Iomeprol 400 mgI ml(-1)) with dilutions of 1/80 (low concentration), 1/50 (medium concentration), 1/40 (high concentration) and 1/20 (very high concentration). Two radiologists drew regions of interest in the lumen and in calcified and non-calcified plaques for each solution. 29 cross-sections with non-calcified plaques and 32 cross-sections with calcified plaques were evaluated. RESULTS Both contrast media showed different attenuation values within lumen and plaque (p<0.0001). The correlation between lumen and non-calcified plaque values was good (Iodixanol r=0.793, Iomeprol r=0.647). Clustered medium- and high-concentration solutions showed similar plaque attenuation values, signal-to-noise ratios (SNRs) (non-calcified plaque: medium solution SNR 31.3±15 vs 31.4±20, high solution SNR 39.4±17 vs 37.4±22; calcified plaque: medium solution SNR 305.2±133 vs 298.8±132, high solution SNR 323.9±138 vs 293±123) and derived contrast-to-noise ratios (p>0.05). CONCLUSION Differently iodinated contrast media have a similar influence on plaque attenuation profiles. ADVANCES IN KNOWLEDGE Since iodine load affects coronary plaque attenuation linearly, different contrast media may be equally employed for coronary atherosclerotic plaque imaging.
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Di Cesare E, Cademartiri F, Carbone I, Carriero A, Centonze M, De Cobelli F, De Rosa R, Di Renzi P, Esposito A, Faletti R, Fattori R, Francone M, Giovagnoni A, La Grutta L, Ligabue G, Lovato L, Marano R, Midiri M, Romagnoli A, Russo V, Sardanelli F, Natale L, Bogaert J, De Roos A. [Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging]. Radiol Med 2012. [PMID: 23184241 DOI: 10.1007/s11547-012-0899-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiac magnetic resonance (CMR) is considered an useful method in the evaluation of many cardiac disorders. Based on our experience and available literature, we wrote a document as a guiding tool in the clinical use of CMR. Synthetically we describe different cardiac disorders and express for each one a classification, I to IV, depending on the significance of diagnostic information expected.
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Carriero A, Bonomo L, Calliada F, Campioni P, Colosimo C, Cotroneo A, Cova M, Ettorre GC, Fugazzola C, Garlaschi G, Macarini L, Mascalchi M, Meloni GB, Midiri M, Mucelli RP, Rossi C, Sironi S, Torricelli P, Beomonte BZ, Zompatori M, Zuiani C. E-learning in radiology: an Italian multicentre experience. Eur J Radiol 2012; 81:3936-41. [PMID: 22902406 DOI: 10.1016/j.ejrad.2012.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 04/17/2012] [Accepted: 07/09/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to design, deliver and evaluate an e-learning teaching programme for post-graduate radiodiagnostics training that would involve various post-graduate schools throughout Italy. MATERIALS AND METHODS All of the Directors of Italian post-graduate schools of radiodiagnostics were sent an e-mail on 27 September 2010 informing them of our willingness to set up an e-learning project for the academic year 2010-2011 in the form of single-subject teaching seminars. The proposed subjects were the semeiotics of the various organs and apparatuses in the context of "Urgent/Emergency Pathology". After having received registrations, a calendar of lessons was planned to be held between 10 November 2010 and 12 October 2011. The validity of the project was tested by means of a multiple-choice questionnaire covering the technical and didactic quality of the entire project, to be completed by the students. RESULTS Fifty-one percent of the universities in Italy participated in the project: Trieste, Udine, Verona, Milan-Bicocca, Novara, Varese, Genoa, Sassari, Rome Campus, the Catholic University of Rome, Chieti, Foggia, Catania, Modena, Florence, Palermo, Bologna, Pavia, Parma and Ferrara. The lessons were attended by a total of 10,261 post-graduate medical students, for an average of 513.1 students per lesson. Seventy percent of the students judged the didactic content "excellent", 25% "good", and 5% "satisfactory"; none said it was unsatisfactory. In terms of visual quality (particularly the details of the radiological images proposed in the form of slides and/or video clips), 73% judged it "excellent", 20% "good", 6% "satisfactory", and 1% "poor". The audio quality was judged "excellent" by 71%, "good" by 22%, "satisfactory" by 6% and "poor" by 1%. In relation to judgement of audio and video quality, it has to be underlined that this was greatly affected by the hardware/software configuration and the band speed and technology of the Internet connection. CONCLUSIONS Technological evolution is overcoming all barriers, and technology is also having a positive impact on the approach to teaching. Our multicentre teaching experience merits the following considerations: the quality of the teaching product was certified by the students' judgements of its didactic content and the quality of reception; the economic cost of the teaching had a minimal impact on the post-graduate schools (€ 18 per lesson). In terms of breaking down national barriers, it is to be hoped that the coordination and integration of diagnostic imaging e-learning projects, with the participation of post-graduate schools in different European countries, can be developed not only in a spirit of "cultural sharing" and the exchange of teaching experiences.
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Bellia M, Benfante A, Menozzii M, Augugliaro G, Scichilone N, Cannizzaro F, Midiri M, Bellia V. Validation of lung densitometry threshold at CT for the distinction between senile lung and emphysema in elderly subjects. Monaldi Arch Chest Dis 2012; 75:162-6. [PMID: 22428218 DOI: 10.4081/monaldi.2011.216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS An ageing lung is characterised by distal airspace enlargement without alveolar wall destruction: therefore the anatomical distinction between senile lung and emphysema is clear-cut. In clinical settings the definition of precise boundaries between normalcy and pathology is more difficult with the risk of overdiagnosis. CT is an important diagnostic advancement in the field of COPD. Most methods for the evaluation of emphysema are based on the detection and measurement of areas characterised by a density level below a threshold assumed to characterize parenchymal destruction. METHODS Our retrospective study included 47 healthy subjects (65-91 years), 36 never smokers and 11 former smokers. As a reference sample we recruited 9 patients with emphysema (69-81 years). Thoracic scan was performed by single slice spiral CT and acquired without contrast enhancement. For each scan and on both lungs we sampled eighteen regions of interest in the upper, middle and lower field. Mean lung density (MLD) and lower limit of normal (LLN) of density distribution were calculated. RESULTS MLD for the whole study sample was -846 +/- 41 HU. -901 HU was the LLN of density distribution in the study sample. No significant correlation was noted between age and MLD. In the emphysematous sample the average lung density was -946 +/- 18 HU. The mean coefficient of variation was 3% in the healthy sample and 2% in the emphysematous one. The difference between groups was significant (p < 0.0001). In one healthy subject only we measured a value slightly below the threshold reported in literature for conventional CT; no emphysematous value fell above the LLN. CONCLUSIONS This study highlights the fact that in the elderly the threshold level of lung density commonly adopted in diagnostic algorithms of emphysema is fully applicable. When applying this method to older subjects the risk of misinterpreting areas of physiologic non-destructive reduction of density as emphysema is low.
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Bartolotta TV, Taibbi A, Matranga D, Sandonato L, Asta S, Midiri M, Lagalla R. Incidence of new foci of hepatocellular carcinoma after radiofrequency ablation: role of multidetector CT. Radiol Med 2011; 117:739-48. [PMID: 22095421 DOI: 10.1007/s11547-011-0752-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 03/31/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE The authors sought to assess the incidence of new foci of hepatocellular carcinoma (HCC) using multidetector computed tomography (MDCT) in patients treated with radiofrequency ablation (RFA). MATERIALS AND METHODS Two readers retrospectively reviewed by consensus the follow-up MDCT studies of 125 patients (88 men and 37 women; mean age 68 years) with 141 HCCs (size 1-5.2 cm; mean 2.2 cm) treated with RFA. MDCT follow-up was performed at 1 and 3 months and every 6-12 months thereafter. Reviewers assessed: (1) the presence of new HCC foci in the same liver segment or in a different segment; (2) complete or incomplete tumour ablation; (3) tumour progression. RESULTS A total of 113 new HCCs (size 0.7-4.8 cm; mean 1.7 cm) were detected in 69/125 (55.2%) patients (mean follow-up 30.38±19.14 months). Of these, 86 (76.1%) new HCCs were multiple (p<0.0001), and 92 (81.4%) occurred in a different segment from that of the treated HCC (p<0.0001). New HCCs were observed in the first 12 months, between 12 and 24 months and after 24 months in 31/69 (44.9%), 24/69 (34.8%) and 14/69 (20.3%) patients, respectively (p=0.175). Mean diseasefree interval was 16.1±16.31 (range 1-52) months. Complete tumour ablation was achieved in 132/141 (93.6%) treated HCCs, and tumour progression occurred in 29/141 (20.6%) cases. CONCLUSIONS In patients with RFA-treated HCCs, MDCT follow-up revealed a high incidence of new HCCs, even after 1 year of follow-up. The new foci tended to be multiple and located in a liver segment different from that of the previously treated nodules.
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Maffei E, Palumbo A, Martini C, Tedeschi C, Arcadi T, La Grutta L, Malagò R, Weustink AC, Mollet NR, De Rosa R, Catalano O, Salamone I, Blandino A, Midiri M, Cademartiri F. Computed tomography coronary angiography in asymptomatic patients. Radiol Med 2011; 116:1161-73. [PMID: 21892711 DOI: 10.1007/s11547-011-0723-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 04/27/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; ≥50% lumen reduction) in intermediate/high-risk asymptomatic patients. MATERIALS AND METHODS A total of 183 consecutive asymptomatic individuals (92 men; mean age 54±11 years) with more than one major risk factor (obesity, hypertension, diabetes, hypercholesterolaemia, family history, smoking) and an inconclusive or nonfeasible noninvasive stress test result (stress electrocardiography, stress echocardiography, nuclear stress scintigraphy) underwent CT-CA in an outpatient setting. All patients underwent conventional coronary angiography (CAG) within 4 weeks. Data from CT-CA were compared with CAG regarding the presence of significant CAD (≥50% lumen reduction). RESULTS Mean calcium score was 177±432, mean heart rate during the CT-CA scan was 58±8 bpm and the prevalence (per-patient) of obstructive CAD was 19%. CT-CA showed single-vessel CAD in 9% of patients, two-vessel CAD in 9% and three-vessel CAD in 0%. Per-patient sensitivity, specificity, positive predictive value and negative predictive value of CT-CA were 100% (90-100), 98% (96-99), 97% (85-99), 100% (97-100), respectively. Positive and negative likelihood ratios were 151 and 0, respectively. CONCLUSIONS CT-CA is an excellent noninvasive imaging modality for excluding significant CAD in intermediate/ high-risk asymptomatic patients with inconclusive or nonfeasible noninvasive stress test.
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Maffei E, Seitun S, Palumbo A, Martini C, Emiliano E, Cuttone A, Aldrovandi A, Malagò R, La Grutta L, Midiri M, Tedeschi C, De Rosa R, Catalano O, Weustink A, Mollet N, Cademartiri F. Prognostic value of Morise clinical score, calcium score and computed tomography coronary angiography in patients with suspected or known coronary artery disease. Radiol Med 2011; 116:1188-202. [DOI: 10.1007/s11547-011-0721-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 09/24/2009] [Indexed: 11/28/2022]
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Fattouch K, Runza G, Moscarelli M, Trumello C, Incalcatera E, Corrado E, La Grutta L, Patni R, Midiri M, Novo S, Ruvolo G. Graft patency and late outcomes for patients with ST-segment elevation myocardial infarction who underwent coronary surgery. Perfusion 2011; 26:401-8. [DOI: 10.1177/0267659111411354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of our study was to assess the long-term clinical outcomes and the grafts patency rates of patients with ST-segment elevation myocardial infarction (STEMI) who underwent urgent or emergency coronary artery bypass grafting (CABG). Materials: Participants in two previous studies comprising 207 STEMI patients undergoing on-pump (145 patients) or off-pump (62 patients) coronary artery bypass graft (CABG) surgery in our institution were prospectively followed to assess late mortality, graft patency, and major adverse cardiac-related event (MACE) rates. Graft patency was evaluated by multi-detector computed tomography angiography 64-slice scan. Mean times of graft implantation were 38±16 months and 37±14 months in on-pump and off-pump, respectively. Follow-up data were obtained in all patients and was 100% complete. Results: Late mortality rate was 7.4% (10 patients) in the on-pump and 6.5% (4 patients) in off-pump groups (p=0.45). Five-year overall survival rate (±SE) was 93.5±2.1% and 92.6±1.9% in the off-pump vs on-pump, respectively. Five years’ freedom from cardiac-related death was 94.9±2.9% in the on-pump group vs 96.8±3.2% in the off-pump group (p=0.25). Five years’ freedom from cardiac-related events was 89.7±1.6% in the on-pump group versus 93.5±1.8% in the off-pump group (p=0.32). In all patients, a total of 449/491 (91.5%) grafts were patent. Percentages of overall grafts classified as patent were similar in the on-pump group (90.7% - 322/355 conduits) versus the off-pump group (91% - 133/146 conduits). Graft patency rates were also similar between the two groups with regard to arterial and saphenous vein conduits, and with regard to different branches of the coronary arteries grafted. Conclusion: Our data suggest that off-pump CABG patients have the same late mortality, MACEs, and graft patency rates as conventional cardioplegic cardiac arrest CABG patients. In our opinion, urgent or emergency CABG for patients with STEMI can be done either way.
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La Grutta L, Runza G, Gentile G, Russo E, Lo Re G, Galia M, Bartolotta TV, Alaimo V, Malagò R, Cademartiri F, Cardinale AE, Midiri M. Prognostic outcome of routine clinical noninvasive multidetector-row computed tomography coronary angiography in patients with suspected coronary artery disease: a 2-year follow-up study. Radiol Med 2011; 116:521-31. [DOI: 10.1007/s11547-011-0655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
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Bartolotta TV, Ienzi R, Cirino A, Genova C, Ienzi F, Pitarresi D, Safina E, Midiri M. Characterisation of indeterminate focal breast lesions on grey-scale ultrasound: role of ultrasound elastography. Radiol Med 2011; 116:1027-38. [DOI: 10.1007/s11547-011-0648-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/30/2010] [Indexed: 12/21/2022]
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Furlan A, Marin D, Vanzulli A, Patera GP, Ronzoni A, Midiri M, Bazzocchi M, Lagalla R, Brancatelli G. Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout. Br J Radiol 2010; 84:403-12. [PMID: 21081569 DOI: 10.1259/bjr/18329080] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC). METHODS 30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs. RESULTS 48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p<0.001, McNemar's test). Objective washout was present in 30 of the 46 HCCs (65%) during the hepatic venous phase and in 42 of the HCCs (91%) during the delayed phase (p=0.001). The delayed phase yielded significantly higher mean TLC absolute values compared with the hepatic venous phase (-16.1±10.8 HU vs -10.5±10.2 HU; p<0.001). CONCLUSIONS The delayed phase is superior to the hepatic venous phase for detection of tumour washout of pathologically proven HCC in cirrhotic patients.
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Sparacia G, Iaia A, Cavarretta G, Mularo V, Fiamma ME, Di Giovanna E, Midiri M. MR Imaging of Bilateral Paramedian Thalamic and Mesencephalic Infarcts. A Case Report. Neuroradiol J 2010; 23:48-51. [PMID: 24148333 DOI: 10.1177/197140091002300108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 06/29/2009] [Indexed: 11/17/2022] Open
Abstract
We describe MR imaging of bilateral infarction of the paramedian portion of the mesencephalus and thalamus due to an occlusion of the Percheron artery. This entity is due to one of the anatomic variants of the perforating arteries supplying the thalamus and mesenchephalus. Clinically this kind of infarction presents with neurologic impairment as a disorder of consciousness, memory dysfunctions, various types of vertical gaze palsy and psychic changes, which need to be differentiated from delirium and coma. At MRI evaluation infarction of the paramedian portion of thalami and midbrain, with a "butterfly wings" pattern, was demonstrated as high signal intensity areas on FLAIR and FSE-T2W images and with diffusion restriction on DWI images.
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Malagò R, D'Onofrio M, Brunelli S, La Grutta L, Midiri M, Tavella D, Benussi P, Pozzi Mucelli R. Anatomical variants and anomalies of the coronary tree studied with MDCT coronary angiography. Radiol Med 2010; 115:679-92. [PMID: 20177986 DOI: 10.1007/s11547-010-0522-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 06/23/2009] [Indexed: 01/17/2023]
Abstract
Anomalies of the coronary arteries are congenital and in most of the cases asymptomatic, although they may present with severe symptoms such as angina pectoris or cardiac arrest. Multidetector CT coronary angiography (MDCT-CA) permits, through curved multiplanar reconstructions and three-dimensional reformatting, noninvasive visualisation of the coronary tree and its variants and anomalies, providing a more accurate alternative to conventional coronary angiography (CCA). The purpose of this pictorial essay is to describe the main variants and anomalies of the coronary arteries using MDCT imaging with multiplanar and three-dimensional reconstructions.
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La Grutta L, Runza G, Lo Re G, Galia M, Alaimo V, Grassedonio E, Bartolotta TV, Malagò R, Tedeschi C, Cademartiri F, De Maria M, Cardinale AE, Lagalla R, Midiri M. Prevalence of myocardial bridging and correlation with coronary atherosclerosis studied with 64-slice CT coronary angiography. LA RADIOLOGIA MEDICA 2009; 114:1024-36. [PMID: 19697102 DOI: 10.1007/s11547-009-0446-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 01/13/2009] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis. MATERIALS AND METHODS A total of 277 patients (mean age 60+/-11 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments. RESULTS Myocardial bridging was present in 82 patients (30%, mean age 59+/-12). Bridges were of variable length (<1 cm 58%; 1-2 cm 32%; >2 cm 10%) and depth (superficial 69%, intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), <50% stenosis (20%) or >50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p<0.0001). CONCLUSIONS MSCT-CA is a reliable, noninvasive method that is able to depict myocardial bridging and associated atherosclerotic plaque in the proximal segments.
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Russo S, Lo Re G, Galia M, Reginelli A, Lo Greco V, D'Agostino T, La Tona G, Coppolino F, Grassi R, Midiri M, Lagalla R. Videofluorography swallow study of patients with systemic sclerosis. Radiol Med 2009; 114:948-59. [PMID: 19562267 DOI: 10.1007/s11547-009-0416-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 07/31/2008] [Indexed: 12/21/2022]
Abstract
PURPOSE This study was undertaken to evaluate the role of the videofluorographic (VFG) swallow study in patients with systemic sclerosis. MATERIALS AND METHODS Over a 23-month period, 45 women (mean age 58 years, range 27-76 years) with a known diagnosis of systemic sclerosis and a history of dysphagia underwent a dynamic and morphological study of the oral, pharyngeal and oesophageal phases of swallowing with videofluorography. All examinations were performed with a remote-controlled digital C-arm device with 16-in image intensifier, 0.6- to 1.2-mm focal spot range and maximum tube voltage of 150 kVp in fluorography and 120 kVp in fluoroscopy. Cineradiographic sequences were acquired for the swallow study with 12 images per second and matrix 512 x 512 after the ingestion of boluses of high-density (250% weight/volume) barium. The evaluation of oesophageal peristalsis was documented with digital cineradiographic sequences with six images per second in the upright and supine positions during the swallowing of barium (60% weight/volume), and the water siphon test was performed with the patient in the supine position to evaluate the presence of gastro-oesophageal reflux disease (GORD). All patients subsequently underwent laryngoscopy, endoscopy and pH monitoring, and the data thus obtained were processed and compared. RESULTS The VFG swallow study identified alterations of epiglottal tilting associated with intraswallowing laryngeal penetration in 26 patients (57.8%), pooling of contrast agent in the valleculae and pyriform sinuses in 23 (51.1%) and radiographic signs of nonspecific hypertrophy of the lingual and/or palatine tonsils in 18 (40%). The study of the oesophageal phase revealed the presence of altered peristalsis in all patients, and in particular, 36 patients (80%) showed signs of atony. Altered oesophageal clearing mechanisms were evident in all 45 patients, sliding hiatus hernia in 43 (93%) and GORD in 44 (97%). CONCLUSIONS Our study demonstrated that in patients with systemic sclerosis, there is no primary alteration of the oral or pharyngeal phase of swallowing. In addition, alterations of epiglottal tilting associated with laryngeal penetration of contrast agent were found to be secondary to chronic GORD. Indeed, in 40% of patients, radiographic signs were found that indicated nonspecific hypertrophy of the lingual tonsil and/or palatine tonsils and nonspecific signs of chronic pharyngeal inflammation, and GORD was identified in 93% of patients, which in 40% of cases extended to the proximal third of the oesophagus. The data obtained were confirmed in 85% of cases with pH monitoring and in all cases with laryngoscopy.
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Pepe A, Positano V, Capra M, Maggio A, Pinto CL, Spasiano A, Forni G, Derchi G, Favilli B, Rossi G, Cracolici E, Midiri M, Lombardi M. Myocardial scarring by delayed enhancement cardiovascular magnetic resonance in thalassaemia major. Heart 2009; 95:1688-93. [PMID: 19491092 DOI: 10.1136/hrt.2008.156497] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) by delayed enhancement (DE) enables visualisation of myocardial scarring, but no dedicated studies are available in thalassaemia major. OBJECTIVE To investigate the prevalence, extent, clinical and instrumental correlates of myocardial fibrosis or necrosis by DE CMR in patients with thalassaemia major. PATIENTS 115 Patients with thalassaemia major consecutively examined at an MRI laboratory. METHODS DE images were acquired to quantify myocardial scarring. Myocardial iron overload was determined by multislice multiecho T2*. Cine images were obtained to evaluate biventricular function. RESULTS DE areas were present in 28/115 patients (24%). The mean (SD) extent of DE was 3.9 (2.4)%. In 26 patients the location of fibrosis was not specific and patchy distribution was prevalent. Two patients showed transmural DE following coronary distribution. The DE group was significantly older than the no-DE group (31 (7.7) years vs 26 (7.7) years, p = 0.004). No significant relation with heart T2* values and biventricular function was found. A significant correlation was found between the presence of DE and changes in ECG (ECG abnormal in the DE group 22/28 patients and in the no-DE group 30/87 patients; chi(2) = 14.9; p<0.001). CONCLUSIONS In patients with thalassaemia the significant presence of myocardial fibrosis/necrosis seems to be a time-dependent process correlating with cardiovascular risk factors and cardiac complications. Levels of HCV antibodies are significantly higher in the serum of patients with thalassaemia with myocardial fibrosis/necrosis. ECG changes showed a good accuracy in predicting myocardial scarring.
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Ardizzone E, Pirrone R, Gambino O, Vitabile S, Scarnato M, Lo Re G, Galia M, Midiri M. Multislice human organ extraction based on GVF. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:3087-90. [PMID: 19163359 DOI: 10.1109/iembs.2008.4649856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Segmentation techniques based on active contours algorithm are widely used in medical imaging. Unfortunately, they require a lot of parameters to be used and this can represent an issue for those physicians with not much informatics skills. This paper proposes a software tool which allows to segment multiple slice can differ organ extraction setting a small number of parameters. Moreover, the tool offers the functionality to perform a multiple segmentation the same time, so that an entire volume composed by hundreds slices can be segmented.
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Cademartiri F, La Grutta L, Palumbo A, Maffei E, Martini C, Seitun S, Coppolino F, Belgrano M, Malagò R, Aldrovandi A, Mollet N, Weustink A, Cova M, Midiri M. Computed tomography coronary angiography vs. stress ECG in patients with stable angina. Radiol Med 2009; 114:513-23. [PMID: 19367464 DOI: 10.1007/s11547-009-0388-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain. MATERIALS AND METHODS MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8+/-7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate>or=70 beats/minute. In order to identify or exclude patients with significant stenoses (>or=50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test. RESULTS The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) for the stress test and 10.0 (95% CI: 1.8-78.4) and 0.0 (95% CI: 0.0-infinity) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD. CONCLUSIONS Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD.
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Bellia M, Lo Casto A, Guddo F, Midiri M, Regio S, Lagalla R, Bellia V. A rare case of pedunculated bronchial hemangioma. Monaldi Arch Chest Dis 2009; 69:189-91. [PMID: 19350843 DOI: 10.4081/monaldi.2008.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe a rare case of pedunculated endobronchial hemangioma observed in a 60-years-old patient complaining of chronic productive cough and accessional dyspnea which had been progressively worsening over 20 years. The lesion was first noticed at fiberoptic bronchoscopy; then computed tomography scan was performed and integrated with tridimensional reconstruction techniques. Pathology showed the picture of a vascular neoplasm, compatible with capillary hemangioma. The lesion was submitted to laser-assisted endoscopic removal in order to relieve the obstruction, leading to remission of symptoms.
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Fazio G, Grassedonio E, Galia M, Mongiovi' M, Novo G, Sutera L, D'angelo L, Visconti C, Evola G, Pipitone S, Midiri M, Novo S. Ventricular arrhythmias in children: the uselessness of MRI. Minerva Cardioangiol 2009; 57:139-141. [PMID: 19202527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Caradonna P, Bellia M, Cannizzaro F, Regio S, Midiri M, Bellia V. Non-invasive diagnosis in a case of bronchopulmonary sequestration and proposal of diagnostic algorithm. Monaldi Arch Chest Dis 2008; 69:137-41. [PMID: 19065849 DOI: 10.4081/monaldi.2008.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The case of a 43-year-old woman with intralobar pulmonary sequestration, Pryce type one, is presented. The medical history was characterised by recurrent bronchopneumonia, productive cough with purulent sputum and hemoptysis in the last three years. Diagnosis was made by CT angiography: multiplanar, maximum intensity projection and volume rendering reconstructions were visualised. A volume reduction of middle and lower lobe with multiple cyst-like bronchiectasis was detected and no evident relationship with tracheobronchial tree was pointed out. Reconstructions aimed at evaluating bronchial structures demonstrated no patency of middle and lower lobar bronchi. The study carried out after contrast medium infusion in arterial phase showed a vascular disorder characterised by an accessory arterial branch arising from the upper portion of thoracic aorta which, after moving caudally to pulmonary hilus with a tortuous course, supplied the atelectatic parenchyma. No anomalous venous drainage was detected. The patient underwent surgery with resection of two pulmonary lobes. CT compares favourably with other alternative imaging technique for pulmonary sequestration as multiplanar reconstructions allow not only the detection of supplying vessel, but also the accurate description of heterogeneous characteristics of the mass and adjacent structures. Finally an imaging-based diagnostic algorhithm is proposed.
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Fazio G, Grassedonio E, Cracolici E, Mongiovi M, Novo G, Sutera L, D'Angelo L, Visconti C, Spoto S, Pipitone S, Ferrara F, Midiri M, Novo S. Ventricular arrhythmias in children: the uselessness of MRI. Minerva Cardioangiol 2008; 56:575-576. [PMID: 18813191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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De Rosa R, Sacco M, Tedeschi C, Pepe R, Capogrosso P, Montemarano E, Rotondo A, Runza G, Midiri M, Cademartiri F. Prevalence of coronary artery intramyocardial course in a large population of clinical patients detected by multislice computed tomography coronary angiography. Acta Radiol 2008; 49:895-901. [PMID: 18608013 DOI: 10.1080/02841850802199825] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intramyocardial course, an inborn coronary anomaly, is defined as a segment of a major epicardial coronary artery that runs intramurally through the myocardium; in particular, we distinguish myocardial bridging, in which the vessel returns to an epicardial position after the muscle bridge, and intramyocardial course, which is described as a vessel running and ending in the myocardium. PURPOSE To evaluate the prevalence of myocardial bridging and intramyocardial course of coronary arteries as defined by multidetector computed tomography (MDCT) angiography. MATERIAL AND METHODS The study population consisted of 242 consecutive patients (211 men, 31 women; mean age 59+/-6 years) with atypical chest pain admitted to our hospital between December 2004 and September 2006. All MDCT examinations were performed using a 16-detector-row scanner (Aquilion 16 CFX; Toshiba Medical System, Tokyo, Japan). Patients with heart rate above 65 bpm received 50 mg atenolol orally for 3 days prior to the MDCT scan, or they increased their usual therapy with beta-blockers, in order to obtain a prescan heart rate <60 bpm. Curved multiplanar and 3D volume reconstructions were performed to explore coronary anatomy. RESULTS In 235 patients, the CT scan was successful and images were appropriate for evaluation. The prevalence of myocardial bridging and intramyocardial course of coronary arteries was 18.7% (47 cases) in our patient population. In 30 segments (63.8%), the vessels ran and ended in the myocardium. In the remaining 17 segments (36.2%), the vessels returned to an epicardial position after the muscle bridge. We found no difference in the prevalence of this inborn coronary anomaly when comparing different clinical characteristics of the study population (sex, age, body-mass index [BMI], etc.). The mean length of the subepicardial artery was 7 mm (range 5-12 mm), and the mean depth in the diastolic phase was 1.9 mm (range 1.2-2.3 mm). There was no significant difference of diameter in these segments between the different R-R phases examined. CONCLUSION Our study is in agreement with major angiographic literature reporting a prevalence of myocardial bridging and intramyocardial course between 0.5% and 33%. MDCT technology represents a useful, noninvasive imaging method to assess and evaluate the location, depth, and length of this anatomical variation.
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