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Buizza G, Paganelli C, Ballati F, Sacco S, Preda L, Iannalfi A, Alexander DC, Baroni G, Palombo M. Improving the characterization of meningioma microstructure in proton therapy from conventional apparent diffusion coefficient measurements using Monte Carlo simulations of diffusion MRI. Med Phys 2021; 48:1250-1261. [PMID: 33369744 DOI: 10.1002/mp.14689] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/08/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Proton therapy could benefit from noninvasively gaining tumor microstructure information, at both planning and monitoring stages. The anatomical location of brain tumors, such as meningiomas, often hinders the recovery of such information from histopathology, and conventional noninvasive imaging biomarkers, like the apparent diffusion coefficient (ADC) from diffusion-weighted MRI (DW-MRI), are nonspecific. The aim of this study was to retrieve discriminative microstructural markers from conventional ADC for meningiomas treated with proton therapy. These markers were employed for tumor grading and tumor response assessment. METHODS DW-MRIs from patients affected by meningioma and enrolled in proton therapy were collected before (n = 35) and 3 months after (n = 25) treatment. For the latter group, the risk of an adverse outcome was inferred by their clinical history. Using Monte Carlo methods, DW-MRI signals were simulated from packings of synthetic cells built with well-defined geometrical and diffusion properties. Patients' ADC was modeled as a weighted sum of selected simulated signals. The weights that best described a patient's ADC were determined through an optimization procedure and used to estimate a set of markers of tumor microstructure: diffusion coefficient (D), volume fraction (vf), and radius (R). Apparent cellularity (ρapp ) was estimated from vf and R for an easier clinical interpretability. Differences between meningothelial and atypical subtypes, and low- and high-grade meningiomas were assessed with nonparametric statistical tests, whereas sensitivity and specificity with ROC analyses. Similar analyses were performed for patients showing low or high risk of an adverse outcome to preliminary evaluate response to treatment. RESULTS Significant (P < 0.05) differences in median ADC, D, vf, R, and ρapp values were found when comparing meningiomas' subtypes and grades. ROC analyses showed that estimated microstructural parameters reached higher specificity than ADC for subtyping (0.93 for D and vf vs 0.80 for ADC) and grading (0.75 for R vs 0.67 for ADC). High- and low-risk patients showed significant differences in ADC and microstructural parameters. The skewness of ρapp was the parameter with highest AUC (0.90) and sensitivity (0.75). CONCLUSIONS Matching measured with simulated ADC yielded a set of potential imaging markers for meningiomas grading and response monitoring in proton therapy, showing higher specificity than conventional ADC. These markers can provide discriminative information about spatial patterns of tumor microstructure implying important advantages for patient-specific proton therapy workflows.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy
| | - Francesco Ballati
- Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy
| | - Simone Sacco
- Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy
| | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1V6LJ, UK
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, 20133, Italy.,Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, 27100, Italy
| | - Marco Palombo
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1V6LJ, UK
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Lucioni M, Rossi C, Lomoro P, Ballati F, Fanizza M, Ferrari A, Garcia-Etienne CA, Boveri E, Meloni G, Sommaruga MG, Ferraris E, Lasagna A, Bonzano E, Paulli M, Sgarella A, Di Giulio G. Positive predictive value for malignancy of uncertain malignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended? Eur Radiol 2020; 31:920-927. [PMID: 32816199 DOI: 10.1007/s00330-020-07161-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/14/2020] [Revised: 06/20/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Breast lesions classified as of "uncertain malignant potential" represent a heterogeneous group of abnormalities with an increased risk of associated malignancy. Clinical management of B3 lesions diagnosed on vacuum-assisted breast biopsy (VABB) is still challenging: surgical excision is no longer the only available treatment and VABB may be sufficient for therapeutic excision. The aim of the present study is to evaluate the positive predictive value (PPV) for malignancy in B3 lesions that underwent surgical excision, identifying possible upgrading predictive factors and characterizing the malignant lesions eventually diagnosed. These results are compared with a subset of patients with B3 lesions who underwent follow-up. METHODS A total of 1250 VABBs were performed between January 2006 and December 2017 at our center. In total, 150 B3 cases were diagnosed and 68 of them underwent surgical excision. VABB findings were correlated with excision histology. A PPV for malignancy for each B3 subtype was derived. RESULTS The overall PPV rate was 28%, with the highest upgrade rate for atypical ductal hyperplasia (41%), followed by classical lobular neoplasia (29%) and flat epithelial atypia (11%). Only two cases of carcinoma were detected in the follow-up cohort, both associated with atypical ductal hyperplasia at VABB. CONCLUSION Open surgery is recommended in case of atypical ductal hyperplasia while, for other B3 lesions, excision with VABB only may be an acceptable alternative if radio-pathological correlation is assessed, if all microcalcifications have been removed by VABB, and if the lesion lacks high-risk cytological features. KEY POINTS • Surgical treatment is strongly recommended in case of ADH, while the upgrade rate in case of pure FEA, especially following complete microcalcification removal by VABB, may be sufficiently low to advice surveillance as a management strategy. • The use of 11-G- or 8-G-needle VABB, resulting in possible complete diagnostic excision of the lesion, can be an acceptable alternative in case of RS, considering open surgery only for selected high-risk patients. • LN management is more controversial: surgical excision may be recommended following classical LN diagnosis on breast biopsy if an additional B3 lesion is concurrently detected while in the presence of isolated LN with adequate radiological-pathological correlation follow-up alone could be an acceptable option.
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Affiliation(s)
- Marco Lucioni
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Rossi
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pascal Lomoro
- Breast Imaging Department, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy.
| | - Francesco Ballati
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marianna Fanizza
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberta Ferrari
- Breast Surgery Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Carlos A Garcia-Etienne
- Breast Surgery Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Emanuela Boveri
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Meloni
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Grazia Sommaruga
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Ferraris
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo and, Università degli Studi, Pavia, Italy
| | - Angioletta Lasagna
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo and, Università degli Studi, Pavia, Italy
| | - Elisabetta Bonzano
- University of Pavia and Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Paulli
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Adele Sgarella
- Breast Surgery Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giuseppe Di Giulio
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Sacco S, Ballati F, Gaetani C, Lomoro P, Farina LM, Bacila A, Imparato S, Paganelli C, Buizza G, Iannalfi A, Baroni G, Valvo F, Bastianello S, Preda L. Multi-parametric qualitative and quantitative MRI assessment as predictor of histological grading in previously treated meningiomas. Neuroradiology 2020; 62:1441-1449. [PMID: 32583368 DOI: 10.1007/s00234-020-02476-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Meningiomas are mainly benign tumors, though a considerable proportion shows aggressive behaviors histologically consistent with atypia/anaplasia. Histopathological grading is usually assessed through invasive procedures, which is not always feasible due to the inaccessibility of the lesion or to treatment contraindications. Therefore, we propose a multi-parametric MRI assessment as a predictor of meningioma histopathological grading. METHODS Seventy-three patients with 74 histologically proven and previously treated meningiomas were retrospectively enrolled (42 WHO I, 24 WHO II, 8 WHO III) and studied with MRI including T2 TSE, FLAIR, Gradient Echo, DWI, and pre- and post-contrast T1 sequences. Lesion masks were segmented on post-contrast T1 sequences and rigidly registered to ADC maps to extract quantitative parameters from conventional DWI and intravoxel incoherent motion model assessing tumor perfusion. Two expert neuroradiologists assessed morphological features of meningiomas with semi-quantitative scores. RESULTS Univariate analysis showed different distributions (p < 0.05) of quantitative diffusion parameters (Wilcoxon rank-sum test) and morphological features (Pearson's chi-square; Fisher's exact test) among meningiomas grouped in low-grade (WHO I) and higher grade forms (WHO II/III); the only exception consisted of the tumor-brain interface. A multivariate logistic regression, combining all parameters showing statistical significance in the univariate analysis, allowed discrimination between the groups of meningiomas with high sensitivity (0.968) and specificity (0.925). Heterogeneous contrast enhancement and low ADC were the best independent predictors of atypia and anaplasia. CONCLUSION Our multi-parametric MRI assessment showed high sensitivity and specificity in predicting histological grading of meningiomas. Such an assessment may be clinically useful in characterizing lesions without histological diagnosis. Key points • When surgery and biopsy are not feasible, parameters obtained from both conventional and diffusion-weighted MRI can predict atypia and anaplasia in meningiomas with high sensitivity and specificity. • Low ADC values and heterogeneous contrast enhancement are the best predictors of higher grade meningioma.
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Affiliation(s)
- Simone Sacco
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francesco Ballati
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Clara Gaetani
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pascal Lomoro
- Department of Radiology, Valduce Hospital, Como, Italy
| | | | - Ana Bacila
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Imparato
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Iannalfi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy.
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Vancheri SG, Savietto G, Ballati F, Maggi A, Canino C, Bortolotto C, Valentini A, Dore R, Stella GM, Corsico AG, Iotti GA, Mojoli F, Perlini S, Bruno R, Preda L. Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms. Eur Radiol 2020; 30:6161-6169. [PMID: 32474630 PMCID: PMC7260475 DOI: 10.1007/s00330-020-06967-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of chest X-ray (CXR) in detecting pulmonary alterations. MATERIALS AND METHODS CXR of 240 symptomatic patients (70% male, mean age 65 ± 16 years), with SARS-CoV-2 infection confirmed by RT-PCR, was retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: group A (0-2 days), 49 patients; group B (3-5), 75 patients; group C (6-9), 85 patients; and group D (> 9), 31 patients. Alteration's type (reticular/ground-glass opacity (GGO)/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-square test. RESULTS Among 240 patients who underwent CXR, 180 (75%) showed alterations (group A, 63.3%; group B, 72%; group C, 81.2%; group D, 83.9%). GGO was observed in 124/180 patients (68.8%), reticular alteration in 113/180 (62.7%), and consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (p < 0.01). Distribution among groups was as follows: reticular alteration (group A, 70.9%; group B, 72.2%; group C, 57.9%; group D, 46.1%), GGO (group A, 67.7%; group B, 62.9%; group C, 71%; group D, 76.9%), and consolidation (group A, 35.5%; group B, 31.4%; group C, 47.8%; group D, 38.5%). Alterations were bilateral in 73.3%. Upper, middle, and lower fields were involved in 36.7%, 79.4%, and 87.8%, respectively. Lesions were peripheral in 49.4%, central in 11.1%, or both in 39.4%. Upper fields and central zones were significantly less involved (p < 0.01). CONCLUSIONS The most frequent lesions in COVID-19 patients were GGO (intermediate/late phase) and reticular alteration (early phase) while consolidation gradually increased over time. The most frequent distribution was bilateral, peripheral, and with middle/lower predominance. Overall rate of negative CXR was 25%, which progressively decreased over time. KEY POINTS • The predominant lung changes were GGO and reticular alteration, while consolidation was less frequent. • The typical distribution pattern was bilateral, peripheral, or both peripheral and central and involved predominantly the lower and middle fields. • Chest radiography showed lung abnormalities in 75% of patients with confirmed SARS-CoV-2 infection, range varied from 63.3 to 83.9%, respectively, at 0-2 days and > 9 days from the onset of symptoms.
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Affiliation(s)
- Sergio Giuseppe Vancheri
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Giovanni Savietto
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy. .,Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Francesco Ballati
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Alessia Maggi
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Costanza Canino
- Medical Oncology Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Adele Valentini
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Roberto Dore
- Radiology Unit, Isituti Clinici Città di Pavia, Pavia, Italy
| | - Giulia Maria Stella
- Unit of Respiratory Diseases, Department of Internal Medicine and Therapeutics, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Angelo Guido Corsico
- Unit of Respiratory Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Giorgio Antonio Iotti
- Unit Anesthesiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Anesthesia and Intensive Care Unit 1, Department of Intensive Medicine, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Francesco Mojoli
- Unit Anesthesiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Anesthesia and Intensive Care Unit 1, Department of Intensive Medicine, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Stefano Perlini
- Department of Internal Medicine and Therapeutics, University of Pavia, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Emergency Department, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Raffaele Bruno
- Department of Infectious and Tropical Diseases, University of Pavia and I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy
| | - Lorenzo Preda
- Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Viale Camillo Golgi, 19, Pavia, 27100, Italy.,Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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Franconeri A, Ballati F, Panzuto F, Raciti MV, Smedile A, Maggi A, Asteggiano C, Esposito M, Stoppa D, Lungarotti L, Bortolotto C, Giardini D, De Silvestri A, Calliada F. A proposal for a semiquantitative scoring system for lymphedema using Non-contrast Magnetic Resonance Lymphography (NMRL): Reproducibility among readers and correlation with clinical grading. Magn Reson Imaging 2020; 68:158-166. [PMID: 32057940 DOI: 10.1016/j.mri.2020.02.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/15/2020] [Accepted: 02/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the ability and reproducibility of Non-contrast Magnetic Resonance Lymphography (NMRL) in detecting and quantify lymphedema, using a semiquantitative scoring system. METHODS AND MATERIAL This is a monocentric retrospective study of 134 consecutive patients with a clinical diagnosis of limb lymphedema who performed a Non-contrast Magnetic Resonance Lymphography (NMRL) at our Institution between November 2014 and February 2017. Lymphedema was classified based both on clinical and radiologic evaluation. An NMRL total score was obtained for each limb's segment and compared to the clinical grade, used as reference standard. NMRL intra-observer, inter-observer variability and intraclass correlation were calculated. NMRL sensitivity, specificity, and accuracy in identifying lymphedema were provided. Based on score distribution an NMRL four-stage system was developed. RESULTS NMRL showed 92% sensitivity, 77% specificity and 82% accuracy in identifying lymphedema. An almost perfect agreement was obtained by expert operators, while substantial agreement was obtained by non-expert operators. Substantial agreement resulted also for the inter-observer variability (Cohen's Kappa K = 0.73, CI 95% [0.69-0.78]). The intra-class correlation showed an almost perfect relationship both by expert and non-expert operators. Excellent correlation between clinical grade and NMRL score and between clinical grade and NMRL stage were found for each segment. CONCLUSIONS NMRL is a confident and reproducible exam with high sensitivity, good specificity and high accuracy in lymphedema detection; the semiquantitative NMRL score resulted a reliable and reproducible tool able to quantify lymphedema severity.
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Affiliation(s)
- Andrea Franconeri
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy.
| | - Francesco Ballati
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Fabio Panzuto
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Maria Vittoria Raciti
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Antonella Smedile
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Alessia Maggi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Carlo Asteggiano
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Marcello Esposito
- Department of Geriatrics and Rehabilitation, University of Parma, Str. dell'Università, 12, 43121 Parma, Italy
| | - Davide Stoppa
- Department of Radiology, Civili Hospital, Corso Milano, 19, 27029 Vigevano, Italy
| | - Luca Lungarotti
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Denisa Giardini
- Lymphedema Center, Nursing home "La Madonnina", Via Quadronno, 29, 20122 Milan, Italy
| | - Annalisa De Silvestri
- Scientific Direction Clinical epidemiology and Biometry Service, - IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Fabrizio Calliada
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy
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6
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Franconeri A, Ballati F, Pin M, Carone L, Danesino GM, Valentini A. Interrupted aortic arch: A case report. Indian J Radiol Imaging 2020; 30:81-83. [PMID: 32476755 PMCID: PMC7240901 DOI: 10.4103/ijri.ijri_273_19] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/09/2019] [Accepted: 12/21/2019] [Indexed: 11/06/2022] Open
Abstract
Interrupted aortic arch diagnosed in adult age is a rare entity, with only a few cases published in the literature. Most of them are classified as type A interrupted aortic arch and differential diagnosis is associated with severe chronic coarctation. We present a case of a 52-year-old woman accessed to the emergency department for chest and right upper limb pain that increased in the last days. She underwent a computed tomography angiogram showing interruption of the aortic arch, distal to left subclavian artery origin, large bilateral collateral vessels connecting subclavian arteries to descending aorta with multiple voluminous aneurysms, a bicuspid aortic valve, dilatated tubular segment of ascending thoracic aorta, and a suspected atrial septal defect. A nonsystematic literature review regarding these conditions has been performed.
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Affiliation(s)
- Andrea Franconeri
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Ballati
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maurizio Pin
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, Pavia, Italy
| | - Luisa Carone
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Gian M Danesino
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Adele Valentini
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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