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Poloni S, Bozzetto M, Du Y, Aiani L, Goddi A, Fiorina I, Remuzzi A. Velocity vector comparison between vector flow imaging and computational fluid dynamics in the carotid bifurcation. Ultrasonics 2023; 128:106860. [PMID: 36244088 DOI: 10.1016/j.ultras.2022.106860] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
It has been largely documented that local hemodynamic conditions, characterized by low and oscillating wall shear stresses, play a key role in the initiation and progression of vascular atherosclerotic lesions. Thus, investigation of the flow field in the carotid bifurcation can lead to early identification of vulnerable plaques. In this scenario, the development of novel non-invasive imaging tools that can be used in routine clinical practice to identify disturbed and recirculating blood flow becomes crucial. In this context, Vector Flow Imaging is becoming a relevant tool as it provides an angle independent assessment of blood flow velocity and multidimensional flow vector visualization. The purpose of the present study was to validate, in several locations of the carotid bifurcation, the high-frame rate vector flow imaging (HiFR-VFI) technique by comparing with computational fluid dynamic simulations (CFD). In all eight carotid bifurcations, HiFR-VFI accurately detected regions of laminar flow as well as recirculation and unsteady flow areas. An accurate and statistically significant agreement was observed between velocity vectors obtained by HiFR-VFI and those computed by CFD, both for vector magnitude (R = 0.85) and direction (R = 0.74). Our study demonstrated that HiFR-VFI is a valid technique for rapid and advanced visual representation of velocity field in large arteries. Thus, it has a great potential in research-based clinical practice for the identification of flow recirculation, low and oscillating velocity gradients near vessel wall. The use of HiFR-VFI may provide a great improvement in the investigation of the role of local hemodynamics in vascular pathologies, as well in the assessment of the effect of pharmacological treatments.
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Affiliation(s)
- Sofia Poloni
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Michela Bozzetto
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen 518057, China
| | - Luca Aiani
- Centro Medico SME - Diagnostica per Immagini, Varese, Italy
| | - Alfredo Goddi
- Centro Medico SME - Diagnostica per Immagini, Varese, Italy
| | - Ilaria Fiorina
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Italy.
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Schneebeli A, Fiorina I, Bortolotto C, Barbero M, Falla D, Cescon C, Raciti MV, Tarantino F, Preda L. Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions. Insights Imaging 2021; 12:26. [PMID: 33598763 PMCID: PMC7889779 DOI: 10.1186/s13244-021-00974-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives Changes in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions. Methods Longitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices; two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2). Results SE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa. Conclusions Strain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-00974-y.
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Affiliation(s)
- Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK. .,Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno/Landquart, Switzerland.
| | - Ilaria Fiorina
- Dipartimento di radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Dipartimento di radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno/Landquart, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Corrado Cescon
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno/Landquart, Switzerland
| | | | - Francesco Tarantino
- Dipartimento di radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Dipartimento di radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Belloni E, Tentoni S, Fiorina I, Bortolotto C, Bottinelli O, Cellina M, Gibelli D, Rosti C, Preda L, Calliada F, Scagnelli P. Reported and Unreported Potentially Important Incidental Findings in Urgent Nonenhanced Abdominal CT for Renal Colic. Med Princ Pract 2021; 30:355-360. [PMID: 33721865 PMCID: PMC8436713 DOI: 10.1159/000515852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/14/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the study was to retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings (PIFs) in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHODS One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January to December 2017 on adult patients from the emergency department with the specific request of urgent evaluation for renal colic, searching for PIFs. RESULTS The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported PIFs between the original report and re-evaluation was significant (p < 0.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the 3 shifts in the original report and in re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopathies, and liver nodules. CONCLUSIONS Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to underreport PIFs even in the urgent setting because of the possible consequences on the patient's health and in order to avoid legal issues, while at the same time satisfying the need for timely and efficient reporting.
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Affiliation(s)
- Elena Belloni
- Department of Radiology, Civil Hospital, Vigevano, Italy
- *Elena Belloni,
| | - Stefania Tentoni
- Institute of Applied Mathematics and Information Technologies “Enrico Magenes”, National Research Council, Pavia, Italy
| | - Ilaria Fiorina
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Olivia Bottinelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Michaela Cellina
- Radiology Unit, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Daniele Gibelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Rosti
- Department of Radiology, Civil Hospital, Vigevano, Italy
| | - Lorenzo Preda
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabrizio Calliada
- Radiology Unit, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Radiology, IRCCS Fondazione Mondino, Pavia, Italy
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Moramarco LP, Capodaglio CA, Quaretti P, Cionfoli N, Fiorina I, Disabella E, D'agostino AM, Urtis M, Arbustini E. Multivessel endovascular therapy for undiagnosed vascular type Ehlers-Danlos syndrome. Successful percutaneous transcatheter coil embolization of hepatic artery pseudoaneurysm with stenting of right renal and iliac arteries in emergency setting. BJR Case Rep 2020; 6:20200025. [PMID: 33299587 PMCID: PMC7709055 DOI: 10.1259/bjrcr.20200025] [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: 02/05/2020] [Revised: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
Among Ehlers-Danlos syndromes, the vascular type is the most severe because of its vascular complications. Transcatheter embolization of medium-sized arteries has become the first-line therapy for life-threatening hemorrhage. Ongoing multiple lesions causing hemorrhagic or ischemic complications in the acute phase can challenge patient management. Multivessel endovascular treatment has never been reported. In this study, we report successful single-session treatment by coiling of a ruptured pseudoaneurysm of the hepatic artery with stenting of dissected right renal and iliac arteries in a 46-year-old female. Percutaneous transfemoral approach was gained and sealed with a plug-based closure device. Genetic disease was subsequently confirmed by molecular analysis.
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Affiliation(s)
| | | | - Pietro Quaretti
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eliana Disabella
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Mario Urtis
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Draghi F, Ferrozzi G, Bortolotto C, Ballerini D, Fiorina I, Preda L. Sonography before and after carpal tunnel release: video article. J Ultrasound 2020; 23:363-364. [PMID: 32378166 DOI: 10.1007/s40477-020-00465-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/25/2022] Open
Abstract
Carpal tunnel release for compression of the median nerve at the wrist is a common procedure, often resulting in good clinical outcomes. There are, however, many anatomical variations in and around the carpal tunnel and it is important to be aware of these during carpal tunnel release. After surgery, recurrent carpal tunnel syndrome is uncommon, but difficult to diagnose and treat. Ultrasonography is often necessary for the evaluation of the anatomical variations before carpal tunnel release and to evaluate the most common complications after carpal tunnel release.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Guia Ferrozzi
- Diagnostic Imaging Department, Centro Medico Inacqua, Piacenza, Italy
- Diagnostic Imaging Department, Centro Medico Riabilitativo Rocca, Piacenza, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Daniela Ballerini
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy.
| | - Ilaria Fiorina
- Unit of Interventional Radiology-Radiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
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Belloni E, Tentoni S, Puci MV, Avogliero F, Della Latta D, Storti S, Alberti B, Bottoni A, Bortolotto C, Fiorina I, Montomoli C, Chiappino D. Effect of iodinated contrast medium on thyroid function: a study in children undergoing cardiac computed tomography. Pediatr Radiol 2018; 48:1417-1422. [PMID: 29855677 DOI: 10.1007/s00247-018-4163-3] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies, and with conflicting results, have evaluated the potential effects of iodinated contrast media on children's thyroid function. OBJECTIVE To investigate the effects of iodinated contrast medium on thyroid function in neonates, infants and young children with congenital heart disease undergoing cardiac computed tomography (CT). MATERIALS AND METHODS We retrospectively evaluated 10 neonates (group 1) and 23 infants and young children (group 2) without thyroid or renal disease for serum levels of thyroid-stimulating hormone, free triiodothyronine and free thyroxine before contrast-enhanced cardiac CT, 48 h after CT and at discharge from the hospital. Cardiac CT was performed with intravenous administration of 1.14±0.17 mL/kg of body weight of iopromide (containing 370 mg of iodine/mL). RESULTS Group 1 had a reduction of thyroid-stimulating hormone from baseline to 48 h post injection (P=0.002). Group 2 had a reduction of thyroid-stimulating hormone median levels from baseline to 48 h post injection and an increase from 48 h to discharge (P=0.0005 and P=0.0001, respectively). CONCLUSION Intravenous iodinated contrast medium in children with congenital heart disease caused transient thyroid-stimulating hormone decrease 48 h after CT, with thyroid-stimulating hormone returning to normal range at discharge.
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Affiliation(s)
- Elena Belloni
- Department of Radiology, Civil Hospital, Corso Milano 19, 27029, Vigevano, Italy.
| | - Stefania Tentoni
- National Research Council, Institute of Applied Mathematics and Information Technologies "Enrico Magenes", Pavia, Italy
| | - Mariangela Valentina Puci
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Francesco Avogliero
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Daniele Della Latta
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Simona Storti
- Laboratory Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Baldassare Alberti
- Endocrinology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Antonio Bottoni
- Endocrinology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Chandra Bortolotto
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Fiorina
- Radiodiagnostic and Interventional Radiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Dante Chiappino
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
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Goddi A, Bortolotto C, Raciti MV, Fiorina I, Aiani L, Magistretti G, Sacchi A, Tinelli C, Calliada F. High-Frame Rate Vector Flow Imaging of the Carotid Bifurcation in Healthy Adults: Comparison With Color Doppler Imaging. J Ultrasound Med 2018; 37:2263-2275. [PMID: 29574932 DOI: 10.1002/jum.14579] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/07/2017] [Accepted: 12/09/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the carotid bifurcation in healthy adults using a commercial system equipped with high-frame rate vector flow imaging (VFI) based on the plane wave and to compare VFI with color Doppler imaging. METHODS Carotid bifurcation diameters and flow characteristics of 60 vessels in 60 healthy volunteers were evaluated quantitatively and qualitatively to assess complex flow patterns and their extension and duration. RESULTS Complex flow in the internal carotid artery (ICA) was associated with a statistically significant difference in the ΔICA sinus-to-common carotid artery (CCA) diameter ratio (the relative change in diameter between the CCA and ICA sinus.) Vector flow imaging and color Doppler imaging were in accordance when detecting complex flow in 96.7% of cases; in 3.3% of cases, only VFI identified small recirculation areas of short duration. Vector flow imaging highlighted a larger extension of the complex flow (mean ± SD, 47.7 ± 28.5 mm2 ; median, 45.5 mm2 ) compared with color Doppler imaging (mean, 29.2 ± 19.9 mm2 ; median, 29.5 mm2 ) and better depicted different complex flow patterns; a strong correlation (r = 0.84) was found between the ΔICA sinus-to-CCA diameter ratio and the complex flow extension. Vector flow imaging showed a longer duration of the flow disturbances (mean, 380 ± 218 milliseconds; median, 352.5 milliseconds) compared with color Doppler imaging (mean, 325 ± 206 milliseconds; median, 333 milliseconds), and there was a strong correlation (r = 0.92). CONCLUSIONS Vector flow imaging is as effective as color Doppler imaging in the detection of flow disturbances, but it is more powerful in the assessment of complex flow patterns.
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Affiliation(s)
- Alfredo Goddi
- Centro Medico SME-Diagnostica per Immagini, Varese, Italy
| | - Chandra Bortolotto
- Radiology Unit, University of Pavia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Maria Vittoria Raciti
- Radiology Unit, University of Pavia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Ilaria Fiorina
- Radiology Unit, University of Pavia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Luca Aiani
- Centro Medico SME-Diagnostica per Immagini, Varese, Italy
| | | | - Andrea Sacchi
- Centro Medico SME-Diagnostica per Immagini, Varese, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Fabrizio Calliada
- Radiology Unit, University of Pavia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
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Quaretti P, Leati G, Moramarco LP, Cionfoli N, Corti R, Tinelli C, Fiorina I, Galli F. Percutaneous Transanastomotic Stent Graft Deployment to Salvage Dysfunctional Native Forearm Radiocephalic Fistulae: Feasibility and Primary Patency at 12 Months. J Vasc Interv Radiol 2018; 29:986-992. [DOI: 10.1016/j.jvir.2018.02.028] [Citation(s) in RCA: 5] [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: 11/10/2017] [Revised: 02/18/2018] [Accepted: 02/25/2018] [Indexed: 10/16/2022] Open
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Bortolotto C, Turpini E, Felisaz P, Fresilli D, Fiorina I, Raciti MV, Belloni E, Bottinelli O, Cantisani V, Calliada F. Median nerve evaluation by shear wave elastosonography: impact of "bone-proximity" hardening artifacts and inter-observer agreement. J Ultrasound 2017; 20:293-299. [PMID: 29204233 DOI: 10.1007/s40477-017-0267-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023] Open
Abstract
Purpose Peripheral nerves frequently travel close to the bone surface and are, therefore, prone to elastosonographic "bone-proximity" hardening artifacts. The impact of these artifacts on quantitative measurements of median nerve stiffness performed by shear wave elastosonography has not been explored. Our aim was to assess normal median nerve stiffness values at various locations. Materials and methods Thirty-six healthy volunteers (24 women and 12 men) aged between 25 and 40 years were evaluated. Two operators performed the evaluation: one expert (6 years of ultrasound experience) and one inexperienced operator (6 months' experience). The nerve was sampled in cross-section at three different locations: mid-forearm, immediately before the carpal tunnel and within the tunnel. The ultrasound scanner was equipped with a 14-MHz linear probe. The Shear Wave module was activated in one-shot mode. Measurements were performed using a ROI corresponding to the diameter of the nerve. Results The mean values of stiffness of the medial nerve were 32.26 kPa ± 18.60 within the carpal tunnel, 22.20 kPa ± 9.84 at the carpal tunnel inlet and 7.62 kPa ± 7.38 in the forearm. Inter-observer agreement assessed using the intraclass correlation coefficient (ICC) was "moderate" within the carpal tunnel (ICC = 0.44), "moderate" at the carpal tunnel inlet (ICC = 0.41) and "fair" in the forearm (ICC = 0.38). Conclusions The stiffness of the median nerve progressively increases in its distal portions, where the nerve approaches the bone surface. Inter-observer agreement was generally good (from fair to moderate).
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Affiliation(s)
- Chandra Bortolotto
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Elena Turpini
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Paolo Felisaz
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Daniele Fresilli
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Fiorina
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Elena Belloni
- Department of Radiology, Civil Hospital, Castel San Giovanni, Italy
| | - Olivia Bottinelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - Fabrizio Calliada
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Goddi A, Fanizza M, Bortolotto C, Raciti MV, Fiorina I, He X, Du Y, Calliada F. Vector flow imaging techniques: An innovative ultrasonographic technique for the study of blood flow. J Clin Ultrasound 2017; 45:582-588. [PMID: 28734035 DOI: 10.1002/jcu.22519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/03/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
Doppler ultrasonography is routinely used to identify abnormal blood flow. Nevertheless, conventional Doppler can be used to determine only the axial component of blood flow velocity and is angle dependent. A new method of multidimensional angle-independent estimation of flow velocity, called Vector Flow Imaging (VFI), has been proposed. It quantitatively evaluates the true velocity vector's amplitude and direction at any location into a vessel and displays a more intuitive depiction of the flow movements. High frame rate VFI, based on plane wave imaging, allows a detailed dynamic visualization of complex flow by showing even transient events, otherwise undetectable. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:582-588, 2017.
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Affiliation(s)
- Alfredo Goddi
- Centro Medico SME-Diagnostica per Immagini, Varese, Italy
| | - Marianna Fanizza
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Chandra Bortolotto
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Maria Vittoria Raciti
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Ilaria Fiorina
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
| | - Xujin He
- Ultrasound R&D Department, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Yigang Du
- Ultrasound R&D Department, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Fabrizio Calliada
- Radiology Department, Fondazione IRCCS Policlinico San Matteo, Via Oberdan 21, Pavia, 27100, Italy
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11
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Bortolotto C, Lungarotti L, Fiorina I, Zacchino M, Draghi F, Calliada F. Influence of subjects' characteristics and technical variables on muscle stiffness measured by shear wave elastosonography. J Ultrasound 2017; 20:139-146. [PMID: 28593004 DOI: 10.1007/s40477-017-0242-9] [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] [Received: 08/30/2016] [Accepted: 02/18/2017] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The aim of this study is to quantitatively assess lower limbs muscle elasticity in a court of healthy subjects and to evaluate the influence of technical variables (e.g., diameter of the ROI-region of interest) and examined subjects' characteristics (e.g., sex, levels of physical activity, side evaluated) on muscle stiffness. MATERIALS AND METHODS 54 healthy subjects (48 men, 6 women) were evaluated for a total of 108 lower limbs. Shear wave elastography was performed with a multifrequency linear probe (15-4 MHz). Two radiologists performed the evaluation of lower limbs from left to right side (first calf and then thigh). The measures were taken on gastrocnemius and on femoral biceps muscle belly. We chose to place for this study two ROIs of 4 and 2 mm of diameter. RESULTS The mean muscle stiffness was 1.98 ± 0.48 (range between 1.89 ± 0.36 and 2.15 ± 0.57 m/s). The difference in muscle stiffness between left and right side of the body and between different levels of physical activity never became statistically significant (p value between 0.314 and 0.915). Only in one test out of eight the difference of muscle stiffness between male and female resulted statistically significant (p value 0.020). When comparing the measurement obtained with a 2 and 4 mm diameter ROIs the values were statistically different only for the left thigh (p value 0.028). CONCLUSION Our study, despite its limitations (low sample and low female population), seems to give some clear advice: physiological or technical factors do not determine statistically significant differences on passive muscle stiffness.
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Affiliation(s)
- Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy
| | - Luca Lungarotti
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy
| | - Ilaria Fiorina
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy
| | - Michela Zacchino
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy
| | - Fabrizio Calliada
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy
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Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Tinelli C, Montagna G, Maestri M. Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients. Vasc Endovascular Surg 2016; 50:221-30. [PMID: 27097842 DOI: 10.1177/1538574416639149] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 11/15/2022]
Abstract
PURPOSE To compare patency in dialysis patients following different endovascular treatment of symptomatic central venous stenosis. MATERIALS AND METHODS A 10-year retrospective evaluation in 70 patients (32 men) dialyzing through vascular access (33, 47%) and tunneled catheters (37, 53%) was made. Three cohorts were compared: angioplasty alone (22), bare metal stent (28), and stent graft (20). Patencies were described with Kaplan-Meier method, and Cox uni- and multivariate models were analyzed to find factors associated. RESULTS All patients had a favorable anatomical and clinical outcome. Restenosis occurred in 22 (31%) of 70 patients requiring 41 additional interventions; 34 of 70 patients died (median follow-up 19.4 months). Primary patency at 3, 6, 12, and 24 months was 100%, 100%, 100%, and 84% for stent graft versus 90%, 79%, 58%, and 43% for angioplasty (P = .014) versus 84%, 80%, 75%, and 46% for bare-metal stent (P = .062). The overall comparison was more favorable for stent graft (P = .020) when the sites of lesions were matched. Patencies for angioplasty and bare-metal stents were equivalent (P = .141). A lower risk of restenosis (hazard rate [HR] 0.20, confidence interval [CI] 0.06-0.7) and fewer reinterventions (P < .01) were associated with stent graft, whereas age (HR 1.04, CI 1.001-1.08) and cardiovascular disease (HR 2.26, CI 1.06-4.84) influenced the overall survival. No difference in assisted primary patency was found. CONCLUSION Stent graft seems to improve primary patency for central venous stenosis and requires fewer reinterventions in a dialysis population with a high prevalence of long-term catheters.
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Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Riccardo Corti
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Leati
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ilaria Fiorina
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Montagna
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Marcello Maestri
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Forneris G, Comelli S, Savio D, Cecere P, Agostinucci A, Quaretti P, Fiorina I, Pozzato M, Roccatello D. SP58137 CASES OF STUCK CATHETER: RESULTS OF AN ITALIAN SURVEY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Forneris G, Savio D, Quaretti P, Fiorina I, Cecere P, Pozzato M, Trogolo M, Roccatello D. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol 2014; 27:619-25. [DOI: 10.1007/s40620-014-0150-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Maestri M. Dialysis catheter-related superior vena cava syndrome with patent vena cava: long term efficacy of unilateral Viatorr stent-graft avoiding catheter manipulation. Korean J Radiol 2014; 15:364-9. [PMID: 24843241 PMCID: PMC4023055 DOI: 10.3348/kjr.2014.15.3.364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/23/2014] [Indexed: 11/17/2022] Open
Abstract
Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.
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Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia 27100, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Giovanni Leati
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Marcello Maestri
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
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