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Pacielli A, Vaudano GP, Bergamasco L, Prochet A, Gollini P, Perna ME. Assessment of post-thrombectomy brain hemorrhage in acute ischemic stroke with dual-energy CT: how reliable is it in clinical practice? Radiol Med 2024; 129:575-584. [PMID: 38368280 DOI: 10.1007/s11547-023-01749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/27/2023] [Indexed: 02/19/2024]
Abstract
PURPOSE Acute ischemic stroke is currently among the main causes of mortality in Western countries. The current guidelines suggest different flowcharts of diagnostic work-up and treatment modalities, including endovascular thrombectomy. Immediately after intra-arterial recanalization, a brain CT scan is usually performed to assess for the presence of peri-procedural complications; in this setting, it is very hard, if possible, to differentiate blood from iodinated contrast material, which is normally present in ischemic tissue because of BBB disruption. Dual-energy CT may be used for this purpose, exploiting its ability to discriminate different materials. MATERIALS AND METHODS We retrospectively studied 44 patients with acute ischemic stroke who were treated with endovascular recanalization at San Giovanni Bosco Hospital in Turin and were then scanned with DECT technology. Subsequent scan was used as standard, since iodine from contrast staining is usually reabsorbed in 24 h and blood persists longer. A χ2 test of independence was performed to examine the relationship between blood detected by DECT scan after the endovascular procedure and the presence of blood in the same areas on the following scans, with a significant result: χ2 (1, N = 37) = 10.7086, p = 0.0010. RESULTS Patients with blood detected on DECT scans had a double chance of having hemorrhagic infarction in follow-up scans, (RR 2.02). The sensitivity and specificity of DECT were respectively 70% and 90%, with an overall diagnostic accuracy of 76% and a positive and negative predictive value, respectively, of 95% and 53%. CONCLUSION Dual-energy CT scan after endovascular recanalization in ischemic stroke identifies early hemorrhagic infarction with excellent specificity and good overall diagnostic accuracy, representing a reliable diagnostic tool in everyday clinical practice.
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Affiliation(s)
- Alberto Pacielli
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy.
| | - Giacomo Paolo Vaudano
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino - A.O.U. Città della Salute e della Scienza di Torino, C.So Bramante 88, 10126, Turin, Italy
| | - Adolfo Prochet
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| | - Paola Gollini
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
| | - Maria Elena Perna
- Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy
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Gatti M, Palmisano A, Gerboni M, Cau R, Pintus A, Porcu M, Tore D, Vignale D, Andreis A, Bergamasco L, De Ferrari GM, Esposito A, Saba L, Fonio P, Faletti R. Value of a short non-contrast CMR protocol in MINOCA. Eur Radiol 2024; 34:994-1002. [PMID: 37581660 PMCID: PMC10853081 DOI: 10.1007/s00330-023-10096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of a short non-contrast CMR (ShtCMR) protocol relative to a matched standard comprehensive CMR (StdCMR) protocol in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). METHODS This multicenter retrospective study included patients with a working diagnosis of MINOCA who underwent a StdCMR between January 2019 and December 2020. An expert and a non-expert reader performed a blinded reading with the ShtCMR (long-axis cine images, T2w-STIR, T1- and T2-mapping). A consensus reading of the StdCMR (reference standard) was performed at least 3 months after the ShtCMR reading session. Readers were asked to report the following: (1) diagnosis; (2) level of confidence in their diagnosis with the ShtCMR; (3) number of myocardial segments involved, and (4) functional parameters. RESULTS A total of 179 patients were enrolled. The ShtCMR lasted 21 ± 9 min and the StdCMR 45 ± 11 min (p < 0.0001). ShtCMR allowed reaching the same diagnosis as StdCMR in 85% of patients when interpreted by expert readers (rising from 66% for poor confidence to 99% for good, p = 0.0001) and in 73% (p = 0.01) by non-expert ones (60% for poor vs 89% for good confidence, p = 0.0001). Overall, the ShtCMR overestimated the ejection fraction, underestimated cardiac volumes (p < 0.01), and underestimated the number of segments involved by pathology (p = 0.0008) when compared with the StdCMR. CONCLUSION The ShtCMR was found to be a debatable alternative to the StdCMR in patients with MINOCA. Nevertheless, when an experienced reader reaches a good or very good diagnostic confidence using the ShtCMR, the reader may choose to stop the examination, reducing the length of the CMR without affecting the patient's diagnosis. CLINICAL RELEVANCE STATEMENT A short non-contrast CMR protocol may be a viable alternative to standard protocols in selected CMR studies of patients with MINOCA, allowing for faster diagnosis while reducing time and resources and increasing the number of patients who can be scanned. KEY POINTS • The ShtCMR lasted 21 ± 9 min and the StdCMR 45 ± 11 min (p < 0.0001). • In 57% of patients with MINOCA, the experienced reader considers that contrast medium is probably not necessary for diagnosis without affecting the patient's diagnosis (99% of agreement rate between ShtCMR and StdCMR).
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Gerboni
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Riccardo Cau
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Alessandra Pintus
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department Cardiovascular and Thoracic, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department Cardiovascular and Thoracic, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
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Gaita F, Cerrato N, Giustetto C, Martino A, Bergamasco L, Millesimo M, Barbonaglia L, Carvalho P, Caponi D, Saglietto A, Bonacchi G, Bianchi F, Silvetti E, Crescenzi C, Canestrelli S, De Maio M, De Ferrari GM, Musumeci G, Rametta F, Scaglione M, Calò L. Asymptomatic Patients With Brugada ECG Pattern: Long-Term Prognosis From a Large Prospective Study. Circulation 2023; 148:1543-1555. [PMID: 37830188 PMCID: PMC10637308 DOI: 10.1161/circulationaha.123.064689] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Brugada syndrome poses significant challenges in terms of risk stratification and management, particularly for asymptomatic patients who comprise the majority of individuals exhibiting Brugada ECG pattern (BrECG). The aim of this study was to evaluate the long-term prognosis of a large cohort of asymptomatic patients with BrECG. METHODS Asymptomatic patients with BrECG (1149) were consecutively collected from 2 Italian centers and followed-up at least annually for 2 to 22 years. For the 539 asymptomatic patients (men, 433 [80%]; mean age, 46±13 years) with spontaneous type 1 documented on baseline ECG (87%) or 12-lead 24-hour Holter monitoring (13%), an electrophysiologic study (EPS) was proposed; for the 610 patients with drug-induced-only type 1 (men, 420 [69%]; mean age, 44±14 years), multiple ECGs and 12-lead Holter were advised in order to detect the occurrence of a spontaneous type-1 BrECG. Arrhythmic events were defined as sudden death or documented ventricular fibrillation or tachycardia. RESULTS Median follow-up was 6 (4-9) years. Seventeen (1.5%) arrhythmic events occurred in the overall asymptomatic population (corresponding to an event-rate of 0.2% per year), including 16 of 539 (0.4% per year) in patients with spontaneous type-1 BrECG and 1 of 610 in those with drug-induced type-1 BrECG (0.03% per year; P<0.001). EPS was performed in 339 (63%) patients with spontaneous type-1 BrECG. Patients with spontaneous type-1 BrECG and positive EPS had significantly higher event rates than patients with negative EPS (7 of 103 [0.7% per year] versus 4 of 236 [0.2% per year]; P=0.025). Among 200 patients who declined EPS, 5 events (0.4% per year) occurred. There was 1 device-related death. CONCLUSIONS The entire population of asymptomatic patients with BrECG exhibits a relatively low event rate per year, which is important in view of the long life expectancy of these young patients. The presence of spontaneous type-1 BrECG associated with positive EPS identifies a subgroup at higher risk. Asymptomatic patients with drug-induced-only BrECG have a minimal arrhythmic risk, but ongoing follow-up with 12-lead Holter monitoring is recommended to detect the appearance of spontaneous type-1 BrECG pattern.
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Affiliation(s)
- Fiorenzo Gaita
- Maria Pia Hospital, GVM Care and Research, Turin, Italy (F.G.)
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
| | - Natascia Cerrato
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy (N.C., D.C., M.S.)
| | - Carla Giustetto
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Annamaria Martino
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | | | - Michele Millesimo
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Lorella Barbonaglia
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy (L.Barbonaglia., F.R.)
| | - Paula Carvalho
- Division of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Italy (P.C.)
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy (N.C., D.C., M.S.)
| | - Andrea Saglietto
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Giacomo Bonacchi
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Francesca Bianchi
- Division of Cardiology, A.O. Ordine Mauriziano, Turin, Italy (F.B., G.M.)
| | - Elisa Silvetti
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Cinzia Crescenzi
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Stefano Canestrelli
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Melissa De Maio
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
| | - Gaetano Maria De Ferrari
- Departments of Medical Sciences (F.G., C.G., M.M., A.S., G.B., G.M.D.F.), University of Turin, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, Turin, Italy (C.G., M.M., A.S., G.B., G.M.D.F.)
| | - Giuseppe Musumeci
- Division of Cardiology, A.O. Ordine Mauriziano, Turin, Italy (F.B., G.M.)
| | - Francesco Rametta
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy (L.Barbonaglia., F.R.)
| | - Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy (N.C., D.C., M.S.)
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy (A.M., E.S., C.C., S.C., M.D.M., L.C.)
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Fronda M, Mistretta F, Calandri M, Ciferri F, Nardelli F, Bergamasco L, Fonio P, Doriguzzi Breatta A. The Role of Immediate Post-Procedural Cone-Beam Computed Tomography (CBCT) in Predicting the Early Radiologic Response of Hepatocellular Carcinoma (HCC) Nodules to Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE). J Clin Med 2022; 11:jcm11237089. [PMID: 36498664 PMCID: PMC9740708 DOI: 10.3390/jcm11237089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study was to evaluate the efficacy of unenhanced cone-beam computed tomography (CBCT) performed at the end of drug-eluting bead transarterial chemoembolization (DEB-TACE) in predicting HCC nodules’ early radiologic response to treatment, assessed using mRECIST criteria with a 30−60 day four-phase contrast-enhanced CT follow-up. Fifty-nine patients (81 lesions) subjected to DEB-TACE as exclusive treatment for HCC lesions (naive/relapse) between February 2020 and October 2021 were prospectively enrolled. In a post-interventional unenhanced CBCT procedure, two experienced radiologists evaluated for each lesion the overall intensity of the contrast media deposit, the homogeneity of the enhancement, and the presence of smooth and complete margins. The univariate analysis found that lesions with complete response (CR+) had a significantly higher incidence of clear and complete margins than CR− lesions (76.9% vs. 17.2%, p = 0.003) and a higher intensity score (67.3% vs. 27.6%, p = 0.0009). A Dmax <30 mm was significantly more common among CR+ than CR− lesions (92.3% vs. 69%, p = 0.01). These features were confirmed as significant predictors for CR+ by multivariate binary logistic regression. The homogeneity of the enhancement did not affect the DEB-TACE outcome. Post-interventional unenhanced CBCT is effective in predicting early radiological response to DEB-TACE, since the presence of an intense contrast media deposit with clear and complete margins in treated HCC lesions is associated with CR.
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Affiliation(s)
- Marco Fronda
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126 Turin, Italy
| | - Francesco Mistretta
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126 Turin, Italy
| | - Marco Calandri
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126 Turin, Italy
- Correspondence:
| | - Fernanda Ciferri
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126 Turin, Italy
| | - Floriana Nardelli
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126 Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, C.so Bramante 88, 10126 Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126 Turin, Italy
| | - Andrea Doriguzzi Breatta
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126 Turin, Italy
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Maffè S, Paffoni P, Bergamasco L, Facchini E, Prenna E, Careri G, Franchetti Pardo N, Paino A, Dellavesa P. P381 A CHALLENGING PACEMAKER IMPLANTATION IN THE PRESENCE OF A GIANT RIGHT CORONARY ANEURYSM COMPRESSING THE RIGHT ATRIUM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Giant coronary artery aneurysm is an uncommon disease, treated with surgerical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential haemodynamic effects and may cause problems when we need to implant a cardiac device. We present a 85–year–old patient, with a previous myocardial infarction and double coronary artery bypass graft in 1995. In 2013 he was hospitalized for heart failure and severe mitral insufficiency, with cardiac surgery indication. Preoperative coronary angiography revealed a giant right coronary aneurysm (65x75mm). The aneurysm was partially thrombosed and in close contact with the posterior sternal wall; it was decided to treat it by coil embolization in order to avoid damage during the initial stages of cardiac surgery (sternotomy and isolation of the pericardium). Subsequently, the replacement of the mitral valve with a bioprosthesis was performed without complications. In 2019 a chest CT scan, in an asymptomatic patient, showed an enlarged coronary aneurysm (85x90mm), completely thrombosed, compressing the right atrium, for which a conservative approach was maintained. The patient was hospitalized in May 2021 following 3 syncopes, with cranial trauma. The EKG shows sinus rhythm with first degree AV block and complete left bundle branch block. Chest CT confirmed the aneurysm, unchanged from 2019 (Fig 1). Transthoracic and transesophageal echocardiography confirmed compression of the mass on the right atrium, reduced to a very small cavity (Fig 2). A stress echocardiogram with dobutamine, performed to evaluate a possible hemodynamic effect of atrial compression, showed no changes in diastolic ventricular filling, arrhythmias, pressure drops, or significant symptoms. Based on these assessments, the syncopes and EKG changes, we implanted a VVIR ventricular pacemaker. The procedure was hampered by the difficulty of passing the lead through the compressed right atrium in order to reach the tricuspid plane and then enter the right ventricle; only after numerous attempts, and with the help of simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure without complications (Fig 3). This case demonstrates the usefulness of the echocardiogram, in particular contexts, in cardiac electro–stimulation procedure
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Affiliation(s)
- S Maffè
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | - P Paffoni
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | | | | | - E Prenna
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | - G Careri
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | | | - A Paino
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
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Prenna E, Maffè S, Facchini E, Bergamasco L, Paffoni P, Careri G, Franchetti Pardo N, Paino A, Dellavesa P. P188 MANAGEMENT OF ANTICOAGULANT AND ANTIPLATELET THERAPY IN THE GREAT ELDERLY: A REAL LIFE CLINICAL CASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
In daily clinical practice we have often to manage great elderly people with multiple comorbidities. In these cases it is not always easy to apply the guidelines, which must sometimes be adapted to the patient we are treating. We present the case of a 99–year–old hypertensive patient in therapy with oncocarbide and acetylsalicylic acid for polycythemia vera. No cardiological history. It came to our attention for NSTEMI during an episode of persistent atrial fibrillation (AF) with a high ventricular rate. Subsequent spontaneous restoration of sinus rhythm. Significant increase in troponin on blood tests. On the echocardiogram, normal biventricular kinetics and systolic function, no significant valvulopathies. Given the age and hemodynamic stability, a conservative approach was chosen. Therefore, antiplatelet therapy was started with acetylsalicylic acid (ASA) and anticoagulant therapy, initially with low molecular weight heparin and then with oral anticoagulant (NOAC); being the patient over 75 we chose Apixaban 2.5 mg bid, in accordance with weight and renal function (Consensus ESC 2016). At 1 month follow up the patient month was stable in good compensation, the 24h–Holter ECG showed stable sinus rhythm. At this point the question was how to proceed with the therapy: maintain the NOAC, as indicated in the NSTEMI guidelines, or continue with ASA alone, also considering that the risk scores usually used in patients with AF to determine the bleeding and cardioembolic risk (HASBLED and CHADS–VASC) are not validated in such elderly patients. We also hypothesized that the short AF paroxysm was related to ongoing myocardial ischemia (and not vice versa); in the literature, however, the indication for anticoagulant therapy does not take these extreme situations into account. Polycythemia vera also contributes to complicating the situation, exposing the patient to an increased risk of thrombotic events in the absence of antiplatelet therapy. After discussing the case with the haematologist, we decided to suspend the NOAC, also considering the absence of new arrhythmic episodes, and to continue with ASA alone. For now, with a follow–up of 6 months, we have not registered thrombotic / haemorrhagic problems or arrhythmic recurrences. The management of the elderly is always complex and will frequently lead us to adapt and customize the treatments on every single patient.
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Affiliation(s)
- E Prenna
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - S Maffè
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - E Facchini
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - L Bergamasco
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - P Paffoni
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - G Careri
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | | | - A Paino
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - P Dellavesa
- DIVISIONE DI CARDIOLOGIA OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
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7
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Facchini E, Maffè S, Paffoni P, Prenna E, Bergamasco L, Careri G, Franchetti Pardo N, Paino A, Dellavesa P. P297 PERICARDIAL EFFUSION WITHOUT HEMODYNAMIC INSTABILITY: WHEN AND TO WHOM THE PERICARDIOCENTESIS? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Cardiac tamponade is traditionally considered a clinical diagnosis, but there are pre–tamponating effusions that occur without signs of cardiogenic shock, and in these situations it can be complex to determine when and which patient treat with pericardiocentesis. The clinical case concerns a 90–year–old woman who comes to the emergency room for exertional dyspnea. Upon arrival blood pressure was 150/90 mmhg, heart rate 70 bpm. On chest x–ray, enlargement of the cardiac silhouette was evident (Fig 1). The echocardiogram showed a circumferential pericardial effusion of 2 centimeters with signs of right cardiac chambers compression (Fig 2). Hospitalized in ICU, the clinical situation was complicated by the onset of atrial fibrillation with a high ventricular response (Fig 3) and immediate cardiogenic shock (BP 70/40 mmHg, tachypnea, altered mental status). We proceed with emergency electrical cardioversion, effective in restoring sinus rhythm with almost immediate arrhythmic recurrence; therefore we perform a pericardiocentesis, with regression of the shock status after aspiration of a few cc of serum–haematic pericardial fluid (total 750 cc); spontaneous restoration of sinus rhythm after the procedure. Neoplastic problems were excluded, IgM positivity for influenza A and B on blood tests. The patient presented no further complication, was discharged at home, in sinus rhythm, with negative follow–up so far. This clinical case focuses the question of the indication and timing of pericardiocentesis. We managed a pericardial effusion with ultrasound signs of compression of the right sections, but in the absence of clinical signs of cardiogenic shock / Beck‘s triad. Given the clinical evolution, should we have perform the pericardiocentesis as soon as the patient arrived, in conditions of hemodynamic stability? Interesting are the score index proposed by Halpern et al. and an ESC position statement that serves to identify patients to undergo urgent pericardiocentesis based not only on clinical factors, but also on imaging evaluation. The total score of our case would have been indicative for an immediate pericardiocentesis. In our opinion, the formulation of a triage system for patients with pericardial effusion and hemodynamic stability that can be routinely implemented in clinical practice would be extremely useful.
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Affiliation(s)
- E Facchini
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - S Maffè
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - P Paffoni
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - E Prenna
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - L Bergamasco
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - G Careri
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | | | - A Paino
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
| | - P Dellavesa
- DIVISIONE DI CARDIOLOGIA, OSPEDALE SS TRINITÀ ASL NO, BORGOMANERO
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8
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Maffè S, Paffoni P, Bergamasco L, Facchini E, Prenna E, Careri G, Franchetti Pardo N, Paino A, Dellavesa P. C3 A RARE AND ATYPICAL CASE OF ICD POCKET HEMATOMA CONTAINING PSEUDOCHYLOUS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Subcutaneous hematoma is a complication in 2–9% of cardiac device implants.In most cases, it is drained or spontaneously reabsorbed; if untreated, there is a risk of infection.While cases of chylothorax and pseudochylothorax are rare, no previous cases of accumulation of chyliform material in the subcutaneous pockets of cardiac devices have ever been documented.We present the case of a 60–year–old man with antibody syndrome antiphospholipids, rheumatoid arthritis, previous acute anterior myocardial infarction and aorto–coronary by–pass surgery, paroxysmal atrial fibrillation, in oral anticoagulant therapy. In 2020, the patient underwent primary prophylactic dual–chamber ICD implantation (EF 33%) at another center, complicated by the formation of a large pocket hematoma, which required drainage and evacuation. In the following weeks, the patient noticed the reappearance of a large swelling in the ICD pocket; however, as it was painless and not troublesome, he did not seek medical attention. After 7 months he came to our observation with signs of heart failure. Clinical examination revealed a large swelling in the left pectoral area (Fig. 1), extending to the nipple, soft, not painful, not hot or red.The patient had no signs of infection (normal ESR, CRP, procalcitonin and WBC). We decided to drain the hematoma, given the size. At the level of the defibrillator pocket, we made a small incision, from wich 100ml of gold–colored, odorless liquid leaked out (Fig. 2), with no evidence of blood material in the pocket. The ICD–case was then wrapped in a rifampicin–releasing antibacterial bag and reinserted into the subcutaneous pocket, without further complications. The chemical–physical examination revealed a cloudy, gold–colored liquid, density of 1020, pH 8.5, high protein content (>400g/l), absence of glucose.Microscopic examination shows isolated leukocytes, rare erythrocytes immersed in mucoid material; this was not pus, as culture testing was negative for bacterial growth. The cholesterol concentration was 704mg/dl, triglycerides 80mg/dl (plasma cholesterol values were 91mg/dl, triglycerides 48mg/dl). The cytological analysis showed a carpet of foamy macrophages filled with cholesterol crystals (Fig. 3). Such evidence supports the diagnosis of pseudochilous, formed from the evolution of an untouched hematoma in a fibrous subcutaneous pocket for more than 6 months.This is the first case in which the presence of chyliform material is documented in an ICD pocket.
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Affiliation(s)
- S Maffè
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | - P Paffoni
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | | | | | - E Prenna
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | - G Careri
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
| | | | - A Paino
- DIVISIONE DI CARDIOLOGIA, BORGOMANERO
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9
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Gatti M, Faletti R, Gentile F, Soncin E, Calleris G, Fornari A, Oderda M, Serafini A, Strazzarino GA, Vissio E, Bergamasco L, Cirillo S, Papotti MG, Gontero P, Fonio P. mEPE-score: a comprehensive grading system for predicting pathologic extraprostatic extension of prostate cancer at multiparametric magnetic resonance imaging. Eur Radiol 2022; 32:4942-4953. [PMID: 35290508 PMCID: PMC9213375 DOI: 10.1007/s00330-022-08595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
Objective To investigate the diagnostic accuracy of the PI-RADS v2.1 multiparametric magnetic resonance imaging (mpMRI) features in predicting extraprostatic extension (mEPE) of prostate cancer (PCa), as well as to develop and validate a comprehensive mpMRI-derived score (mEPE-score). Methods We retrospectively reviewed all consecutive patients admitted to two institutions for radical prostatectomy for PCa with available records of mpMRI performed between January 2015 and December 2020. Data from one institution was used for investigating diagnostic performance of each mEPE feature using radical prostatectomy specimens as benchmark. The results were implemented in a mEPE-score as follows: no mEPE features: 1; capsular abutment: 2; irregular or spiculated margin: 3; bulging prostatic contour, or asymmetry of the neurovascular bundles, or tumor-capsule interface > 1.0 cm: 4; ≥ 2 of the previous three parameters or measurable extraprostatic disease: 5. The performance of mEPE features was evaluated using the five diagnostic parameters and ROC curve analysis. Results Two-hundred patients were enrolled at site 1 and 76 at site 2. mEPE features had poor sensitivities ranging from 0.08 (0.00–0.15) to 0.71 (0.59–0.83), whereas specificity ranged from 0.68 (0.58–0.79) to 1.00. mEPE-score showed excellent discriminating ability (AUC > 0.8) and sensitivity = 0.82 and specificity = 0.77 with a threshold of 3. mEPE-score had AUC comparable to ESUR-score (p = 0.59 internal validation; p = 0.82 external validation), higher than or comparable to mEPE-grade (p = 0.04 internal validation; p = 0.58 external validation), and higher than early-and-late-EPE (p < 0.0001 internal and external validation). There were no significant differences between readers having different expertise with EPE-score (p = 0.32) or mEPE-grade (p = 0.45), but there were significant differences for ESUR-score (p = 0.02) and early-versus-late-EPE (p = 0.03). Conclusions The individual mEPE features have low sensitivity and high specificity. The use of mEPE-score allows for consistent and reliable assessment for pathologic EPE. Key Points • Individual PI-RADS v2.1 mpMRI features had poor sensitivities ranging from 0.08 (0.00–0.15) to 0.71 (0.59–0.83), whereas Sp ranged from 0.68 (0.58–0.79) to 1.00. • mEPE-score is an all-inclusive score for the assessment of pEPE with excellent discriminating ability (i.e., AUC > 0.8) and Se = 0.82, Sp = 0.77, PPV = 0.74, and NPV = 0.84 with a threshold of 3. • The diagnostic performance of the expert reader and beginner reader with pEPE-score was comparable (p = 0.32). Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08595-9.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Francesco Gentile
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Enrico Soncin
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giorgio Calleris
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alberto Fornari
- Radiology Unit, Mauriziano Umberto I Hospital, 10128, Turin, Italy
| | - Marco Oderda
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessandro Serafini
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | | | - Elena Vissio
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Cirillo
- Radiology Unit, Mauriziano Umberto I Hospital, 10128, Turin, Italy
| | - Mauro Giulio Papotti
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
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10
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Gatti M, Calandri M, Biondo A, Geninatti C, Piatti C, Ruggirello I, Santonocito A, Varello S, Bergamasco L, Bironzo P, Boccuzzi A, Brazzi L, Caironi P, Cardinale L, Cavallo R, Riccardini F, Limerutti G, Veltri A, Fonio P, Faletti R. Emergency room comprehensive assessment of demographic, radiological, laboratory and clinical data of patients with COVID-19: determination of its prognostic value for in-hospital mortality. Intern Emerg Med 2022; 17:205-214. [PMID: 33683539 PMCID: PMC7938271 DOI: 10.1007/s11739-021-02669-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 02/10/2021] [Indexed: 02/06/2023]
Abstract
Mortality risk in COVID-19 patients is determined by several factors. The aim of our study was to adopt an integrated approach based on clinical, laboratory and chest x-ray (CXR) findings collected at the patient's admission to Emergency Room (ER) to identify prognostic factors. Retrospective study on 346 consecutive patients admitted to the ER of two North-Western Italy hospitals between March 9 and April 10, 2020 with clinical suspicion of COVID-19 confirmed by reverse transcriptase-polymerase reaction chain test (RT-PCR), CXR performed within 24 h (analyzed with two different scores) and recorded prognosis. Clinical and laboratory data were collected. Statistical analysis on the features of 83 in-hospital dead vs 263 recovered patients was performed with univariate (uBLR), multivariate binary logistic regression (mBLR) and ROC curve analysis. uBLR identified significant differences for several variables, most of them intertwined by multiple correlations. mBLR recognized as significant independent predictors for in-hospital mortality age > 75 years, C-reactive protein (CRP) > 60 mg/L, PaO2/FiO2 ratio (P/F) < 250 and CXR "Brixia score" > 7. Among the patients with at least two predictors, the in-hospital mortality rate was 58% against 6% for others [p < 0.0001; RR = 7.6 (4.4-13)]. Patients over 75 years had three other predictors in 35% cases against 10% for others [p < 0.0001, RR = 3.5 (1.9-6.4)]. The greatest risk of death from COVID-19 was age above 75 years, worsened by elevated CRP and CXR score and reduced P/F. Prompt determination of these data at admission to the emergency department could improve COVID-19 pretreatment risk stratification.
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Affiliation(s)
- Marco Gatti
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Marco Calandri
- Radiology Department A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
- grid.7605.40000 0001 2336 6580Department of Oncology, University of Turin, Turin, Italy
| | - Andrea Biondo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Carlotta Geninatti
- Radiology Department A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
| | - Clara Piatti
- Radiology Department A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
| | - Irene Ruggirello
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Ambra Santonocito
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Sara Varello
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Laura Bergamasco
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Bironzo
- grid.7605.40000 0001 2336 6580Department of Oncology, University of Turin, Turin, Italy
- Thoracic Oncology Unit, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
| | - Adriana Boccuzzi
- grid.415081.90000 0004 0493 6869Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, TO Italy
| | - Luca Brazzi
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Anesthesia Unit, University of Turin, Turin, Italy
| | - Pietro Caironi
- grid.7605.40000 0001 2336 6580Department of Oncology, University of Turin, Turin, Italy
- Department of Anesthesia and Critical Care, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
| | - Luciano Cardinale
- Radiology Department A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
| | - Rossana Cavallo
- grid.7605.40000 0001 2336 6580Department of Public Health and Pediatrics, Laboratory of Microbiology and Virology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Franco Riccardini
- grid.7605.40000 0001 2336 6580Department of Medical Science, University of Turin, Turin, Italy
| | - Giorgio Limerutti
- Department of Radiology, S.C. Radiodiagnostica Ospedaliera, Turin, Italy
| | - Andrea Veltri
- Radiology Department A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
- grid.7605.40000 0001 2336 6580Department of Oncology, University of Turin, Turin, Italy
| | - Paolo Fonio
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
| | - Riccardo Faletti
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Radiology Unit, University of Turin, Turin, Italy
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11
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Ruffino MA, Fronda M, Bergamasco L, Natrella M, Fanelli G, Bellosta R, Pegorer M, Attisani L, Ruggiero M, Malfa P, Patane' D, Lucatelli P, Corona M, Ricci C, Candeloro L, Ferri M, Varello S, Gibello L, Veraldi GF, Mezzetto L, Fonio P. Prognostic risk factors for loss of patency after femoropopliteal bailout stenting with dual-component stent: results from the TIGRIS Italian Multicenter Registry. Radiol Med 2021; 126:1129-1137. [PMID: 34057667 DOI: 10.1007/s11547-021-01373-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 05/12/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify the risk factors associated with patency loss after bailout stenting with third-generation hybrid heparin-bonded nitinol stent of the femoropopliteal segment. METHODS Prospective, multicenter, single-arm registry including 156 patients (50 females, mean age 72 ± 11 years) subjected, from February 2017 to December 2018, to provisional stenting with Gore Tigris vascular stent of the distal superficial femoral artery, with or without involvement of the popliteal artery, in 9 different centers. The 194 lesions, with Rutherford score ≥ 3, were stented in case of recoil, dissection or residual stenosis not responding to percutaneous trans-luminal angioplasty (PTA). The follow-up (FU) was performed with clinical evaluation and duplex ultrasound (DUS) at 1, 6 and 12 months. RESULTS The primary patency rate was 99(95%CI 98-100)% at 1 month, 86(80-92)% at 6 months and 81(74-88)% at-12 months. After patency loss, 13/23 (56.5%) patients were re-treated, yielding a primary assisted patency of 91(86-96)% at 6 months and 88(82-94)% at 12 months and a secondary patency of 94(90-98)% at 6 months and 90(84-95)% at 12 months. Rutherford score ≥ 4 (p = 0.03) and previous severe treatments (p = 0.01) were identified as risk factors for early patency loss during FU. The involvement of the popliteal artery was not an independent risk factor for loss of patency. CONCLUSIONS The bailout stenting of the femoropopliteal segment with third-generation nitinol stents is a safe and effective option in case of recoil, dissection or residual stenosis not responding to PTA. Critical limb ischemia and history of previous major treatment at the same level are significant prognostic factors for patency loss during FU.
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Affiliation(s)
- Maria Antonella Ruffino
- Department of Diagnostic Imaging and Radiotherapy, Vascular Radiology, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, Turin, Italy
| | - Marco Fronda
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, Via Genova 3, Turin, Italy.
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin-A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, Turin, Italy
| | - Massimiliano Natrella
- Department of Diagnostic and Interventional Radiology, Interventional Radiology, U. Parini Hospital, Via Ginevra 3, Aosta, Italy
| | - Gianluca Fanelli
- Department of Diagnostic and Interventional Radiology, Interventional Radiology, U. Parini Hospital, Via Ginevra 3, Aosta, Italy
| | - Raffaello Bellosta
- Cardiovascular Department, Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Via Bissolati 57, Brescia, Italy
| | - Matteo Pegorer
- Cardiovascular Department, Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Via Bissolati 57, Brescia, Italy
| | - Luca Attisani
- Cardiovascular Department, Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Via Bissolati 57, Brescia, Italy
| | - Massimo Ruggiero
- Endovascular Surgery-Vascular Surgery Unit, ASL BR1-Ospedale "A. Perrino", Strada per lo Spada 5, Brindisi, Italy
| | - Pierantonio Malfa
- UOC Diagnostic Imaging and Interventional Radiology, A.O. Per L'emergenza "Cannizzaro", Via Messina 829, Catania, Italy
| | - Domenico Patane'
- UOC Diagnostic Imaging and Interventional Radiology, A.O. Per L'emergenza "Cannizzaro", Via Messina 829, Catania, Italy
| | - Pierleone Lucatelli
- Department of Radiological Oncological and Anatomo-Pathological Sciences, Vascular and Interventional Radiology, Sapienza University of Rome, Viale del Policlinico 155, Roma, Italy
| | - Mario Corona
- Department of Radiological Oncological and Anatomo-Pathological Sciences, Vascular and Interventional Radiology, Sapienza University of Rome, Viale del Policlinico 155, Roma, Italy
| | - Carmelo Ricci
- Interventional Radiology Unit, Radiology Department, A.O.U. Senese, Viale Bracci 16, Siena, Italy
| | - Laura Candeloro
- Interventional Radiology Unit, Radiology Department, A.O.U. Senese, Viale Bracci 16, Siena, Italy
| | - Michelangelo Ferri
- S.C. Vascular and Endovascular Surgery, Ospedale Umberto I, Largo Filippo Turati 62, Turin, Italy
| | - Sara Varello
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, Via Genova 3, Turin, Italy
| | - Lorenzo Gibello
- Vascular Surgery Unit, Department of Surgical Sciences, University of Torino-A.O.U. Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, Turin, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, Integrated University Hospital of Verona, Piazzale Aristide Stefani 1, Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, Integrated University Hospital of Verona, Piazzale Aristide Stefani 1, Verona, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, A.O.U. Città Della Salute e Della Scienza di Torino, Via Genova 3, Turin, Italy
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12
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Gatti M, Palmisano A, Esposito A, Fiore S, Monti CB, Andreis A, Pistelli L, Vergara P, Bergamasco L, Giustetto C, De Cobelli F, Fonio P, Faletti R. Feature tracking myocardial strain analysis in patients with bileaflet mitral valve prolapse: relationship with LGE and arrhythmias. Eur Radiol 2021; 31:7273-7282. [PMID: 33870458 DOI: 10.1007/s00330-021-07876-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Anatomical substrate and mechanical trigger co-act in arrhythmia's onset in patients with bileaflet mitral valve prolapse (bMVP). Feature tracking (FT) may improve risk stratification provided by cardiac magnetic resonance (CMR). The aim was to investigate differences in CMR and FT parameters in bMVP patients with and without complex arrhythmias (cVA and no-cVA). METHODS In this retrospective study, 52 patients with bMVP underwent 1.5 T CMR and were classified either as no-cVA (n = 32; 12 males; 49.6 ± 17.4 years) or cVA (n = 20; 3 males; 44.7 ± 11.2 years), the latter group including 6 patients (1 male; 45.7 ± 12.7 years) with sustained ventricular tachycardia or ventricular fibrillation (SVT-FV). Twenty-four healthy volunteers (11 males, 36.2 ± 12.5 years) served as control. Curling, prolapse distance, mitral annulus disjunction (MAD), and late gadolinium enhancement (LGE) were recorded and CMR-FT analysis performed. Statistical analysis included non-parametric tests and binary logistic regression. RESULTS LGE and MAD distance were associated with cVA with an odds ratio (OR) of 8.51 for LGE (95% CI 1.76, 41.28; p = 0.008) and of 1.25 for MAD (95% CI 1.02, 1.54; p = 0.03). GLS 2D (- 11.65 ± 6.58 vs - 16.55 ± 5.09 1/s; p = 0.04), PSSR longitudinal 2D (0.04 ± 1.62 1/s vs - 1.06 ± 0.35 1/s; p = 0.0001), and PSSR radial 3D (3.95 ± 1.97 1/s vs 2.64 ± 1.03 1/s; p = 0.0001) were different for SVT-VF versus the others. PDSR circumferential 2D (1.10 ± 0.54 vs. 0.84 ± 0.34 1/s; p = 0.04) and 3D (0.94 ± 0.42 vs. 0.69 ± 0.17 1/s; p = 0.04) differed between patients with and without papillary muscle LGE. CONCLUSIONS CMR-FT allowed identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT-VF. LGE and MAD distance were associated with cVA. KEY POINTS • CMR-FT allows identifying several subtle myocardial deformation abnormalities in bMVP patients, especially those involving the papillary muscle. • CMR-FT allows identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT and VF. • In patients with bMVP, the stronger predictor of cVA is LGE (OR = 8.51; 95% CI 1.76, 41.28; p = 0.008), followed by MAD distance (OR = 1.25; 95% CI 1.02, 1.54; p = 0.03).
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Anna Palmisano
- Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Stefano Fiore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Pistelli
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco De Cobelli
- Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
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Marquis A, Zhuang J, Marra G, Zhao X, Calleris G, Kan Y, Beltrami M, Huang H, Oderda M, Zhang Q, Faletti R, Wang W, Molinaro L, Bergamasco L, Guo H, Gontero P. Outcomes and predictors of pain in transperineal free-hand mpMRI fusion-targeted biopsies under local anesthesia: A multicenter study of 1,008 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Guo H, Gontero P. Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases. BJU Int 2020; 127:122-130. [PMID: 32455504 DOI: 10.1111/bju.15121] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the outcomes of multiparametric magnetic resonance imaging (mpMRI) transperineal targeted fusion biopsy (TPFBx) under local anaesthesia. PATIENTS AND METHODS We prospectively screened 1327 patients with a positive mpMRI undergoing TPFBx (targeted cores and systematic cores) under local anaesthesia, at two tertiary referral institutions, between September 2016 and May 2019, for inclusion in the present study. Primary outcomes were detection of clinically significant prostate cancer (csPCa) defined as (1) International Society of Urological Pathologists (ISUP) grade >1 or ISUP grade 1 with >50% involvement of prostate cancer (PCa) in a single core or in >2 cores (D1) and (2) ISUP grade >1 PCa (D2). Secondary outcomes were: assessment of peri-procedural pain (numerical rating scale [NRS]) and procedure timings; erectile (International Index of Erectile Function) and urinary (International Prostate Symptom Score) function changes; and complications. We also investigated the value of systematic sampling and concordance with radical prostatectomy (RP). RESULTS A total of 1014 patients were included, of whom csPCa was diagnosed in 39.4% (n = 400). The procedure was tolerable (NRS pain score 3.1 ± 2.3), with no impact on erectile (P = 0.45) or urinary (P = 0.58) function, and a low rate of complications (Clavien-Dindo grades 1 or 2, n = 8; grade >2, n = 0). No post-biopsy sepsis was recorded. Twenty-two men (95% confidence interval [CI] 17-29) needed to undergo additional systematic biopsy to diagnose one csPCa missed by targeted biopsies (D1). ISUP grade concordance of biopsies with RP was as follows: k = 0.40 (95% CI 0.31-0.49) for targeted cores alone and k = 0.65 (95% CI 0.57-0.72; P < 0.05) overall. CONCLUSIONS The use of TPFBx under local anaesthesia yielded good csPCa detection and was feasible, quick, well tolerated and safe. Infectious risk was negligible. Addition of systematic to targeted cores may not be needed in all men, although it improves csPCa detection and concordance with RP.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Junlong Zhuang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Mattia Beltrami
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Xiaozhi Zhao
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Yansheng Kan
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Haifeng Huang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Riccardo Faletti
- Department of, Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Qing Zhang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Luca Molinaro
- Department of, Pathology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Wei Wang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Laura Bergamasco
- Department of, Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Hongqian Guo
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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15
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Mariscotti G, Durando M, Ruggirello I, Belli P, Caumo F, Nori J, Zuiani C, Tagliafico A, Bicchierai G, Romanucci G, Londero V, Campanino PP, Bussone R, Castellano I, Mule' A, Caneva A, Bianchi S, Di Loreto C, Bergamasco L, Calabrese M, Fonio P, Houssami N. Lesions of uncertain malignant potential of the breast (B3) on vacuum-assisted biopsy for microcalcifications: Predictors of malignancy. Eur J Radiol 2020; 130:109194. [PMID: 32795765 DOI: 10.1016/j.ejrad.2020.109194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/04/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate clinical, radiologic and pathologic features of B3 lesions diagnosed on VABB targeting microcalcifications, for identifying predictors of malignancy. METHOD This retrospective multi-centre study included consecutive VABBs performed over a 10-year period on suspicious microcalcifications not associated with other radiological signs diagnosed as B3 on histology from VABB, with outcomes ascertained by surgical excision. Clinical, demographic, radiological and histological (B3 subcategory) data were collected. For statistical analysis (univariate and binary logistic regression), the primary outcome variable was the upgrade rate to malignancy after surgery. Predictors of upgrade to malignancy were identified from clinical, demographic, radiological and pathological variables (including B3 subcategory). RESULTS Amongst 447 VABBs, there were 57(12.7 %) upgrades to malignancy at surgical histology (36 DCIS and 21 invasive cancer). At univariate analysis, variables significantly associated with increased risk of upgrade to malignancy were age>55 years (p = 0.01), lesion size>10 mm (p < 0.0001), BI-RADS 4b-c and 5 (p = 0.0001), and fine pleomorphic morphology (p = 0.002) of microcalcifications. Binary logistic regression confirmed as significant independent risk factors age, lesion size and BI-RADS category (p = 0.02, 0.02 and 0.0006 respectively). Amongst subcategories of B3 lesions, lobular neoplasia was significantly(p = 0.04) associated with upgrade, confirmed as an independent risk factor [p = 0.03, OR = 2.3(1.1-4.7)]. Flat epithelial atypia was significantly(p = 0.004) associated with reduced odds of upgrade, but binary logistic regression showed only borderline association [p = 0.052, OR = 0.4(0.2-1.01)]. CONCLUSIONS Across B3 lesions diagnosed on histology from VABB of suspicious microcalcifications, older age, size>10 mm, BI-RADS category≥ 4b on imaging, and lobular neoplasia were risk factors for upgrade to malignancy. This information can be used to discuss patients' tailored management options.
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Affiliation(s)
- Giovanna Mariscotti
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Manuela Durando
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Irene Ruggirello
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Paolo Belli
- Department of Radiological, Radiotherapic and Hematological Sciences, Fondazione Policlinico A. Gemelli IRCCS - Universita' Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Francesca Caumo
- Radiology Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, P.le S. Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Alberto Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy; Department of Radiology, IRCCS San Martino Hospital, 16132, Genova, Italy.
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37034 Verona, Italy.
| | - Viviana Londero
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, P.le S. Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Pier Paolo Campanino
- Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100, Torino, Italy.
| | - Riccardo Bussone
- Breast Surgery, Presidio Sanitario Ospedale Cottolengo, Via S. Giuseppe Benedetto Cottolengo, 9, 10152, Torino, Italy.
| | | | - Antonino Mule'
- Department of Histopathology and Cytodiagnosis, Fondazione Policlinico A. Gemelli IRCCS -Universita' Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | | | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of medical and surgical critical care, University of Florence, Florence, Italy.
| | - Carla Di Loreto
- Anatomic Pathology Institute, Department of Medicine (DAME), University of Udine, Udine, Italy.
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, C.so Bramante 88, 10126, Torino, Italy.
| | - Massimo Calabrese
- Diagnostic Senology, IRCCS - Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Paolo Fonio
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia.
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16
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Marra G, Zhuang J, Beltrami M, Marquis A, Zhao X, Calleris G, Kan Y, Oderda G, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Guo H, Gontero P. Outcomes and predictors of pain in men undergoing transperineal free-hand mpMRI fusion-targeted biopsies under local anesthesia: A multicenter prospective study of 1008 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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17
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Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Tappero S, D’Agate D, Wang W, Bergamasco L, Guo H, Gontero P. Do we need addition of systematic cores when performing transperineal mpMRI targeted biopsy under local anesthesia? Results of a multicenter prospective study of 1,014 cases. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Marra G, Zhuang J, Beltrami M, Marquis A, Zhao X, Calleris G, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Guo H, Gontero P. Pain in men undergoing transperineal free-hand mpMRI fusion-targeted biopsies under local anesthesia: Outcomes and predictors from a multicenter study of 1008 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Tappero S, D’Agate D, Guo H, Gontero P. Transperineal free-hand mpMRI fusion targeted biopsies under local anesthesia for prostate cancer diagnosis: A multicenter prospective study of 1,014 cases. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Gatti M, Cosentino A, Cura Stura E, Bergamasco L, Garabello D, Pennisi G, Puppo M, Salizzoni S, Veglia S, Davini O, Rinaldi M, Fonio P, Faletti R. Accuracy of cardiac magnetic resonance generated 3D models of the aortic annulus compared to cardiovascular computed tomography generated 3D models. Int J Cardiovasc Imaging 2020; 36:2007-2015. [PMID: 32472299 DOI: 10.1007/s10554-020-01902-9] [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: 03/13/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
To evaluate the accuracy of 3D models of the aortic-root generated from non-contrast cardiac magnetic resonance (CMR). Data were retrospectively collected from 30 consecutive patients who underwent surgical aortic valve replacement and had available records of both intra-operative assessment and pre-surgery annulus assessment by cardiovascular computed tomography (CCT) and CMR. The 3D models were independently segmented, modelled and printed by two blinded "manufacturers". The measurements on the models were carried out by two cardiac surgeons with Hegar dilator. Data were analyzed with non-parametric tests. There was no significant intra- or inter-observer variability (p ≥ 0.13). The agreement between the diameter of the 3D model derived from CMR images and either the anatomical reference of the intraoperative measurement (p = 0.10, r = 0.97) or the radiological reference of the 3D model generated from CCT (p = 0.71, r = 0.92) was very good. The process of segmentation plus the post-processing was about 17 ± 2 min for a model created by CMR, significantly higher than a model created from CCT (7 ± 2 min; p < 0.001). The printing time for a single model did not differ between the two modalities (p = 0.61) and was less than 60 min. The cost for a single model was approximately 0.5 €. 3D models generated from non-contrast CMR performed well when compared to the anatomical reference standard and are comparable to the pair CCT derived models.
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy.
| | - Aurelio Cosentino
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy
| | - Erik Cura Stura
- Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Domenica Garabello
- Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Torino, Italy
| | - Giovanni Pennisi
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Mattia Puppo
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Simona Veglia
- Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Torino, Italy
| | - Ottavio Davini
- Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Torino, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Torino, Italy
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21
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Ruffino MA, Fronda M, Varello S, Discalzi A, Mancini A, Muratore P, Rossato D, Bergamasco L, Righi D, Fonio P. Emergency management of iatrogenic arterial injuries with a low-profile balloon-expandable stent-graft: Preliminary results. Medicine (Baltimore) 2020; 99:e19655. [PMID: 32282715 PMCID: PMC7220351 DOI: 10.1097/md.0000000000019655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Endovascular treatment of arterial injuries with stent-graft is a reliable alternative approach in patients not suitable for embolization or at high risk for surgery. The aim of our study was to evaluate the efficacy and the safety of the BeGraft stent-graft, a low-profile balloon expandable covered stent, for emergency endovascular treatment of iatrogenic arterial injuries.Between August 2015 and September 2018, 34 consecutive patients (mean age 71 ± 12 years, 9 females) underwent implantation of BeGraft stent-grafts for iatrogenic arterial injuries (22 active bleedings, 11 pseudoaneurysms, and 1 enteric-iliac fistula). The primary endpoints were technical and clinical success and rates of major and minor complications. The secondary endpoint was the patency of the device during the follow-up. Imaging follow-up was performed by duplex ultrasound and/or computed tomography angiography (according to lesion site/target vessel), at 1-6-12-15 and 24 months.In all 34 patients (100%), the lesion or the defect was effectively excluded with a cumulative amount of 42 stent-grafts. The clinical success was documented in 30/34 patients (88.2%). Neither device- or procedure-related deaths, or major complications occurred. A minor complication was reported in 1 patient (2.9%), successfully treated during the same procedure. Thirty (88.2%) patients were available for a mean follow-up time of 390 ± 168 days (minimum 184, maximum 770), with no observed loss of patency, yielding a 100% Kaplan-Meier cumulative survival patency function. The percentage of patent patients was 30/30 at 6 months, 22/22 at 12 months, and 5/5 at 15 months.Endovascular treatment of iatrogenic arterial injuries with the BeGraft stent-graft is minimally invasive and effective, with good patency rate at midterm follow-up.
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Affiliation(s)
- Maria Antonella Ruffino
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, A.O.U. Città della Salute e della Scienza di Torino
| | - Marco Fronda
- Department of Surgical Sciences - Radiology Unit, University of Torino - A.O.U. Città della Salute e della Scienza di Torino
| | - Sara Varello
- Department of Surgical Sciences - Radiology Unit, University of Torino - A.O.U. Città della Salute e della Scienza di Torino
| | - Andrea Discalzi
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, A.O.U. Città della Salute e della Scienza di Torino
| | - Andrea Mancini
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, A.O.U. Città della Salute e della Scienza di Torino
| | - Pierluigi Muratore
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, A.O.U. Città della Salute e della Scienza di Torino
| | - Denis Rossato
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, A.O.U. Città della Salute e della Scienza di Torino
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Dorico Righi
- Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, A.O.U. Città della Salute e della Scienza di Torino
| | - Paolo Fonio
- Department of Surgical Sciences - Radiology Unit, University of Torino - A.O.U. Città della Salute e della Scienza di Torino
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22
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Gatti M, Calandri M, Bergamasco L, Darvizeh F, Grazioli L, Inchingolo R, Ippolito D, Rousset S, Veltri A, Fonio P, Faletti R. Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia. Radiol Med 2020; 125:348-355. [PMID: 31916102 DOI: 10.1007/s11547-019-01127-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 08/07/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the features of arterial enhancement pattern of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC) by triple-phase arterial magnetic resonance imaging (MRI). METHODS Data were retrospectively collected from 52 consecutive patients who underwent triple-phase arterial MRI using hepatocyte-specific contrast agents (Gd-EOB-DTPA) from January 2017 to October 2017, with a MR imaging diagnosis of HCC or FNH. The images were independently assessed by two blinded readers. Contrast enhancement ratio (CER) and liver-to-lesion contrast ratio (LLCR) were calculated. The lesions were classified visually and also based on the peak of LLCR into the following groups: (1) early arterial, (2) middle arterial and (3) late arterial. Data were eventually analysed using nonparametric tests. RESULTS The CER analysis showed no significant difference between HCC and FNH patients (p > 0.05). LLCRFNH were significantly higher than LLCRHCC in the early arterial (p = 0.01), but not in the middle and late arterial phases (p = 0.20 and p = 0.82, respectively). LLCRHCC presented a meaningful increase from early to middle arterial phase (p = 0.009), whereas LLCRFNH showed a decrease from middle to late arterial phase (p = 0.004). Based on the peak of LLCR, 17 (55%) FNHs were classified into early, 11 (35%) in middle and only 3 (10%) in late arterial phase groups. Similarly, 14 (34%) HCCs were categorized into early, 13 (32%) in middle and 14 (33%) in late arterial phase groups. There was a good agreement between qualitative analysis and LLCR in 85% of cases. CONCLUSION The optimal visualization of FNH has been detected in early and middle arterial phases while HCC has been best observed during middle and late arterial phases.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Marco Calandri
- Department of Oncology, Radiology Unit, University of Torino, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Fatemeh Darvizeh
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia "Spedali Civili", P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, 75100, Matera, Italy
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Stefano Rousset
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Andrea Veltri
- Department of Oncology, Radiology Unit, University of Torino, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
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23
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Mariscotti G, Durando M, Tagliafico A, Campanino PP, Bosco D, Casella C, Bussone R, Ala A, Castellano I, Sapino A, Bergamasco L, Fonio P, Houssami N. Corrigendum to "Preoperative breast cancer staging with multi-modality imaging and surgical outcomes" [Eur. J. Radiol. 122 (2020) 108766]. Eur J Radiol 2020; 126:108919. [PMID: 32197783 DOI: 10.1016/j.ejrad.2020.108919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Giovanna Mariscotti
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Manuela Durando
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Alberto Tagliafico
- Department of Experimental Medicine, University of Genoa, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, 16132, Genoa, Italy.
| | - Pier Paolo Campanino
- Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100, Torino, Italy.
| | - Davide Bosco
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Cristina Casella
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Riccardo Bussone
- Breast Surgery, Presidio Sanitario Ospedale Cottolengo, Via S. Giuseppe Benedetto Cottolengo, 9, 10152, Torino, Italy.
| | - Ada Ala
- Breast Surgery, Department of Surgery, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero S. Anna, Via Ventimiglia, 1, 10126, Torino, Italy.
| | - Isabella Castellano
- Department of Medical Sciences, University of Turin, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Santena, 7, Torino, Italy.
| | - Anna Sapino
- Candiolo Cancer Institute FPO-IRCCs, 10060, Candiolo, Torino, Italy; Department of Medical Sciences, University of Torino, 10126, Torino, Italy.
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, C.so Bramante 88, 10126, Torino, Italy.
| | - Paolo Fonio
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.
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Mariscotti G, Durando M, Pavan LJ, Tagliafico A, Campanino PP, Castellano I, Bussone R, Ala A, De Sanctis C, Bergamasco L, Fonio P, Houssami N. Intraoperative breast specimen assessment in breast conserving surgery: comparison between standard mammography imaging and a remote radiological system. Br J Radiol 2020; 93:20190785. [PMID: 32101449 DOI: 10.1259/bjr.20190785] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare standard specimen mammography (SSM) with remote intraoperative specimen mammography (ISM) assessment in breast conserving-surgery (BCS) based on operative times, intraoperative additional excision (IAE) and re-intervention rates. METHODS AND MATERIALS We retrospectively compared 129 consecutive patients (136 lesions) who had BCS with SSM at our centre between 11/2011 and 02/2013 with 138 consecutive patients (144 lesions) who underwent BCS with ISM between 08/2014 and 02/2015.SSM or ISM were performed to confirm the target lesions within the excised specimen and margin adequacy. The utility of SMM and ISM was evaluated considering pathology as gold-standard, using χ2 or Fisher's exact tests for comparison of categorical variables, and non-parametric Mann-Whitney test for continuous variables. RESULTS The two groups did not statistically differ for age (p = 0.20), lesion size (p = 0.29) and morphology (p = 0.82) or tumor histology type (p = 0.65). Intraoperative time was significantly longer (p < 0.00001) for SSM (132 ± 43 min) than for ISM (90 ± 42 min). The proportions requiring IAE did not significantly differ between SSM group (39/136 lesions (40%)) and ISM group (52/144 lesions (57%)) (p = 0.19), overall and in stratified analysis by mammographic features. Re-intervention rates were not statistically different between the two groups [SSM:19/136 (14%), ISM:13/144 (9%); p = 0.27]. CONCLUSION The introduction of ISM in BCS significantly reduced surgical time but did not change IAE and re-intervention rates, highlighting facilitated communication between surgeons and radiologists. ADVANCES IN KNOWLEDGE Compared to standard mammography imaging, the use of ISM significantly reduced surgical time.
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Affiliation(s)
- Giovanna Mariscotti
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette Via Genova 3, 10126 Torino, Italy
| | - Manuela Durando
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette Via Genova 3, 10126 Torino, Italy
| | - Luca Jacopo Pavan
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette Via Genova 3, 10126 Torino, Italy
| | - Alberto Tagliafico
- Department of Experimental Medicine, University of Genoa IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
| | - Pier Paolo Campanino
- Breast Imaging Service. Ospedale Koelliker.C.so Galileo Ferraris 256 - 10100, Torino, Italy
| | - Isabella Castellano
- Department of Medical Sciences, University of Turin, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Santena, 7, Torino, Italy
| | - Riccardo Bussone
- Breast Surgery, Presidio Sanitario Ospedale Cottolengo Via S. Giuseppe Benedetto Cottolengo, 9 - 10152, Torino, Italy
| | - Ada Ala
- Breast Surgery, Department of Surgery, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero S. Anna, Via Ventimiglia, 1, 10126, Torino, Italy
| | - Corrado De Sanctis
- Department of Gynecology and Obstetrics, Breast Unit, A.O.U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero S. Anna, Via Ventimiglia, 1, 10126 Torino, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, C.so Bramante 88, 10126 Torino, Italy
| | - Paolo Fonio
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette Via Genova 3, 10126 Torino, Italy
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia
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Marra G, Marquis A, Tappero S, D'Agate D, Oderda M, Calleris G, Falcone M, Faletti R, Molinaro L, Zitella A, Bergamasco L, Gontero P. Transperineal Free-hand mpMRI Fusion-targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single-center Prospective Study. Urology 2020; 140:122-131. [PMID: 32061825 DOI: 10.1016/j.urology.2019.11.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility of "in-office" TPFBx under local anesthesia (LA). MATERIALS AND METHODS We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of prostate cancer (CaP), according to predefined exclusion criteria. RESULTS We included 459 men (TPFBx n = 279 including n = 338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n = 180). Median procedural time and maximum pain were 19 minutes and 5 numeric rating scale (NRS) points; pain was highest at the time of LA. Only 1 major complication occurred (Clavien 3a). Hematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and 1 case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (P = .86 and P = .89). In comparison with TPSBx the sole differences were pain during prostatic sampling (P = .03), duration of hematospermia (P <.0001) and procedural time (P <.001) all higher for TPFBx. Clinically significant (cs) CaP was detected in n = 150 (53.8%) patients in the TPFBx group (34.9%, 51.7%, and 75% of Pirads 3, 4, and 5, respectively). Addition of systematic cores detected n = 25 csCaP that were missed by targeted cores (17.4% of all csCaP). CONCLUSION TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csCaP detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy.
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Stefano Tappero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Daniele D'Agate
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Marco Falcone
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Riccardo Faletti
- Department of Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Luca Molinaro
- Department of Pathology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Andrea Zitella
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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Mariscotti G, Durando M, Tagliafico A, Campanino PP, Bosco D, Casella C, Bussone R, Ala A, Castellano I, Sapino A, Bergamasco L, Fonio P, Houssami N. Preoperative breast cancer staging with multi-modality imaging and surgical outcomes. Eur J Radiol 2019; 122:108766. [PMID: 31809942 DOI: 10.1016/j.ejrad.2019.108766] [Citation(s) in RCA: 10] [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: 05/19/2019] [Revised: 11/10/2019] [Accepted: 11/20/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare the rates of mastectomy and re-operation after breast-conserving surgery (BCS) among patients who had different pre-operative multi-modality imaging, hence identifying significant predictors of mastectomy and re-operations within each group. METHOD Retrospective study of consecutive patients with primary breast cancer treated January 2010 - December 2016, divided in 3 groups, undergoing pre-operative local staging respectively with conventional imaging modalities only (2D mammography, ultrasound (US)), conventional imaging and tomosynthesis (DBT) and/or MRI. The primary outcome was identification of significant predictors of surgical outcomes, within each group. Study variables examined in univariate analysis were age, lesion dimension, breast density, multifocality, tumor size, histology, and if associated with outcomes they were included in binary logistic regression analysis. RESULTS Amongst 1547 patients, patient and tumor characteristics differed across the three groups, as did mastectomy rates which were 18 % (102/562) for 2D + US, 36 % (154/428) for 2D + DBT + US, 45 % (250/557) for 2D+/-DBT + US + MRI(p < 0.001). Variables strongly associated with mastectomy were larger lesions and multifocality (as was multi-modality group). Re-operation rate showed an opposite trend: 12.2 % (56/459) for 2D + US, 8 % (22/272) for 2D + DBT + US, 6.5 % (20/306) for 2D+/-DBT + US + MRI. Re-operation rate for 2D+/-DBT + US + MRI was lower than for 2D + US (p = 0.01) but similar to 2D + DBT + US (p = 0.58). Patients who had 2D + US and re-operations had significantly larger lesions, more underestimation, higher proportion of invasive carcinoma with in-situ component than those who did not require re-operation. CONCLUSIONS Patients who had larger tumors and multifocal disease were more frequently staged by adding DBT and/or MRI to conventional imaging (mammography and US) which was associated with more extensive surgical treatment but lower reoperation rates.
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Affiliation(s)
- Giovanna Mariscotti
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Manuela Durando
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Alberto Tagliafico
- Department of Experimental Medicine, University of Genoa, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, 16132, Genoa, Italy.
| | - Pier Paolo Campanino
- Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100, Torino, Italy.
| | - Davide Bosco
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Cristina Casella
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Riccardo Bussone
- Breast Surgery, Presidio Sanitario Ospedale Cottolengo, Via S. Giuseppe Benedetto Cottolengo, 9, 10152, Torino, Italy.
| | - Ada Ala
- Breast Surgery, Department of Surgery, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero S. Anna, Via Ventimiglia, 1, 10126, Torino, Italy.
| | - Isabella Castellano
- Department of Biomedical Sciences and Human Oncology, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Santena, 7, Torino, Italy.
| | - Anna Sapino
- Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCs), 10060, Candiolo, Torino, Italy.
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, C.so Bramante 88, 10126, Torino, Italy.
| | - Paolo Fonio
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.
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Giustetto C, Nangeroni G, Cerrato N, Rudic B, Tülümen E, Gribaudo E, Giachino DF, Barbonaglia L, Biava LM, Carvalho P, Bergamasco L, Borggrefe M, Gaita F. Ventricular conduction delay as marker of risk in Brugada Syndrome. Results from the analysis of clinical and electrocardiographic features of a large cohort of patients. Int J Cardiol 2019; 302:171-177. [PMID: 31771792 DOI: 10.1016/j.ijcard.2019.11.121] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/04/2019] [Accepted: 11/15/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Brugada Syndrome is a genetic arrhythmogenic disease with a variable clinical spectrum. The role of clinical and ECG parameters in the risk stratification is still uncertain. AIMS In a large cohort of Brugada patients we analysed clinical and ECG features to determine the variables with prognostic value for the occurrence of a first documented arrhythmic event and for recurrences. METHODS We enrolled 614 patients, subdivided into 3 groups according to their clinical presentation: 531 (88%) asymptomatic, 69 (10%) with previous unexplained syncope and 14 (2%) with aborted sudden death. We also compared the ECG characteristics of patients with a single documented arrhythmic event (either at presentation or at follow-up, 17 patients), with those of patients with arrhythmic recurrences (13 patients). RESULTS The event rate was 1.3% in the asymptomatic patients and 15% among patients with unexplained syncope (median follow-up 6 years), p < 0.0001. In both groups a QRS duration ≥110 ms in lead II and/or V6 and/or S wave duration ≥40 ms in lead I and/or II were significant risk factors for the occurrence and timing of events at follow-up. The same ECG risk factors were also significantly associated with arrhythmic recurrences. CONCLUSIONS The arrhythmic risk of Brugada patients is related not only to the symptoms at presentation, but also to the presence of a ventricular conduction delay (QRS duration ≥ 110 ms and/or S wave duration ≥ 40 ms). The ECG conduction parameters also affect the timing of events and recurrences.
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Affiliation(s)
- Carla Giustetto
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy.
| | - Giulia Nangeroni
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Natascia Cerrato
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Boris Rudic
- 1st Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Elena Gribaudo
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Daniela Francesca Giachino
- Medical Genetics, University of Torino, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Lorenza Michela Biava
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Paula Carvalho
- Division of Cardiology, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Laura Bergamasco
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Fiorenzo Gaita
- Division of Cardiology, University of Torino, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Torino, Italy
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Budano C, Garrone P, Castagno D, Bissolino A, Andreis A, Bertolo L, Mazzini D, Bergamasco L, Marra S, Gaita F. Same-day CIED implantation and discharge: Is it possible? The E-MOTION trial (Early MObilization after pacemaker implantaTION). Int J Cardiol 2019; 288:82-86. [DOI: 10.1016/j.ijcard.2019.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Pozzi G, Castellano I, D'Anna MR, De Matteis A, Milanesio L, Durando M, Ferrando PM, Bergamasco L, Ala A. B3-lesions of the breast: Risk of malignancy after vacuum-assisted breast biopsy versus core needle biopsy diagnosis. Breast J 2019; 25:1308-1309. [PMID: 31338958 DOI: 10.1111/tbj.13476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Giada Pozzi
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Rosa D'Anna
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Antonio De Matteis
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Luisella Milanesio
- Breast Screening Unit (Regional Reference Center), AOU Città della Salute e della Scienza, Turin, Italy
| | - Manuela Durando
- Radiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza, Turin, Italy
| | - Pietro Maria Ferrando
- Plastic Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Laura Bergamasco
- Department of Medical and Surgical Sciences, Division of Statistics, AOU Città della Salute e della Scienza, Turin, Italy
| | - Ada Ala
- Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy
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Gatti M, Faletti R, Calleris G, Giglio J, Berzovini C, Gentile F, Marra G, Misischi F, Molinaro L, Bergamasco L, Gontero P, Papotti M, Fonio P. Prostate cancer detection with biparametric magnetic resonance imaging (bpMRI) by readers with different experience: performance and comparison with multiparametric (mpMRI). Abdom Radiol (NY) 2019; 44:1883-1893. [PMID: 30788558 DOI: 10.1007/s00261-019-01934-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [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] [Indexed: 12/20/2022]
Abstract
PURPOSE To study the detection of clinically significant prostate cancer (PCa) by readers with different experience, comparing performance with biparametric magnetic resonance imaging (bmMRI) and with the reference multiparametric (mpMRI). METHODS Retrospective analysis of 68 patients with mpMRI of the prostate at 1.5 Tesla using a 32 phased-array coil. Forty-five patients (cases) underwent radical prostatectomy, whereas 23 (controls) had a negative prostate biopsy and ≥ 2.5 years of negative follow-up. Six observers (two with 1000 cases interpreted, two with 300, two with 100) performed the analysis first with bpMRI including diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps and T2-weighted (T2W) imaging in three planes and, after 1 month, with mpMRI, adding dynamic contrast enhancement (DCE). The performance was quantified by sensitivity (SNS), specificity (SPC) and area under the curve (AUC) of the ROC (Receiver Operating Characteristics) procedure. RESULTS Concordance within observers of equivalent experience was good (weighted Cohen's k ≈ 0.7). The two expert readers performed as well in bpMRI as in mpMRI (SNS = 0.91-0.96, AUC = 0.86-0.93; p ≥ 0.10); readers with 300 cases performed well in mpMRI, but significantly worse in bpMR: SNS = 0.58 versus 0.91 (p < 0.0001) and AUC = 0.73 versus 0.86 (p = 0.01); the limited experience of readers with 100 cases showed in mpMRI (SNS = 0.71; AUC = 0.77) and even more in bpMRI (SNS = 0.50; AUC = 0.68). CONCLUSION The study revealed the impact of the readers' experience when using bpMRI. The bpMRI without contrast media was a valid alternative for expert readers, whereas less experienced ones needed DCE to significantly boost SNS and AUC. Results indicate 700-800 cases as threshold for reliable interpretation with bpMRI.
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giorgio Calleris
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Jacopo Giglio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Claudio Berzovini
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Francesco Gentile
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giancarlo Marra
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Misischi
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Luca Molinaro
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy
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Gatti M, Palmisano A, Faletti R, Benedetti G, Bergamasco L, Bioletto F, Peretto G, Sala S, De Cobelli F, Fonio P, Esposito A. Two-dimensional and three-dimensional cardiac magnetic resonance feature-tracking myocardial strain analysis in acute myocarditis patients with preserved ejection fraction. Int J Cardiovasc Imaging 2019; 35:1101-1109. [PMID: 30929101 DOI: 10.1007/s10554-019-01588-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/04/2019] [Accepted: 03/23/2019] [Indexed: 12/15/2022]
Abstract
To explore the potential role of two- (2D) and three-dimensional (3D) cardiac magnetic resonance (CMR) feature tracking (FT) myocardial strain analysis in identifying sub-clinical myocardial systolic and diastolic dysfunction in acute myocarditis patients with preserved ejection fraction (EF). Prospective two centre study-control study. Thirty patients (9 female, 37.2 ± 11.8 years.) with a CMR diagnosis of acute myocarditis according to the Lake Louise Criteria and preserved EF (≥ 55%) were included in the analysis. CMR data from 24 healthy volunteers (11 female, 36.2 ± 12.5 years.) served as control. 2D and 3D LV tissue tracking analysis were performed in a random fashion by two double-blinded operators. Variables were checked for normality and analysed with parametric test. The baseline characteristics of myocarditis patients with preserved EF and the healthy volunteers were perfectly comparable, except for the LV mass index and T1 and T2 mapping values (p < 0.001). The results of the interobserver variability in the 2D and 3D LV CMR FT myocardial strain analysis were p > 0.42, ICC > 0.80 and η2 > 0.98. There was no statistical difference in 2D and 3D global radial, circumferential and longitudinal strain peak (%) and both systolic and diastolic strain rate (1/s) between acute myocarditis with preserved EF and healthy volunteers (all p = ns). There were no difference in 2D and 3D global radial, circumferential and longitudinal strain peak and both systolic and diastolic strain rate of the LV between acute myocarditis patients with preserved ejection fraction and healthy volunteers.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Giulia Benedetti
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Fabio Bioletto
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giovanni Peretto
- Vita Salute San Raffaele University, Milan, Italy
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele Scientific Institute, Milan, Italy
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
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Faletti R, Gatti M, Bergamasco L, Bertello C, Bonamini R, Capitolo L, Cesarani F, Ferroni F, Imazio M, Gaita F, Fonio P. "Infarct-like" myocarditis: can the clinical presentation predict results of cardiovascular magnetic resonance examination? Minerva Med 2019; 110:86-88. [PMID: 30667207 DOI: 10.23736/s0026-4806.18.05624-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy -
| | | | - Claudio Bertello
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | | | - Leonardo Capitolo
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | | | - Francesca Ferroni
- Division of Pediatric Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Imazio
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
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Faletti R, Gatti M, Cosentino A, Bergamasco L, Cura Stura E, Garabello D, Pennisi G, Salizzoni S, Veglia S, Ottavio D, Rinaldi M, Fonio P. 3D printing of the aortic annulus based on cardiovascular computed tomography: Preliminary experience in pre-procedural planning for aortic valve sizing. J Cardiovasc Comput Tomogr 2018; 12:391-397. [PMID: 29857953 DOI: 10.1016/j.jcct.2018.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
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Mariscotti G, Durando M, Houssami N, Berzovini C, Esposito F, Fasciano M, Campanino P, Bosco D, Bussone R, Ala A, Castellano I, Sapino A, Bergamasco L, Fonio P, Gandini G. Preoperative MRI evaluation of lesion–nipple distance in breast cancer patients: thresholds for predicting occult nipple–areola complex involvement. Clin Radiol 2018; 73:735-743. [DOI: 10.1016/j.crad.2018.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Faletti R, Gatti M, Bassano S, Finocchietti D, Fiore S, Colla L, Bergamasco L, Cassinis MC, Fonio P. Follow-up of acute pyelonephritis: what causes the diffusion-weighted magnetic resonance imaging recovery to lag clinical recovery? Abdom Radiol (NY) 2018; 43:639-646. [PMID: 28660334 DOI: 10.1007/s00261-017-1242-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze with diffusion-weighted magnetic resonance imaging (DW-MRI) the evolution and progress to resolution of acute pyelonephritis (APN) foci over a period of 3 months after onset. METHODS 30 women (age 22-51 years) with clinical, laboratory (white blood cell and C-reactive protein), and DW-MRI (4b-values 0, 50, 600, 1000 s/mm2) diagnosis of APN were prospectively enrolled. Two double-blinded radiologists evaluated the number of APN foci, and for each of them dimension (D), absolute diffusion coefficient (ADC), and its ratio R to the ADC of unaffected parenchyma. Signature of radiological recovery was focus no longer visible (DW-) and ADC of its site not inferior to the ADC of the unaffected parenchyma, i.e., R ≥ 0.9. Clinical and DW-MRI follow-ups (FU) were performed at 1 and 3 months. RESULTS At the acute stage (t 0), 187 APN foci were found, with ADC0 = 1.3 ± 0.2 × 10-3 mm2/s, R 0 = 0.65 ± 0.12, and D 0 = 14 ± 7.5 mm. By the 1-month FU (t 1), all patients had no symptoms and physiological laboratory values; despite this, only 80 (43%) foci were solved, increasing to 138 (74%) by at the 3-month FU. The ROC curve (AUC ≥ 0.80) identified R 0 ≤ 0.6 and D 0 > 15 mm as forecast of slow radiologic resolution. About 80% of foci unsolved at 1 month but with R 1 ≥ 0.8 and D 1 ≤ 10 mm reached solution at 3 months. CONCLUSIONS DW-MRI recovery of APN foci does not always coincide with clinical recovery. The evolution of an APN focus is shaped by its initial values R 0 and D 0. About half of the foci still visible at 1 month reached radiological resolution in the two following months.
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Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Serena Bassano
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Daniela Finocchietti
- SCDU Nephrology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Fiore
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Loredana Colla
- SCDU Nephrology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria Carla Cassinis
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
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Andreis A, Budano C, Levis M, Garrone P, Usmiani T, D’Ascenzo F, De Filippo O, D’Amico M, Bergamasco L, Biancone L, Marra S, Colombo A, Gaita F. Contrast-induced kidney injury. J Cardiovasc Med (Hagerstown) 2017; 18:908-915. [DOI: 10.2459/jcm.0000000000000543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mariscotti G, Durando M, Houssami N, Fasciano M, Tagliafico A, Bosco D, Casella C, Bogetti C, Bergamasco L, Fonio P, Gandini G. Comparison of synthetic mammography, reconstructed from digital breast tomosynthesis, and digital mammography: evaluation of lesion conspicuity and BI-RADS assessment categories. Breast Cancer Res Treat 2017; 166:765-773. [PMID: 28819781 DOI: 10.1007/s10549-017-4458-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 05/30/2017] [Accepted: 08/08/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the interpretive performance of synthetic mammography (SM), reconstructed from digital breast tomosynthesis (DBT), and full-field digital mammography (FFDM) in a diagnostic setting, covering different conditions of breast density and mammographic signs. METHODS A retrospective analysis was conducted on 231 patients, who underwent FFDM and DBT (from which SM images were reconstructed) between September 2014-September 2015. The study included 250 suspicious breast lesions, all biopsy proven: 148 (59.2%) malignant and 13 (5.2%) high-risk lesions were confirmed by surgery, 89 (35.6%) benign lesions had radiological follow-up. Two breast radiologists, blinded to histology, independently reviewed all cases. Readings were performed with SM alone, then with FFDM, collecting data on: probability of malignancy for each finding, lesion conspicuity, mammographic features and dimensions of detected lesions. RESULTS Agreement between readers was good for BI-RADS classification (Cohen's k-coefficient = 0.93 ± 0.02) and for lesion dimension (Wilcoxon's p = 0.76). Visibility scores assigned to SM and FFDM for each lesion were similar for non-dense and dense breasts, however, there were significant differences (p = 0.0009) in distribution of mammographic features subgroups. SM and FFDM had similar sensitivities in non-dense (respectively 94 vs. 91%) and dense breasts (88 vs. 80%) and for all mammographic signs (93 vs. 87% for asymmetric densities, 96 vs. 75% for distortion, 92 vs. 85% for microcalcifications, and both 94% for masses). Based on all data, there was a significant difference in sensitivity for SM (92%) vs. FFDM (87%), p = 0.02, whereas the two modalities yielded similar results for specificity (SM: 60%, FFDM: 62%, p = 0.21). CONCLUSIONS SM alone showed similar interpretive performance to FFDM, confirming its potential role as an alternative to FFDM in women having tomosynthesis, with the added advantage of halving the patient's dose exposure.
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Affiliation(s)
- Giovanna Mariscotti
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy.
| | - Manuela Durando
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Mirella Fasciano
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy
| | - Alberto Tagliafico
- Department of Experimental Medicine, University of Genoa, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, 16132, Genoa, Italy
| | - Davide Bosco
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy
| | - Cristina Casella
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy
| | - Camilla Bogetti
- Department of Diagnostic and Interventional Radiology, AUSL Valle d'Aosta, Regional Hospital, Viale Ginevra 3, 11100, Aosta, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, 10126, Turin, Italy
| | - Paolo Fonio
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy
| | - Giovanni Gandini
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Turin, Italy
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Giustetto C, Cerrato N, Ruffino E, Gribaudo E, Scrocco C, Barbonaglia L, Bianchi F, Bortnik M, Rossetti G, Carvalho P, Riccardi R, Castagno D, Anselmino M, Bergamasco L, Gaita F. Etiological diagnosis, prognostic significance and role of electrophysiological study in patients with Brugada ECG and syncope. Int J Cardiol 2017; 241:188-193. [DOI: 10.1016/j.ijcard.2017.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
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Scrocco C, Giustetto C, Callegari M, Maury P, Tulumen E, Anttonen O, Giachino D, Cuccurullo A, Rollin A, Bergamasco L, Borggrefe M, Gaita F. P6428Short QT interval: when does it matter? A multi-parametric analysis for diagnosing Short QT Syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Faletti R, Gatti M, Arezzo A, Stola S, Benedini MC, Bergamasco L, Morino M, Fonio P. Preoperative staging of rectal cancer using magnetic resonance imaging: comparison with pathological staging. MINERVA CHIR 2017; 73:13-19. [PMID: 28497665 DOI: 10.23736/s0026-4733.17.07392-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy of magnetic resonance (MR) in loco-regional staging of rectal cancer by comparing the MR results with histologic findings, considered as standard reference. METHODS Between July 2013 and March 2015, fifty-two patients, 27 (51.9%) males, age 66.75±13.77 years, with rectal cancer, were staged preoperatively with MR and proceeding straight to surgery. Two observers with experience in abdominal MR independently reviewed the images. T stage and N stage were evaluated according to the 7th edition of TNM classification. The estimate of Ln probability of malignancy (low, moderate, high) was based on nodal size, border contour and signal intensity and comparison between ADC value of the Ln's belonging to the three different classifications were performed. Statistical testing included Cohen's kappa coefficient, Mann-Whitney's, Kruskal-Wallis, χ2, Fisher's Exact Test and Receiving Operating Characteristics curve. RESULTS MR correctly assessed T stage in 47/52 cases (90.4%; kw=0.89±0.06), with inter-operator concordance of k=0.81±0.08. For Ln staging, concordance between estimate of high probability malignancy and pathology was kw=0.62±0.11. ADC was significantly different for the three grades of estimated malignancy probability (P=0.0003), decreasing from 1.227±0.298×10-3 mm2/s (low) to 1.120±0.306×10-3 mm2/s (moderate) and finally to 0.818±0.168×10-3 mm2/s (high). The ROC curve procedure established the good ability of ADC to discriminate high malignancy Ln's (AUC=0.88) with cut-off at <1×10-3 mm2/s. The percentage of high malignancy Ln's in the lateral pelvic space was higher than in other sites (55.6% vs. 17.6%, P=0.0003). CONCLUSIONS MR is an accurate imaging method in T staging and N staging of rectal cancer: prediction of N was improved by considering dimension, morphology and signal characteristic and the ability of ADC to identify high probability malignant nodes underlines its importance in the diagnostic process.
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Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy -
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Silvia Stola
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Maria C Benedini
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | | | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
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Gontero P, Calleris G, Marra G, Oderda M, Giglio J, Misischi F, Gentile F, Cimpoesu P, Molinaro L, Bergamasco L, Faletti R, Fonio P, Frea B. MP03-08 IMPACT OF DYNAMIC CONTRAST-ENHANCED SEQUENCES IN PROSTATE CANCER DETECTION: BIPARAMETRIC VERSUS MULTIPARAMETRIC MRI INTERPRETED BY 5 RADIOLOGY RESIDENTS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Usmiani T, Andreis A, Budano C, Sbarra P, Andriani M, Garrone P, Fanelli AL, Calcagnile C, Bergamasco L, Biancone L, Marra S. AKIGUARD (Acute Kidney Injury GUARding Device) trial: in-hospital and one-year outcomes. J Cardiovasc Med (Hagerstown) 2017; 17:530-7. [PMID: 26702595 DOI: 10.2459/jcm.0000000000000348] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Contrast-induced acute kidney injury (CIAKI) in patients with chronic kidney disease undergoing coronary angiography or percutaneous coronary intervention is a common iatrogenic complication associated with increased morbidity and mortality. This study compares sodium bicarbonate/isotonic saline/N-acetylcysteine/vitamin C prophylaxis (BS-NAC) against high-volume forced diuresis with matched hydration in CIAKI prevention. METHODS One-hundred and thirty-three consecutive patients undergoing coronary angiography or percutaneous coronary intervention with estimated glomerular filtration rate less than 60 mL/min/1.73m were randomized to the study group receiving matched hydration (MHG) or to the control group receiving BS-NAC. MHG received in vein (i.v.) 250 mL isotonic saline bolus, followed by a 0.5 mg/kg furosemide i.v. bolus to forced diuresis. A dedicated device automatically matched the isotonic saline i.v. infusion rate to the urinary output for 1 h before, during and 4 h after the procedure. RESULTS MHG had the lowest incidence of CIAKI (7 vs. 25%, P = 0.01), major adverse cardiac and cerebrovascular events at 1 year (7 vs. 32%, P < 0.01) and readmissions to cardiology/nephrology departments (8 vs. 25%, P = 0.03; hospitalization days 1.0 ± 3.8 vs. 4.9 ± 12.5, P = 0.01). Three months after the procedure the decrease in the estimated glomerular filtration rate was 0.02% for MHG versus 15% for the control group. CONCLUSION Matched hydration was more effective than BS-NAC in CIAKI prevention. One-year follow-up showed that matched hydration was associated also with limited chronic kidney disease progression, major adverse cardiac and cerebrovascular events and hospitalizations.
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Affiliation(s)
- Tullio Usmiani
- aCardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza di Torino-Molinette bDepartment of Surgical Sciences, University of Torino cNephrology Department, A.O.U. Città della Salute e della Scienza di Torino-Molinette, Turin, Italy
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Agnoletti G, Gala S, Ferroni F, Bordese R, Appendini L, Pace Napoleone C, Bergamasco L. Endothelin inhibitors lower pulmonary vascular resistance and improve functional capacity in patients with Fontan circulation. J Thorac Cardiovasc Surg 2017; 153:1468-1475. [PMID: 28283234 DOI: 10.1016/j.jtcvs.2017.01.051] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/04/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effects of endothelin inhibitors (ERAs) on hemodynamic and functional parameters in patients post-Fontan procedure with high pulmonary vascular resistance (PVR). METHODS Among our cohort of patients with Fontan circulation, 8 children, 8 adolescents, and 8 adults had PVR ≥2 WU*m2. These patients were treated with ERAs (minors with bosentan, adults with macitentan) and reevaluated after 6 months. Pre- and posttreatment hemodynamic variables were assessed by cardiac catheterization. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). Our primary endpoint was to obtain a reduction of PVR; the secondary endpoint was to obtain an improvement of functional capacity. RESULTS Under treatment, New York Heart Association class improved for adolescents and adults. PVR decreased (P = .01) in all groups: in children from the median value 2.3 (interquartile range 2.0-3.1) to 1.9 (1.4-2.3) WU*m2, in adolescents from 2.3 (2.1-2.4) to 1.7 (1.4-1.8) WU*m2, and in adults from 2.8 (2.0-4.7) to 2.1 (1.8-2.8)WU*m2. In 71% of patients, PVR fell to less than 2 WU*m2. Cardiac index increased in adolescents from 2.6 (2.4-3.3) to 3.6 (3.4-4.3) L/min/m2, P = .04, and in adults from 2.1 (2.0-2.3) to 2.8 (2.3-4.7) L/min/m2, P = .03. CPET showed that only adolescents displayed a significant functional improvement. Anaerobic threshold improved from 17 (13-19) to 18 (13-20) mL/kg/min, P = .03; oxygen consumption and VO2 max increased from 1.3 (1.0-1.6) to 1.7 (1.1-1.9) L/min, P = .02 and from 25 (21-28) to 28 (26-31) L/min, P = .02, respectively. Oxygen pulse increased from 7.9 (5.7-10.4) to 11.2 (8.2-13.0) L/beat, P = .01. CONCLUSIONS This is the first study that assesses by cardiac catheterization and CPET the effects of ERA in patients with Fontan circulation with increased PVR. These results suggest that ERAs might provide most pronounced hemodynamic and functional improvement in adults and adolescents.
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Affiliation(s)
- Gabriella Agnoletti
- Division of Pediatric Cardiology, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy.
| | - Simona Gala
- Division of Pediatric Cardiology, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy
| | - Francesca Ferroni
- Division of Pediatric Cardiology, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy
| | - Roberto Bordese
- Division of Pediatric Cardiology, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy
| | - Lorenzo Appendini
- Division of Statistics, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy
| | - Carlo Pace Napoleone
- Division of Cardiac Surgery, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy
| | - Laura Bergamasco
- Division of Statistics, Citta' della Salute e della Scienza, Turin, ASL CN1, Saluzzo, Italy
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Faletti R, Gatti M, Baralis I, Bergamasco L, Bonamini R, Ferroni F, Imazio M, Stola S, Gaita F, Fonio P. Clinical and magnetic resonance evolution of "infarct-like" myocarditis. Radiol Med 2017; 122:273-279. [PMID: 28070840 DOI: 10.1007/s11547-016-0723-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 10/11/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
Abstract
AIMS To analyse the clinical and magnetic resonance evolution of myocarditis in patients with an "infarct-like" presentation pattern. METHODS The study is a retrospective analysis of 52 patients with clinical diagnosis of "infarct-like" myocarditis confirmed by CMR as acute myocarditis according to Lake Louise criteria and 6 months follow-up. The CMR protocol included T2-weighted (oedema), early (hyperaemia) and late (fibrosis/necrosis) gadolinium enhancement sequences, according to Lake Louise criteria. Clinical and radiological follow-up by CMR was performed after a median time interval of 6 months (interquartile range 5-8). Quantitative outcomes were checked for normality and compared with the non-parametric Wilcoxon's test for matched data. RESULTS At the clinical follow-up all patients were free of symptoms and reported no cardiac complications. The CMR follow-up evidenced a significant increase of the ejection fraction (from 53 ± 6 to 55 ± 4%, p = 0.03), a decrease of the ventricular mass [from 67.0 (58.8-79.0) to 61.0 (54.0-67.0), p < 0.0001] without significant modification of the cardiac volume index (p = 0.26). No patient had residual oedema or capillary leakage: the T2 ratio decreased from 3.94 (3.00-4.86) to 0.98 (0.75-1.17) with p < 0.0001 and the Early gadolinium enhancement (EGE) ratio from 5.7 (4.8-6.5) to 2.9 (2.4-3.2) with p < 0.0001. Late gadolinium enhancement (LGE) persisted over the course of the follow-up in 48/52 patients, but with a significant reduction in every patient (LGE % from 34.3 ± 9.1 to 19.4 ± 6.6%; p < 0.0001). CONCLUSION Patients diagnosed with "infarct-like" myocarditis, according to both clinical and CMR examinations may look forward to a positive evolution with a good prognosis.
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Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Ilaria Baralis
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Rodolfo Bonamini
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Ferroni
- Division of Pediatric Cardiology, Citta' della Salute e della Scienza, Turin, Italy
| | - Massimo Imazio
- University Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Silvia Stola
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Fiorenzo Gaita
- University Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
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Mariscotti G, Durando M, Houssami N, Zuiani C, Martincich L, Londero V, Caramia E, Clauser P, Campanino PP, Regini E, Luparia A, Castellano I, Bergamasco L, Sapino A, Fonio P, Bazzocchi M, Gandini G. Digital breast tomosynthesis as an adjunct to digital mammography for detecting and characterising invasive lobular cancers: a multi-reader study. Clin Radiol 2016; 71:889-95. [DOI: 10.1016/j.crad.2016.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/07/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- G Mariscotti
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy.
| | - M Durando
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy
| | - N Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia
| | - C Zuiani
- Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy
| | - L Martincich
- Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, 10060 Candiolo, Torino, Italy
| | - V Londero
- Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy
| | - E Caramia
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy
| | - P Clauser
- Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy
| | - P P Campanino
- Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100 Torino, Italy
| | - E Regini
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy
| | - A Luparia
- U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), 38100 Trento, Italy
| | - I Castellano
- Department of Biomedical Sciences and Human Oncology, A. O. U. Città della Salute e della Scienza of Turin, University of Turin, Via Santena,7, Torino, Italy
| | - L Bergamasco
- Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, 10126 Torino, Italy
| | - A Sapino
- Department of Biomedical Sciences and Human Oncology, A. O. U. Città della Salute e della Scienza of Turin, University of Turin, Via Santena,7, Torino, Italy
| | - P Fonio
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy
| | - M Bazzocchi
- Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy
| | - G Gandini
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy
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46
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Oderda M, Faletti R, Battisti G, Dalmasso E, Falcone M, Marra G, Palazzetti A, Zitella A, Bergamasco L, Gandini G, Gontero P. Prostate Cancer Detection Rate with Koelis Fusion Biopsies versus Cognitive Biopsies: A Comparative Study. Urol Int 2016; 97:230-7. [PMID: 27256369 DOI: 10.1159/000445524] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/17/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Targeted fusion biopsies have led to an improved prostate cancer (PCa) detection rate (CDR). Our aim was to assess if device-assisted fusion biopsies are superior to cognitive ones in terms of CDR. The association between multiparametric MRI parameters and PCa was also evaluated. METHODS We retrospectively enrolled 50 patients who underwent transrectal biopsy with elastic fusion (Koelis; group KB, n = 25) or cognitive approach (group CB, n = 25). Targeted biopsies were done on targets, while a variable number of random biopsies were performed depending on the clinical case. RESULTS The groups did not significantly differ in terms of age, prostate-specific antigen, prostate volume and previous biopsies. Mean number of random cores was significantly inferior in KB group (8.4 vs. 12.1) and mean number of targeted biopsies was significantly higher (3.6 vs. 2.6). CDR was higher in fusion biopsies (64 vs. 40%), with the gap becoming significant when considering CDR of MRI targets only (59 vs. 27%). The difference was marked for lesions ≤10 mm, where CDR was 52% in KB against 21% in CB group. CONCLUSIONS According to our study, elastic fusion biopsies performed with Koelis achieve an increased per-patient and per-lesion CDR as compared to cognitive biopsies, especially in the case of lesions ≤10 mm.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences, Urology, University of Turin, Turin, Italy
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Faletti R, Battisti G, Discalzi A, Grognardi ML, Martinello S, Oderda M, Gontero P, Bergamasco L, Cassinis MC, Fonio P. Can DW-MRI, with its ADC values, be a reliable predictor of biopsy outcome in patients with suspected prostate cancer? Abdom Radiol (NY) 2016; 41:926-33. [PMID: 27193791 DOI: 10.1007/s00261-015-0574-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 12/19/2022]
Abstract
PURPOSE To relate the multiparametric magnetic resonance imaging (mp-MRI) of patients with suspect peripheral prostate cancer (PCa) to the results of the subsequent biopsy: in particular to explore whether DWI and ADC can predict the biopsy outcome and to investigate the relation between ADC and Gleason score (GS). MATERIALS AND METHODS 175 consecutive patients who underwent 1.5 T mp-MRI followed by prostate biopsy were retrospectively analyzed by two independent radiologists. ADC values were measured in the peripheral suspect lesion areas (ADCSL) and in the contralateral zones (ADCNSL) obtaining ADCnorm = ADCSL/ADCNSL. Results on T2W images, DWI, ADC values, and perfusion studies were matched to their corresponding biopsy. RESULTS Negative DWI and T2W had 100% negative predictive value (NPV). When DWI was positive, ADCSL > 0.90 × 10 > 0.90 × 10(-3) mm(2)/s (ADCnorm > 0.60) identified by the ROC curve (AUC = 0.80) corresponded to NPV = 85%. In positive biopsies, ADCSL and ADCnorm decreased significantly from GS = 6 to GS ≥ 8 with Spearman coefficient ρ = -0.40 and ROC curve AUC = 0.72. CONCLUSION mp-MRI allows a reliable prediction of a negative biopsy through the values of DWI, T2W, and ADC. In positive biopsies, there is a moderate correlation between ADC and the various GS levels.
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Affiliation(s)
- R Faletti
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy.
| | - G Battisti
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - A Discalzi
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - M L Grognardi
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - S Martinello
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - M Oderda
- Urology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - P Gontero
- Urology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - L Bergamasco
- Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - M C Cassinis
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
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Pol R, Ruggiero T, Gallesio G, Riso M, Bergamasco L, Mortellaro C, Mozzati M. Efficacy of Anti-Inflammatory and Analgesic of Superpulsed Low Level Laser Therapy After Impacted Mandibular Third Molars Extractions. J Craniofac Surg 2016; 27:685-90. [DOI: 10.1097/scs.0000000000002523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Faletti R, Gatti M, Salizzoni S, Bergamasco L, Bonamini R, Garabello D, Marra WG, La Torre M, Morello M, Veglia S, Fonio P, Rinaldi M. Cardiovascular magnetic resonance as a reliable alternative to cardiovascular computed tomography and transesophageal echocardiography for aortic annulus valve sizing. Int J Cardiovasc Imaging 2016; 32:1255-63. [PMID: 27117264 DOI: 10.1007/s10554-016-0899-8] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/16/2016] [Indexed: 11/26/2022]
Abstract
To assess the accuracy and reproducibly of cardiovascular magnetic resonance (CMR) in the measurement of the aortic annulus and in process of valve sizing as compared to intra-operative sizing, cardiovascular computed tomography (CCT) and transesophageal echocardiography (TEE). Retrospective study on 42 patients who underwent aortic valve replacement from September 2010 to September 2015, with available records of pre surgery annulus assessment by CMR, CCT and TEE and of peri-operative assessment. In CCT and CMR, the annular plane was considered a virtual ring formed by the lowest hinge points of the valvular attachments to the aorta. In TEE the annulus was measured at the base of leaflet insertion in the mid-esophageal long-axis view using the X-plane technique. Two double-blinded operators performed the assessments for each imaging technique. Intra-operative evaluation was performed using Hegar dilators. Continuous variables were studied with within-subject ANOVA, Bland-Altman (BA) plots, Wilcoxon's and Friedman's tests; trends were explored with scatter plots. Categorical variables were studied with Fisher's exact test. The intra- and inter-operator reliability was satisfying. There were no significant differences between the annulus dimensions measured by CMR and either one of the three references. Valve sizing for CoreValve by CMR had the same good agreement with CCT and TEE, with a 78 % match rate; for SAPIEN XT the agreement was slightly better (82 %) for CCT than for TEE (66 %). MR performs well when compared to the surgical reference of intra-operative sizing and stands up to the level of the most used imaging references (CCT and TEE).
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Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Rodolfo Bonamini
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Domenica Garabello
- Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Turin, Italy
| | - Walter Grosso Marra
- Division of Cardiology, Department of Medical Sciences,, University of Turin, Turin, Italy
| | - Michele La Torre
- Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mara Morello
- Division of Cardiology, Department of Medical Sciences,, University of Turin, Turin, Italy
| | - Simona Veglia
- Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
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Marzullo R, Bordese R, Bassignana A, Ferraro G, Dall'Orto G, Ferrarotti L, Libertucci D, Rissone L, Amoroso G, Actis Dato G, Albera C, Bergamasco L, Agnoletti G. [Preliminary results and future perspectives of the Piedmont Adult Congenital Heart Disease Registry]. G Ital Cardiol (Rome) 2016; 17:225-33. [PMID: 27029881 DOI: 10.1714/2190.23668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adults with congenital heart disease are a relatively new population that progressively increases in size and complexity. In Italy, there are no accurate data concerning the distribution of congenital defects and the long-term outcome relating to both congenital heart disease per se and comorbidities, due to the aging process. METHODS The Piedmont Adult Congenital Heart Disease Registry has been designed to investigate these aspects and to support a high quality healthcare development for grown-up congenital heart patients. Within 2 years, 459 consecutive patients routinely followed in 10 divisions of cardiology in Piedmont were included in the project. Electronic dedicated software has supported data collection. RESULTS Mean age of patients is 35 ± 16 years. Septal defects are the most common type of congenital heart disease (35.3%). At baseline evaluation, 71.7% of patients reported a previous surgical and/or percutaneous treatment and 6.3% an electrophysiological procedure. Freedom from intervention is 44%, 81% and 56% at the age of 18, 30 and 45 years, respectively. Patients who had a treatment during infancy show a better intervention-free survival (p=0.038) compared with patients treated during adulthood. Despite the majority of the population had an almost preserved functional status, 27.5% had ≥1 long-term sequelae (arrhythmias 27.5%; pulmonary hypertension 5.2%; neurological problems 4.1%; cyanosis 4.8%; liver dysfunction 2.4%; enteropathy 2.4%; lung disease 2.2%). During 2 years of follow-up, the estimated mortality rate is 0.88%. CONCLUSIONS Adults with congenital heart disease are a heterogeneous population of relatively young patients with relevant clinical and social problems. The late sequelae related to both the underlying heart disease and the advancing age require continuous monitoring and lifelong specialized care.
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Affiliation(s)
- Raffaella Marzullo
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| | - Roberto Bordese
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| | | | - Gaetana Ferraro
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | - Daniela Libertucci
- Dipartimento Cardiovascolare e Toracico, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | - Carlo Albera
- S.C. Pneumologia, A.O.U. San Luigi Gonzaga, Orbassano (TO)
| | - Laura Bergamasco
- Dipartimento di Scienze Mediche e Chirurgiche, A.O.U. Città della Salute e della Scienza, Torino
| | - Gabriella Agnoletti
- S.C. Cardiologia Pediatrica, Ospedale Regina Margherita, A.O.U. Città della Salute e della Scienza, Torino
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