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Russo G, Zambrano A, Burzotta F, Pedicino D, Graziani F, Cangemi S, Bianchini F, Bruno P, Locorotondo G, Calabrese M, Aurigemma C, Romagnoli E, Trani C. Temporal trends of frame expansion and paravalvular leak reduction after transcatheter aortic valve replacement with self-expandable prostheses. Minerva Cardiol Angiol 2024; 72:172-181. [PMID: 38088090 DOI: 10.23736/s2724-5683.23.06368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Paravalvular leakage (PVL) is a common finding after transcatheter aortic valve replacement (TAVR) and affects late clinical outcome. It is more frequent with self-expandable (SE) transcatheter-heart-valve (THV). Few is known about SE-THV expansion after implantation. The purpose is to assess SE-THV frame expansion and its possible influence on PVL. METHODS We designed a prospective pilot study to assess the time-course of SE-THV frame dimensions and PVL after TAVR. Consecutive patients undergoing TAVR with SE-THV were enrolled. Prosthesis fluoroscopy and echocardiography were prospectively performed immediately after TAVR (T0) and before discharge (T1) to grade PVL. Prosthesis diameters were assessed in 2 fluoroscopic orthogonal views. PVL reduction ≥1+ from T0 to T1 at echocardiography was the primary study endpoint. RESULTS Twenty-five patients were enrolled. Mean interval between T0 and T1 evaluations was 5 days. Grade 1 or 2 was present in 76% of patients at T0 and in 68% at T1 (P=0.034). A total of 7 patients (28%) improved PVL ≥1 grade from T0 to T1. Differences between T0 and T1 fluoroscopic diameters were not statistically significant. When comparing the diameter changes according to PVL evolution, patients with PVL improvement (as compared with those without) had significantly larger minimum diameter increase at both annulus/inflow (P=0.016) and outflow/distal edge (P=0.027). CONCLUSIONS PVL may improve in the early days after SE-THV and those patients with PVL improvement may have THV frame expansion. Further studies are needed to confirm such preliminary observations and to establish the clinical relevance of this phenomenon.
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Affiliation(s)
- Giulio Russo
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Aniello Zambrano
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
- Sacred Heart Catholic University, Rome, Italy
| | - Daniela Pedicino
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesca Graziani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Stefano Cangemi
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesco Bianchini
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Piergiorgio Bruno
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Gabriella Locorotondo
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Michele Calabrese
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Cristina Aurigemma
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Enrico Romagnoli
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
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Noteboom S, van Nederpelt DR, Bajrami A, Moraal B, Caan MWA, Barkhof F, Calabrese M, Vrenken H, Strijbis EMM, Steenwijk MD, Schoonheim MM. Feasibility of detecting atrophy relevant for disability and cognition in multiple sclerosis using 3D-FLAIR. J Neurol 2023; 270:5201-5210. [PMID: 37466663 PMCID: PMC10576669 DOI: 10.1007/s00415-023-11870-4] [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: 05/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Disability and cognitive impairment are known to be related to brain atrophy in multiple sclerosis (MS), but 3D-T1 imaging required for brain volumetrics is often unavailable in clinical protocols, unlike 3D-FLAIR. Here our aim was to investigate whether brain volumes derived from 3D-FLAIR images result in similar associations with disability and cognition in MS as do those derived from 3D-T1 images. METHODS 3T-MRI scans of 329 MS patients and 76 healthy controls were included in this cross-sectional study. Brain volumes were derived using FreeSurfer on 3D-T1 and compared with brain volumes derived with SynthSeg and SAMSEG on 3D-FLAIR. Relative agreement was evaluated by calculating the intraclass correlation coefficient (ICC) of the 3D-T1 and 3D-FLAIR volumes. Consistency of relations with disability and average cognition was assessed using linear regression, while correcting for age and sex. The findings were corroborated in an independent validation cohort of 125 MS patients. RESULTS The ICC between volume measured with FreeSurfer and those measured on 3D-FLAIR for brain, ventricle, cortex, total deep gray matter and thalamus was above 0.74 for SAMSEG and above 0.91 for SynthSeg. Worse disability and lower average cognition were similarly associated with brain (adj. R2 = 0.24-0.27, p < 0.01; adj. R2 = 0.26-0.29, p < 0.001) ventricle (adj. R2 = 0.27-0.28, p < 0.001; adj. R2 = 0.19-0.20, p < 0.001) and deep gray matter volumes (adj. R2 = 0.24-0.28, p < 0.001; adj. R2 = 0.27-0.28, p < 0.001) determined with all methods, except for cortical volumes derived from 3D-FLAIR. DISCUSSION In this cross-sectional study, brain volumes derived from 3D-FLAIR and 3D-T1 show similar relationships to disability and cognitive dysfunction in MS, highlighting the potential of these techniques in clinical datasets.
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Affiliation(s)
- Samantha Noteboom
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
| | - D R van Nederpelt
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - A Bajrami
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, Regional Multiple Sclerosis Center, University of Verona, Verona, Italy
| | - B Moraal
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - M W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - F Barkhof
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Institutes of Healthcare Engineering and Neurology, University College London, London, United Kingdom
| | - M Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, Regional Multiple Sclerosis Center, University of Verona, Verona, Italy
| | - H Vrenken
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - E M M Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - M D Steenwijk
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - M M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
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Oliva F, Bartoli A, Garofalo E, Calabrese M, Oliva G, Maffulli N. Influence of Exercise on Musculoskeletal Disorders Associated with Gut Microbiota: A Narrative Review. Muscles Ligaments Tendons J 2023. [DOI: 10.32098/mltj.01.2023.01] [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: 03/16/2023]
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4
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Resnati G, Pizzi A, Calabrese M. Anion–anion self-assembly via Matere bond and other σ-hole interactions. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322095043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Vecchio G, Torsiello E, Calabrese M, Padulo J, Maffulli N, Oliva F. Motor Behavior Disorders in Children with Developmental Dyslexia: a Comprehensive Narrative Review of the Literature. Muscles Ligaments Tendons J 2022. [DOI: 10.32098/mltj.03.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Graziani F, Cialdella P, Lillo R, Locorotondo G, Genuardi L, Ingrasciotta G, Cangemi S, Nesta M, Bruno P, Aurigemma C, Romagnoli E, Calabrese M, Giambusso N, Lombardo A, Burzotta F, Trani C. Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis. ESC Heart Fail 2022; 9:1721-1730. [PMID: 35348288 PMCID: PMC9065843 DOI: 10.1002/ehf2.13846] [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: 09/20/2021] [Revised: 12/26/2021] [Accepted: 02/04/2022] [Indexed: 11/21/2022] Open
Abstract
Aims There are limited data about the intraprocedural haemodynamic study performed immediately before and after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). We aimed to evaluate the acute haemodynamic impact of TAVI in patients with severe AS and to investigate invasive and non‐invasive parameters predicting all‐cause mortality. Methods and results A total of 245 consecutive AS patients (43% male, mean age 80.3 ± 7.3 years) undergoing TAVI were enrolled. Intraprocedural left heart catheterization (LHC) and echocardiogram before and after TAVI were performed. The clinical endpoint was the death for any cause. LHC after TAVI revealed significant changes in aortic and left ventricular (LV) pressures, including indexes of intrinsic myocardial contractility and diastolic function such as positive dP/dT (1128.9 ± 398.7 vs. 806.3 ± 247.2 mmHg/s, P ˂ 0.001) and negative dP/dT (1310.7 ± 431.1 vs. 1075.1 ± 440.8 mmHg/s, P ˂ 0.001). Post‐TAVI echo showed a significant reduction in LV end‐diastolic (P = 0.036) and end‐systolic (P ˂ 0.001) diameters, improvement in LV ejection fraction (from 55 ± 12% to 57.2 ± 10.5%, P ˂ 0.001), and pulmonary artery systolic pressure (42.1 ± 14.2 vs. 33.1 ± 10.7 mmHg, P < 0.001). After a mean follow‐up time interval of 24 months, 47 patients died. Post‐TAVI significant aortic regurgitation at echocardiography was the only independent predictor of mortality (hazard ratio 5.592, confidence interval 1.932–16.184, P = 0.002). Conclusions Left heart catheterization performed immediately before and after prosthesis release offers a unique insight in the assessment of LV adaptation to severe AS and the impact of TAVI on LV, catching changes in indexes of intrinsic contractility and myocardial relaxation. Aortic regurgitation assessed by echocardiography was the only independent predictor of mortality in patients undergoing TAVI.
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Affiliation(s)
- Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Rosa Lillo
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Genuardi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gessica Ingrasciotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cangemi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Calabrese
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicole Giambusso
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Graziani F, Cialdella P, Lillo R, Locorotondo G, Genuardi L, Ingrasciotta G, Nesta ML, Bruno P, Aurigemma C, Romagnoli E, Calabrese M, Giambusso N, Lombardo A, Burzotta F, Trani C. Acute hemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. There are limited data about the intraprocedural hemodynamic study performed immediately before and after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). Purpose. We aimed to evaluate the acute hemodynamic impact of TAVI in patients with severe AS and to investigate invasive and non-invasive parameters predicting all-cause mortality. Methods. A total of 245 consecutive AS patients undergoing TAVI were enrolled. Intraprocedural left heart catheterization (LHC) and echocardiogram before and after TAVI were performed. The clinical endpoint was the death for any cause. Results. LHC after TAVI revealed significant changes in aortic and LV pressures, including indexes of intrinsic myocardial contractility and diastolic function such as positive dP/dT (1128.9 ± 398.7 vs 806.3 ± 247.2 mmHg/sec, p˂0.001; Figure 1A) and negative dP/dT (1310.7± 431.1 vs 1075.1 ± 440.8 mmHg/sec, p˂0.001; Figure 1B). Post TAVI echo showed a significant reduction in LV end diastolic volume index (54.6 ± 18.4 ml/m2 vs 51.7 ± 17.5 ml/m2; p = 0.017; Figure 1C), improvement in left ventricle ejection fraction (from 55 ± 12 to 57.2 ± 10.5%, p˂0.001; Figure 1D) and pulmonary artery systolic pressure (42.1 ± 14.2 vs 33.1 ± 10.7 mmHg, p < 0.001; Figure 1E). After a mean follow-up time interval of 24 months, 47 patients died. Post-TAVI aortic regurgitation (2- 3- 4+) at echocardiography was the only independent predictor of mortality (HR 4.43, C.I. 1,71 – 11,45, p = 0.002; Figure 2). Conclusions. LHC performed immediately before and after prosthesis release offers a unique insight in the assessment ofLV adaptation to severe AS and the impact of TAVI on LV, catching changes in indexes of intrinsic contractility and myocardial relaxation. Aortic regurgitation assessed by echocardiography was the only independent predictor of mortality in patients undergoing TAVI.
FIGURE LEGEND
Figure 1. A-B: Impact of TAVI on haemodynamic parameters: Box plot with median and interquartile ranges of positive dP/dT and negative dP/dT values pre vs post TAVI. C-D-E: Impact of TAVI on echocardiographic parameters: Box plot with median and interquartile ranges of left ventricular end diastolic volume index (LVEDVi), left ventricular ejection fraction (EF) and pulmonary artery systolic pressure (PASP) values pre vs post TAVI.
Figure 2. Kaplan-Meier curves for survival showing that AR (2-3-4+) assessed with echocardiography had the strongest association with mortality. Abstract Figure 1. Abstract Figure 2.
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Affiliation(s)
- F Graziani
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - P Cialdella
- Catholic University of the Sacred Heart, Rome, Italy
| | - R Lillo
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - G Locorotondo
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - L Genuardi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - G Ingrasciotta
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - ML Nesta
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - P Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - C Aurigemma
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - E Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - M Calabrese
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - N Giambusso
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - A Lombardo
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - F Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
| | - C Trani
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences,, Rome, Italy
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Calabrese M, Chmelo J, Prasad P, Brown J, Wallace L, Phillips A. P-OGC60 Predicting the risk of venous thromboembolism during neoadjuvant therapy for oesophagogastric cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.188] [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
Background
Locally advanced oesophageal cancer is usually treated with neoadjuvant treatment (NAT) followed by surgery. Venous thromboembolism (VTE) is a recognised complication in these patients. Those who develop VTE may have an inferior vena cava filter placed prior to surgery to reduce the risk of further complications. This study aimed to identify specific risks for VTE during (NAT) for oesophagogastric cancer (OGC) and whether this increases postoperative morbidity.
Methods
Patients undergoing NAT for OGC followed by surgery at a single high-volume centre between January 2015 and June 2020 were identified from a prospectively maintained database. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for the development of VTE as well as the association between diagnosis of VTE and morbidity.
Results
The incidence of VTE in this cohort was 6.7% (27/406). Independent risk factors for developing VTE in multivariable analysis were BMI – OR 1.093 (p = 0.045) and age – OR 1.067 (p = 0.019). Type of chemo(radio)therapy regimen used, pT, pN stage, previous history of ischaemic heart disease or being an active smoker at diagnosis was not associated with VTE occurrence. Diagnosis of VTE during neoadjuvant treatment was not associated with a higher risk of developing a serious postoperative complication (Clavien-Dindo grade III and above) (p = 0.699).
Conclusions
Patients with a raised BMI or older age are at higher risk of developing VTE during NAT for OGC. These patients must be appropriately counseled on the higher risk of VTE prior to commencing NAT. However, the development of a VTE does not appear to confer any additional post-operative complication risk.
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Affiliation(s)
- Michele Calabrese
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Jakub Chmelo
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Pooja Prasad
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Joshua Brown
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Lauren Wallace
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Alexander Phillips
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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Brown J, Calabrese M, Chmelo J, Prasad P, Phillips A. P-OGC59 Pattern of recurrence following neoadjuvant treatment and two-stage oesophagectomy for oesophageal/junctional adenocarcinoma: 10-year results from a high-volume centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.187] [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
Background
Disease recurrence remains high following oesophagectomy for oesophageal and junctional adenocarcinoma in spite of the incremental gains from improved neoadjuvant treatment (NAT). Follow-up remains important for the detection and treatment of recurrence, although the optimum surveillance strategy remains undefined. Recurrence after treatment can occur locoregionally, distantly, or a combination of both. This retrospective review of a single, high-volume centre’s 10-year experience has sought to determine the pattern of recurrence in those who have received curative NAT followed by two-stage subtotal oesophagectomy (2S-STO) for oesophageal and junctional adenocarcinoma.
Methods
A retrospective analysis was performed on a cohort of patients from a high-volume, single centre between January 2009 and January 2019 who had confirmed disease recurrence after receiving NAT and 2S-STO for either oesophageal or junctional (Siewert I/II) adenocarcinoma. The Unit’s prospectively collected cancer database was utilised as well as patients’ notes to determine the pattern of recurrence seen in this cohort. Patients receiving a three-stage or transhiatal oesophagectomy for any cause, or those diagnosed with squamous cell carcinoma were excluded.
Results
215 patients were identified with recurrence following NAT and 2S-STO for oesophageal/junctional adenocarcinoma within the 10-year period. The median age was 69 (range 23-85) with 67% being male and 33% female. The median time to diagnosis of recurrence was 13 months following surgery. 87 (40%) patients were diagnosed with locoregional recurrence, with the commonest pattern being in mediastinal or abdominal lymph nodes, followed by peritoneal disease. 62 (29%) patients were diagnosed with distant recurrence, with the vast majority being in the liver or lungs. 66 (31%) patients had evidence of both locoregional and distant spread at diagnosis of recurrence.
Conclusions
The incidence of recurrence following curative treatment for oesophageal and junctional adenocarcinoma remains high. Locoregional disease appears to be the commonest pattern of recurrence as identified in this study, which would confirm spread predominates via the lymphatic and transcoelomic routes. Liver and lung remain the commonest sites for haematogenous spread, although other sites include adrenal, brain and bone. Although the optimum follow-up strategy remains undefined in such patients, timely investigation of symptoms is required for early diagnosis so as to optimise the benefits of palliative treatment.
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Affiliation(s)
- Joshua Brown
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upone Tyne, United Kingdom
| | - Michele Calabrese
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upone Tyne, United Kingdom
| | - Jakub Chmelo
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upone Tyne, United Kingdom
| | - Pooja Prasad
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upone Tyne, United Kingdom
| | - Alexander Phillips
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upone Tyne, United Kingdom
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Wallace L, Brown J, Calabrese M, Prasad P, Chmelo J, Hayes N. P-BN18 Cholecystectomy following ERCP: A retrospective audit from a single centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.019] [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: 11/12/2022]
Abstract
Abstract
Background
15% of the adult population are estimated to have gallstones (GS) and managing GS related disease can represent a significant challenge to surgical and endoscopic services alike. One particular challenge is the management of bile duct calculi (BDC), and treatment can vary according to the unit/institution. NICE has published guidelines (CG188) on the management of GS disease with the recommendation that bile duct clearance and cholecystectomy be offered for symptomatic and asymptomatic BDC. This retrospective audit was performed to determine compliance of a single centre with respect to offering cholecystectomy following ERCP for BDC.
Methods
A retrospective audit was performed for the year 2018 at a single centre utilising the trust ERCP database. The audit was analysed against NICE guideline CG188 and specifically whether patients treated with ERCP for BDC were then treated with cholecystectomy or had a documented justification as to why cholecystectomy was declined. 2018 was chosen so that at least a 2-year period of follow-up could be analysed. As well as the trust ERCP database, the trust electronic documentation record and paper notes were consulted to determine compliance with the guideline.
Results
149 ERCPs were performed on 121 patients at this centre in 2018. Of these, 82 patients were included as 39 had an ERCP for malignant disease or had already had a cholecystectomy. Of those 82, 51 (62%) had an ERCP as an emergency while 31 (38%) had an elective procedure. The median age was 65, 54% being male and 46% female. 45 (55%) had a cholecystectomy following ERCP, 29 as an emergency, and 16 electively. Of those 37 who did not have a cholecystectomy, 20 (54%) had no recorded documentation to justify a decision not to proceed to cholecystectomy.
Conclusions
GS disease has the potential to cause significant morbidity. If an ERCP has been performed for BDC, NICE recommends that cholecystectomy should be offered to mitigate further GS related complications. Patients may of course decline an operation, or a joint decision made not to pursue operative management due to identified surgical risks. This audit demonstrated that 54% of patients at this institution who did not have a cholecystectomy following ERCP had no documented reason why cholecystectomy was declined. Robust follow-up and documentation measures have since been put in place and a follow-up audit is being performed to monitor improvement.
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Affiliation(s)
- Lauren Wallace
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Joshua Brown
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Michele Calabrese
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Pooja Prasad
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Jakub Chmelo
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Nick Hayes
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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11
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Vaccara E, Ridolfi L, Pellecchia G, Dordolo M, Gavotti C, Brunetti N, Calabrese M, Garlaschi A, Levrero F. Contrast enhancement digital mammography dosimetry: preliminary evaluation of dose increase in thick/dense breast. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00543-9] [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: 11/15/2022] Open
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12
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Buccino M, Daliri M, Calabrese M, Somma R. A numerical study of arsenic contamination at the Bagnoli bay seabed by a semi-anthropogenic source. Analysis of current regime. Sci Total Environ 2021; 782:146811. [PMID: 33848853 DOI: 10.1016/j.scitotenv.2021.146811] [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] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
Bagnoli Coroglio is an urban district of the City of Naples (South Italy), which fronts the Tyrrhenian Sea for nearly 3 km. It is part of the Campi Flegrei caldera, one of the most explosive volcanic areas in Europe. The need for redeveloping the site after the intense industrial activities of the twentieth century has prompted a remarkable research effort to investigate the pollution's degree, nature, and extent at both the land and seafloor. This article focuses on releasing thermal waters from a natural channel as a source of arsenic contamination in the Bagnoli marine sediments; the thermal waters originate from the nearby Agnano hot-springs and have been conveying artificially to the track since the mid-XIX century. As a first part of the outcomes, the work describes the flow regime that characterizes the marine area. The analysis has been conducted via numerical simulations carried out with the software package Delft3D, developed by Deltares, which employs dynamically interfacing modules to account for wave propagation, generation of currents, and presence of coastal structures. Climatic inputs to the software (waves, winds, and tide) have specifically been gathered and analyzed within this research. The numerical study has permitted to furnish, for the first time, a clear and systematic view of the hydrodynamic forcings that characterize the area under investigation. In particular, a leading role in the transport of pollutants could be played by rip current systems, whose characteristics vary with climate intensity (waves and wind) and coastal structures characteristics. Due to its inherently dynamic nature, the proposed approach seems especially desirable in situations where different contamination sources are compared. As such, it could be successfully applied to other sites also.
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Affiliation(s)
- M Buccino
- Dept. of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Italy.
| | - M Daliri
- Dept. of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Italy.
| | - M Calabrese
- Dept. of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Italy.
| | - Renato Somma
- Italian Institute of Geophysics and Vulcanology (INGV), Italy; CNR-IRISS, Naples, Italy.
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13
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Cruciani F, Brusini L, Zucchelli M, Retuci Pinheiro G, Setti F, Boscolo Galazzo I, Deriche R, Rittner L, Calabrese M, Menegaz G. Interpretable deep learning as a means for decrypting disease signature in multiple sclerosis. J Neural Eng 2021; 18. [PMID: 34181581 DOI: 10.1088/1741-2552/ac0f4b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/28/2021] [Indexed: 11/12/2022]
Abstract
Objective.The mechanisms driving multiple sclerosis (MS) are still largely unknown, calling for new methods allowing to detect and characterize tissue degeneration since the early stages of the disease. Our aim is to decrypt the microstructural signatures of the Primary Progressive versus the Relapsing-Remitting state of disease based on diffusion and structural magnetic resonance imaging data.Approach.A selection of microstructural descriptors, based on the 3D-Simple Harmonics Oscillator Based Reconstruction and Estimation and the set of new algebraically independent Rotation Invariant spherical harmonics Features, was considered and used to feed convolutional neural networks (CNNs) models. Classical measures derived from diffusion tensor imaging, that are fractional anisotropy and mean diffusivity, were used as benchmark for diffusion MRI (dMRI). Finally, T1-weighted images were also considered for the sake of comparison with the state-of-the-art. A CNN model was fit to each feature map and layerwise relevance propagation (LRP) heatmaps were generated for each model, target class and subject in the test set. Average heatmaps were calculated across correctly classified patients and size-corrected metrics were derived on a set of regions of interest to assess the LRP contrast between the two classes.Main results.Our results demonstrated that dMRI features extracted in grey matter tissues can help in disambiguating primary progressive multiple sclerosis from relapsing-remitting multiple sclerosis patients and, moreover, that LRP heatmaps highlight areas of high relevance which relate well with what is known from literature for MS disease.Significance.Within a patient stratification task, LRP allows detecting the input voxels that mostly contribute to the classification of the patients in either of the two classes for each feature, potentially bringing to light hidden data properties which might reveal peculiar disease-state factors.
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Affiliation(s)
- F Cruciani
- Department of Computer Science, University of Verona, Verona, Italy
| | - L Brusini
- Department of Computer Science, University of Verona, Verona, Italy
| | - M Zucchelli
- Athena Project-Team, Inria Sophia Antipolis-Méditerranée, Université Côte d'Azur, Sophia Antipolis, France
| | - G Retuci Pinheiro
- MICLab, School of Electrical and Computer Engineering (FEEC), UNICAMP, Campinas, Brazil
| | - F Setti
- Department of Computer Science, University of Verona, Verona, Italy
| | | | - R Deriche
- Athena Project-Team, Inria Sophia Antipolis-Méditerranée, Université Côte d'Azur, Sophia Antipolis, France
| | - L Rittner
- MICLab, School of Electrical and Computer Engineering (FEEC), UNICAMP, Campinas, Brazil
| | - M Calabrese
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - G Menegaz
- Department of Computer Science, University of Verona, Verona, Italy
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14
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Tortorella C, Solaro C, Annovazzi P, Boffa L, Buscarinu MC, Buttari F, Calabrese M, Cavalla P, Cocco E, Cordioli C, De Luca G, Di Filippo M, Fantozzi R, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Fermo SL, Malucchi S, Maniscalco GT, Moccia M, Nociti V, Paolicelli D, Pesci I, Prosperini L, Ragonese P, Tomassini V, Clerici VLAT, Rodegher M, Gherardi M, Gasperini C. Informing MS patients on treatment options: a consensus on the process of consent taking. Neurol Sci 2020; 41:2249-2253. [PMID: 32240416 DOI: 10.1007/s10072-020-04339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
In the last years, change in multiple sclerosis (MS) therapeutic scenario has highlighted the need for an improved doctor-patient communication in advance of treatment initiation in order to allow patient's empowerment in the decision-making process. AIMS: The aims of our project were to review the strategies used by Italian MS specialists to inform patients about treatment options and to design a multicentre shared document that homogenizes the information about disease-modifying treatment (DMTs) and the procedure of taking informed consent in clinical practice. RESULTS: The new resource, obtained by consensus among 31 neurologists from 27 MS Centres in Italy with the supervision of a medico-legal advisor, received the aegis of Italian Neurological Society (SIN) and constitutes a step toward a standardized decision process around DMTs in MS.
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Affiliation(s)
- C Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.
| | - C Solaro
- Department of Rehabilitation, Mons L Novarese Hospital, Moncrivello, Italy
| | - P Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, PO di Gallarate, (VA), Italy
| | - L Boffa
- Department of Neurosciences, MS Center, Tor Vergata University, Rome, Italy
| | - M C Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs Sapienza University Rome, Rome, Italy
| | - F Buttari
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - M Calabrese
- Neurology B, Department of Neurosciences Biomedicine and Movements, University of Verona, Verona, Italy
| | - P Cavalla
- MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy
| | - E Cocco
- Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - C Cordioli
- Multiple Sclerosis Center, ospedale di Montichiari, Spedali Civili di Brescia, Montichiari, Italy
| | - G De Luca
- Neurology Clinic, Multiple Sclerosis Center SS. Annunziata Hospital, Chieti, Italy
| | - M Di Filippo
- Clinica Neurologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - R Fantozzi
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - D Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Science, University of Campania, Naples, Italy
| | - R Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Laroni
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Lo Fermo
- Clinica Neurologica A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - S Malucchi
- Neurologia 2-CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - G T Maniscalco
- Department of Neurology and Stroke Unit, "A. Cardarelli Hospital", Naples, Italy
| | - M Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - V Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario 'A Gemelli' IRCCS, Rome, Italy
| | - D Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - I Pesci
- Ospedale di Vaio, Centro SM, Fidenza, Parma, Italy
| | - L Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - P Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Palermo, Italy
| | - V Tomassini
- Department of Neurosciences, Imaging and Clinical Sciences, School of Medicine, Institute for Advanced Biomedical Technologies (ITAB), University of Chieti-Pescara "G. d'Annunzio, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - V L A Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - M Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Gherardi
- SC Medicina Legale AUSL Valle D'Aosta, Aosta, Italy
| | - C Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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15
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Garlaschi A, Fregatti P, Oddone C, Friedman D, Houssami N, Calabrese M, Tagliafico AS. Intraoperative digital breast tomosynthesis using a dedicated device is more accurate than standard intraoperative mammography for identifying positive margins. Clin Radiol 2019; 74:974.e1-974.e6. [PMID: 31521327 DOI: 10.1016/j.crad.2019.08.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
AIM To compare a standard intra-operative mammography (IM) device with digital breast tomosynthesis using a dedicated device (Mozart system) in the evaluation of surgical margins at first excision. MATERIALS AND METHODS The study received institutional review board approval and written informed consent was obtained from participants. From January 2018 to December 2018, a prospective analysis of the images of IM device and intra-operative digital breast tomosynthesis with a dedicated device (Mozart system) in n=89 breast cancer patients (average patients age: 58 years, age range: 35-76 years) was undertaken. Images were evaluated by two expert breast radiologists independently of each other and blinded to each other's interpretation, who indicated the positive cases requiring surgical re-excision intra-operatively. RESULTS Mean cancer size was 12.5±4.5 mm. Radiological signs of the lesions were microcalcifications (n=71), nodules (n=10), and architectural distortions (n=8). A total of 20/89 (17%) patients underwent intra-operative re-excision for positive margins. Intra-operative digital breast tomosynthesis with a dedicated device and IM showed discrepancies in 15/89 cases (17%). Mozart system results informed the necessity to perform a re-excision (n=15). Overall, receiver operating characteristic (ROC) curve analysis showed and area under the ROC curve (AUC) of 0.82 for the Mozart system versus 0.65 for IM. ROC analysis of radiological findings with microcalcifications showed an AUC of 0.92 for the Mozart system versus 0.74 for IM, whereas AUC in cases with no microcalcifications were 0.87 and 0.75, respectively. CONCLUSION Intra-operative digital breast tomosynthesis with a dedicated device provides more information (better accuracy) than IM and facilitated a reduction in re-excision rates.
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Affiliation(s)
- A Garlaschi
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - P Fregatti
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - C Oddone
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - D Friedman
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - N Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Calabrese
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - A S Tagliafico
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy; Department of Health Sciences (DISSAL) - Radiology Unit, University of Genoa, Genoa, Italy.
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16
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Magliozzi R, Reynolds R, Calabrese M. MRI of cortical lesions and its use in studying their role in MS pathogenesis and disease course. Brain Pathol 2019; 28:735-742. [PMID: 30020563 DOI: 10.1111/bpa.12642] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 06/07/2018] [Accepted: 06/21/2018] [Indexed: 02/01/2023] Open
Abstract
Cortical grey matter (GM) demyelination is present from the earliest stages of multiple sclerosis (MS) and is associated with physical deficits and cognitive impairment. In particular, the rate of disability progression in MS, both in the relapsing and progressive phases, appears to be strictly associated with degenerative GM demyelination and diffuse cortical atrophy. In the last decade, several histopathological studies and advanced radiological methodologies have contributed to better identify the exact involvement/load of cortical pathology in MS, even if the specific inflammatory features and the precise cell and molecular mechanisms of GM demyelination and neurodegeneration in MS remain still not fully understood. It has been proposed that a combined neuropathology, imaging and molecular approach may help to define a more detailed characterization and precise assessment of the heterogeneous features of GM injury and inflammation in MS. This, in turn, will possibly identify specific imaging and biohumoral (cerebrospinal fluid/serum) correlates of cortical pathology that may have an important role in predicting and monitor the disease evolution.
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Affiliation(s)
- R Magliozzi
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.,Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - R Reynolds
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - M Calabrese
- Neurology B, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
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17
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Levrero F, Vaccara E, Guidasci GR, Calabrese M, Dordolo M, Tagliafico A, Gristina L, Schiaffino S, Massone A, Piana M. 229. Breast Imaging Quality: Conventional Handheld Ultrasound versus Automated 3D Breast Ultrasound System. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.240] [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: 10/27/2022] Open
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18
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Affiliation(s)
- M Calabrese
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
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19
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Turri G, Calabrese M, Pancheri E, Gajofatto A, Marafioti V, Monaco S. Response to Nagai et al
. Eur J Neurol 2017; 24:e54. [DOI: 10.1111/ene.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- G. Turri
- Department of Neurosciences, Biomedicine and Movement Sciences; University Hospital of Verona; Verona
| | - M. Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences; University Hospital of Verona; Verona
| | - E. Pancheri
- Department of Neurosciences, Biomedicine and Movement Sciences; University Hospital of Verona; Verona
| | - A. Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences; University Hospital of Verona; Verona
| | - V. Marafioti
- Cardiovascular and Thoracic Department; University Hospital of Verona; Verona Italy
| | - S. Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences; University Hospital of Verona; Verona
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20
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Gobbin F, Marangi A, Orlandi R, Richelli S, Turatti M, Calabrese M, Forgione A, Alessandrini F, Benedetti MD, Monaco S, Gajofatto A. A case of acute fulminant multiple sclerosis treated with alemtuzumab. Mult Scler Relat Disord 2017; 17:9-11. [PMID: 29055482 DOI: 10.1016/j.msard.2017.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/28/2022]
Abstract
We describe the case of a woman who came to our attention for acute onset and very rapidly worsening left hemiplegia, vision loss and cognitive impairment. MRI, laboratory and clinical investigations were highly suggestive of an active inflammatory demyelinating disease. Following exclusion of other possible etiologies, a diagnosis of Marburg's variant multiple sclerosis was made. After repeated high-dose steroids and plasma-exchange, the patient was treated with a first course of alemtuzumab followed by improvement of the clinical and MRI picture. This is the first reported case of Marburg type multiple sclerosis treated with alemtuzumab.
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Affiliation(s)
- F Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A Marangi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - R Orlandi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - S Richelli
- Unit of Intensive Rehabilitation, Ospedale Sacro Cuore, Negrar, Verona, Italy
| | - M Turatti
- Unit of Neurology B, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A Forgione
- Unit of Neurology, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy
| | - F Alessandrini
- Unit of Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M D Benedetti
- Unit of Neurology B, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - S Monaco
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
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21
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Castellaro M, Magliozzi R, Palombit A, Pitteri M, Silvestri E, Camera V, Montemezzi S, Pizzini FB, Bertoldo A, Reynolds R, Monaco S, Calabrese M. Heterogeneity of Cortical Lesion Susceptibility Mapping in Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 38:1087-1095. [PMID: 28408633 DOI: 10.3174/ajnr.a5150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/21/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative susceptibility mapping has been used to characterize iron and myelin content in the deep gray matter of patients with multiple sclerosis. Our aim was to characterize the susceptibility mapping of cortical lesions in patients with MS and compare it with neuropathologic observations. MATERIALS AND METHODS The pattern of microglial activation was studied in postmortem brain tissues from 16 patients with secondary-progressive MS and 5 age-matched controls. Thirty-six patients with MS underwent 3T MR imaging, including 3D double inversion recovery and 3D-echo-planar SWI. RESULTS Neuropathologic analysis revealed the presence of an intense band of microglia activation close to the pial membrane in subpial cortical lesions or to the WM border of leukocortical cortical lesions. The quantitative susceptibility mapping analysis revealed 131 cortical lesions classified as hyperintense; 33, as isointense; and 84, as hypointense. Quantitative susceptibility mapping hyperintensity edge found in the proximity of the pial surface or at the white matter/gray matter interface in some of the quantitative susceptibility mapping-hyperintense cortical lesions accurately mirrors the microglia activation observed in the neuropathology analysis. CONCLUSIONS Cortical lesion susceptibility maps are highly heterogeneous, even at individual levels. Quantitative susceptibility mapping hyperintensity edge found in proximity to the pial surface might be due to the subpial gradient of microglial activation.
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Affiliation(s)
- M Castellaro
- From the Department of Information Engineering (M. Castellaro, A.P., E.S., A.B.), University of Padova, Padova, Italy
- Neurology B (M. Castellaro, R.M., M.P., V.C., S.M., M. Calabrese), Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - R Magliozzi
- Neurology B (M. Castellaro, R.M., M.P., V.C., S.M., M. Calabrese), Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
- Division of Brain Sciences (R.M., R.R.), Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - A Palombit
- From the Department of Information Engineering (M. Castellaro, A.P., E.S., A.B.), University of Padova, Padova, Italy
| | - M Pitteri
- Neurology B (M. Castellaro, R.M., M.P., V.C., S.M., M. Calabrese), Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - E Silvestri
- From the Department of Information Engineering (M. Castellaro, A.P., E.S., A.B.), University of Padova, Padova, Italy
| | - V Camera
- Neurology B (M. Castellaro, R.M., M.P., V.C., S.M., M. Calabrese), Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - S Montemezzi
- Neurology B (M. Castellaro, R.M., M.P., V.C., S.M., M. Calabrese), Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
- Neuroradiology and Radiology Units (S.M., F.B.P.), Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - F B Pizzini
- Neuroradiology and Radiology Units (S.M., F.B.P.), Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - A Bertoldo
- From the Department of Information Engineering (M. Castellaro, A.P., E.S., A.B.), University of Padova, Padova, Italy
| | - R Reynolds
- Division of Brain Sciences (R.M., R.R.), Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - S Monaco
- From the Department of Information Engineering (M. Castellaro, A.P., E.S., A.B.), University of Padova, Padova, Italy
| | - M Calabrese
- Neurology B (M. Castellaro, R.M., M.P., V.C., S.M., M. Calabrese), Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
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22
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Turri G, Calabrese M, Pancheri E, Monaco S, Gajofatto A, Marafioti V. QTc interval in patients with multiple sclerosis: an inference from the insula of Reil? Eur J Neurol 2017; 24:491-496. [PMID: 28111831 DOI: 10.1111/ene.13229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate the correlation between the duration of the QTc interval and the brain lesion load at the level of the structures involved in superior autonomic control (insula, cingulate cortex and amygdala-hippocampus) in multiple sclerosis (MS) patients. METHODS Thirty-one consecutive patients with relapsing-remitting MS were recruited. The QT interval was measured manually in all 12 leads by a single blinded observer, with the longest QT value adjusted for heart rate by using the Bazett's formula. All patients performed a brain magnetic resonance imaging (MRI) scan including three-dimensional double inversion recovery and three volumetric fast-field echo sequences. The following MRI measures were obtained: (i) global and regional cortical thickness (CTh); (ii) white matter lesion load volume; (iii) cortical damage blindly assessed by a trained observer who assigned, on the basis of the number of cortical lesions, a score from 0 to 5 for each of the brain areas analysed. RESULTS In all, 16% of the patients had an increased QTc interval. The QTc interval was correlated with disease duration, cortical insular lesion volume and grey matter lesion volume in the three examined areas and inversely correlated with global and insular CTh. CONCLUSIONS An increased QTc interval in patients with MS may have a cerebral origin possibly driven by involvement of the insular cortex. With the recent introduction in clinical practice of treatments with potential cardiac effects such as fingolimod, the recognition of a long QTc interval could be clinically crucial and should encourage appropriate electrocardiographic monitoring in order to prevent the risk of malignant ventricular pro-arrhythmia and iatrogenic sudden death.
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Affiliation(s)
- G Turri
- Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - M Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - E Pancheri
- Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - S Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - A Gajofatto
- Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - V Marafioti
- Cardiovascular and Thoracic Department, University Hospital of Verona, Verona, Italy
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Cutrona G, Matis S, Colombo M, Massucco C, Baio G, Valdora F, Emionite L, Fabris S, Recchia AG, Gentile M, Neumaier CE, Reverberi D, Massara R, Boccardo S, Basso L, Salvi S, Rosa F, Cilli M, Zupo S, Truini M, Tassone P, Calabrese M, Negrini M, Neri A, Morabito F, Fais F, Ferrarini M. Effects of miRNA-15 and miRNA-16 expression replacement in chronic lymphocytic leukemia: implication for therapy. Leukemia 2017; 31:1894-1904. [DOI: 10.1038/leu.2016.394] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/27/2016] [Accepted: 12/06/2016] [Indexed: 12/23/2022]
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Imperiale A, Zandrino F, Calabrese M, Parodi G, Massa T. Abscesses of the breast: US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy. Acta Radiol 2016; 42:161-5. [PMID: 11259943 DOI: 10.1080/028418501127346666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The usual therapeutic approach to acute breast abscesses (ABAs) not responsive to systemic antibiotics is surgical incision and drainage. Our purpose was to assess the efficacy of treating ABAs with serial US-guided percutaneous aspiration and local injection of antibiotics. Material and Methods: Twenty-six patients with 28 ABAs, in whom systemic antibiotic therapy had failed, underwent serial US-guided aspiration with local injection a of large-spectrum antibiotic. The treatment was repeated weekly until complete resolution was observed at clinical and US examination. The volume of the ABAs was calculated before each US-guided aspiration. Follow-up US examinations were performed at 1, 4, and 12 weeks after clinical and US resolution. A comparison betweeen costs of surgical and US-guided treatment of ABAs in our institution was done. Results: In 27 ABAs the treatment was successful: a progressive volume reduction and a complete resolution at clinical and US examination was observed within 1 to 7 weeks. In 1 case only, with a large ABA markedly increased in volume at the second examination, surgical drainage was performed. Conclusion: US-guided aspiration with local antibiotic injection is a safe and effective approach to ABAs, cheaper than surgical drainage of these lesions.
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Affiliation(s)
- A Imperiale
- National Institute for Cancer Research, University of Genoa, Genoa, Italy
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Calabrese M, Castellaro M, Bertoldo A, De Luca A, Pizzini FB, Ricciardi GK, Pitteri M, Zimatore S, Magliozzi R, Benedetti MD, Manganotti P, Montemezzi S, Reynolds R, Gajofatto A, Monaco S. Epilepsy in multiple sclerosis: The role of temporal lobe damage. Mult Scler 2016; 23:473-482. [DOI: 10.1177/1352458516651502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Although temporal lobe pathology may explain some of the symptoms of multiple sclerosis (MS), its role in the pathogenesis of seizures has not been clarified yet. Objectives: To investigate the role of temporal lobe damage in MS patients suffering from epilepsy, by the application of advanced multimodal 3T magnetic resonance imaging (MRI) analysis. Methods: A total of 23 relapsing remitting MS patients who had epileptic seizures (RRMS/E) and 23 disease duration matched RRMS patients without any history of seizures were enrolled. Each patient underwent advanced 3T MRI protocol specifically conceived to evaluate grey matter (GM) damage. This includes grey matter lesions (GMLs) identification, evaluation of regional cortical thickness and indices derived from the Neurite Orientation Dispersion and Density Imaging model. Results: Regional analysis revealed that in RRMS/E, the regions most affected by GMLs were the hippocampus (14.2%), the lateral temporal lobe (13.5%), the cingulate (10.0%) and the insula (8.4%). Cortical thinning and alteration of diffusion metrics were observed in several regions of temporal lobe, in insular cortex and in cingulate gyrus of RRMS/E compared to RRMS ( p< 0.05 for all comparisons). Conclusions: Compared to RRMS, RRMS/E showed more severe damage of temporal lobe, which exceeds what would be expected on the basis of the global GM damage observed.
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Affiliation(s)
- M Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M Castellaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - A Bertoldo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - A De Luca
- Department of Information Engineering, University of Padova, Padova, Italy/Scientific Institute, IRCCS “Eugenio Medea”, Neuroimaging Lab, Bosisio Parini, LC, Italy
| | - FB Pizzini
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - GK Ricciardi
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - M Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Zimatore
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - R Magliozzi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy/Division of Brain Sciences, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - MD Benedetti
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - P Manganotti
- Neurology Section, University Hospital of Trieste, Trieste, Italy
| | - S Montemezzi
- Neuroradiology and Radiology Units, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - R Reynolds
- Division of Brain Sciences, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - A Gajofatto
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Monaco
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Santi RM, Ceccarelli M, Catania G, Monagheddu C, Evangelista A, Bernocco E, Monaco F, Federico M, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Calabrese M, Levis A, Visco C, Contino L, Ciccone G, Ladetto M. PO-03 - Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in Non Hodgkin Lymphoma (NHL). A pooled data analysis of twelve clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Res 2016; 140 Suppl 1:S177. [PMID: 27161692 DOI: 10.1016/s0049-3848(16)30136-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies show that the risk of VTE in NHL pts is similar to that observed in high risk solid tumors (i.e. pancreatic, ovarian cancer). VTE in NHL occurs in most cases within three months from diagnosis and can have substantial impact on treatment delivery and outcome as well as on quality of life. However few data are available on potential predictors. AIMS To better clarify the epidemiology of early (within six months from treatment start) VTE in NHL we conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk. PATIENTS AND METHODS From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. For 9 studies study period included the entire trial population was included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. VTE definition and grading was stated according to standard criteria of toxicity (CTCAE V4.0). Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. This pooled data analysis was approved by local IRB. RESULTS Overall, 1,717 patients belonging to 12 studies were evaluated. Eight were phase I/II or II (25% of pts) and 4 phase III (75% of pts). M/F ratio was 1.41, Median age was 57, (IQ range (IQR) 49-66). Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25 (IQR 22-28). Median Hb, WBC and platelets counts were 13g/dl) (IQR 11.5-14.2), 7.1*10^(9)/l (IQR 5.6-10.3), 224*10^(9)/l (IQR 169-298), respectively. 1189 pts were evaluable Khorana score: 58% low risk, 30% intermediate risk, 12% were high risk. Human erythropoetin support was given to 9% of patients. All pts received Rituximab. Planned therapeutic programs included ASCT in 27% of pts, conventional chemotherapy in 67% a conventional chemotherapy plus lenalidomide in 6%. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%), including 21 grade III-IV VTE (18 pts). None was fatal. Median time from study enrolment to VTE was 63 days (IQR: 35-110). Considering death as a competitive event the 6 months cumulative incidence of VTE was 2,2% in low risk Khorana score, 4.5% (95%IC: 2.3-6.7) in intermediate and 6.6% (95%IC: 2.4-10.8) in high risk (p=0.012) (figure 1). Khorana score was predictive also for grade III-IV events as they were 0,7% (95% CI:0.1-1.4) in low risk and 2.0% (95% CI:0.8-3.3) in intermediate-high risk (p=0.048). The results were similar also after excluding lenalidomide containing studies. The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score (intermediate risk adjHR=1.96; 95%IC: 0.84-4.56 and high risk adjHR=3.81; 95%IC: 1.51-9.58) and DLCL-B histotype (adjHR=2.58; 95% CI: 1.01-6.55) were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE (OR=1.85; 95% CI: 1.23-2.79). CONCLUSIONS Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL. Prospective validation including also patients not eligible for clinical trials is needed.
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Affiliation(s)
| | - M Ceccarelli
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - G Catania
- Division of Hematology, Az Osp SS Antinio e Biagio e Cesare Arrigo, Alessandria
| | - C Monagheddu
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - A Evangelista
- Unit of Cancer Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino
| | - E Bernocco
- Division of Haematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandrio
| | - F Monaco
- Division of Hematology, AZ Osp SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Federico
- Oncologia Medica, Università di Modena e Reggio Emilia, Modena
| | - U Vitolo
- Hematology II, Azienda Ospedaliera Città della Salute, Torino
| | - S Cortelazzo
- Department of Haematology and Bone Marrow Transplantation, Regional Hospital, S. Maurizio, Bolzano/Bozen
| | - M G Cabras
- Division of Hematology, Ospedale Businco, Cagliari
| | - M Spina
- Division of Hematology, IRCCS CRO Aviano
| | - L Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano
| | - C Boccomini
- Division of Hematology II, AOU Citta della Salute e della Scienza, Torino
| | - A Chiappella
- Department of Hematology, Azienda Ospedaliera Città della Salute e della Scienza, Torino
| | - A Bari
- Program of Innovative Therapy in Oncology and Hematology, Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia, Modena
| | - S Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - M Calabrese
- Fondazione Italiana Linfomi Onlus, Alessandria
| | - A Levis
- Italian Lymphoma Foundation (FIL), Alessandria
| | | | | | - G Ciccone
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Az Osp Citta della salute e della Scienza, Torino
| | - M Ladetto
- Division of Hematology, Az Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Italy
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Silipo S, Calabrese M, Juergenson I, Tozzi M, Monaco S, Bertolasi L. 11. Visual electrophysiology revealed the diagnosis in an unusual case of bilateral blindness at the multiple sclerosis center. A case of bilateral chronic optic neuropathy related to inverted papilloma of paranasal sinuses. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.019] [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: 11/16/2022]
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Paternoster G, Covino A, Mercorella R, Di Leo C, Calabrese M, Pittella G. Effectiveness of sub-albumin protein leakage membrane EMIC2 in post cardio-surgery rhabdomyolysis. J Cardiothorac Vasc Anesth 2015. [DOI: 10.1053/j.jvca.2015.05.008] [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: 11/11/2022]
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De Bonis M, Lapenna E, Nisi T, Giacomini A, Calabrese M, Miceli A, Alfieri O, Glauber M. 216 * UNTREATED MILD TO MODERATE TRICUSPID REGURGITATION IN DILATED CARDIOMYOPATHY PATIENTS SUBMITTED TO MITRAL REPAIR: WHAT HAPPENS AT LONG-TERM? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.216] [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: 11/14/2022] Open
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Paternoster G, Covino A, Mercorella R, Di Leo C, Calabrese M, Pittella G. Effectiveness of sub-albumin protein leakage membrane EMIC2 in post-cardiac surgery rhabdomyolysis. Crit Care 2014. [PMCID: PMC4069381 DOI: 10.1186/cc13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Puthenparampil M, Seppi D, Rinaldi F, Federle L, Calabrese M, Perini P, Gallo P. Increased incidence of multiple sclerosis in the Veneto region, Italy. Mult Scler 2013; 19:601-4. [PMID: 23599184 DOI: 10.1177/1352458512461970] [Citation(s) in RCA: 16] [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: 11/16/2022]
Abstract
BACKGROUND To what extent the progressive increase in the incidence of multiple sclerosis (MS) observed in the province of Padova over the period 1970-1999 was an expression of a real increased risk of developing MS remained unclear. OBJECTIVE The objective of this paper is to update the epidemiological figures of MS and probe whether the risk of having MS has increased in the province of Padova during the decade 2000-2009. METHODS All patients born in Italy and having a diagnosis of MS or possible MS identified through analysis of all available sources of information were included in the study. The incidence and prevalence rates between 2000 and 2009 were obtained and compared with our previously published data. RESULTS On 31 December 2009, the overall prevalence was 139.5/100,000, 192.0 ± 9.5 for females and 83.9 ± 6.3 for males. During the decade 2000-2009, the overall incidence rate of MS was 5.5 ± 0.5, 7.4 ± 0.8 for females and 3.5 ± 0.6 for males. The onset-diagnosis delay, the female/male ratio and the mean age at onset did not significantly change compared to the prior period of observation. CONCLUSION Our findings support the hypothesis of a real increased risk of developing MS in the province of Padova. Moreover, the actual prevalence of 1.4/1000 makes our region a high-risk geographical area for MS. The role played by exogenous factors in determining susceptibility to MS needs to be thoroughly investigated.
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Affiliation(s)
- M Puthenparampil
- The Multiple Sclerosis Centre of the Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Italy
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Tagliafico AS, Tagliafico G, Cavagnetto F, Calabrese M, Houssami N. Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories. Br J Radiol 2013; 86:20130255. [PMID: 24029631 DOI: 10.1259/bjr.20130255] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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 breast density estimated from two-dimensional full-field digital mammography (2D FFDM) and from digital breast tomosynthesis (DBT) according to different Breast Imaging-Reporting and Data System (BI-RADS) categories, using automated software. METHODS Institutional review board approval and written informed patient consent were obtained. DBT and 2D FFDM were performed in the same patients to allow within-patient comparison. A total of 160 consecutive patients (mean age: 50±14 years; mean body mass index: 22±3) were included to create paired data sets of 40 patients for each BI-RADS category. Automatic software (MedDensity(©), developed by Giulio Tagliafico) was used to compare the percentage breast density between DBT and 2D FFDM. The estimated breast percentage density obtained using DBT and 2D FFDM was examined for correlation with the radiologists' visual BI-RADS density classification. RESULTS The 2D FFDM differed from DBT by 16.0% in BI-RADS Category 1, by 11.9% in Category 2, by 3.5% in Category 3 and by 18.1% in Category 4. These differences were highly significant (p<0.0001). There was a good correlation between the BI-RADS categories and the density evaluated using 2D FFDM and DBT (r=0.56, p<0.01 and r=0.48, p<0.01, respectively). CONCLUSION Using DBT, breast density values were lower than those obtained using 2D FFDM, with a non-linear relationship across the BI-RADS categories. These data are relevant for clinical practice and research studies using density in determining the risk. ADVANCES IN KNOWLEDGE On DBT, breast density values were lower than with 2D FFDM, with a non-linear relationship across the classical BI-RADS categories.
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Affiliation(s)
- A S Tagliafico
- Department of Experimental Medicine, University of Genova, Genova, Italy
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Rinaldi F, Seppi D, Calabrese M, Perini P, Gallo P. Switching therapy from natalizumab to fingolimod in relapsing–remitting multiple sclerosis: clinical and magnetic resonance imaging findings. Mult Scler 2012; 18:1640-3. [DOI: 10.1177/1352458512464282] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Clinical and/or neuroimaging evidence of disease reactivation has been described in multiple sclerosis (MS) patients after a break from natalizumab. Whether fingolimod might be a therapeutic option following natalizumab needs to be evaluated. Twenty-two relapsing remitting MS patients having JC virus antibodies (JCVAb+) in serum were shifted from natalizumab to fingolimod after a three-month washout period. Neurological evaluation with the Expanded Disability Status Scale (EDSS) was performed monthly for a mean follow-up period of nine months. In 20/22 patients, brain magnetic resonance imaging (MRI) was obtained within one month after therapy initiation. Disease reactivation was observed in 11/22 (50%) patients: clinical relapses in six patients (four patients within the first month of therapy) and MRI activity in a further five patients (three patients within the first month of therapy). Clinical and/or MRI signs suggestive of disease rebound were observed in three patients. Our data indicate that fingolimod does not exert clinical activity quickly enough to stop MS reactivation after a break from natalizumab.
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Affiliation(s)
- F Rinaldi
- Multiple Sclerosis Centre of Padova, University Hospital, Italy
| | - D Seppi
- Multiple Sclerosis Centre of Padova, University Hospital, Italy
| | - M Calabrese
- Multiple Sclerosis Centre of Padova, University Hospital, Italy
| | - P Perini
- Multiple Sclerosis Centre of Padova, University Hospital, Italy
| | - P Gallo
- Multiple Sclerosis Centre of Padova, University Hospital, Italy
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Calabrese M, Poretto V, Favaretto A, Alessio S, Bernardi V, Romualdi C, Rinaldi F, Perini P, Gallo P. Cortical lesion load associates with progression of disability in multiple sclerosis. Brain 2012; 135:2952-61. [DOI: 10.1093/brain/aws246] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Ferrari ME, Cremonesi M, Di Dia A, Botta F, De Cicco C, Sarnelli A, Pedicini P, Calabrese M, Orecchia R, Pedroli G, Paganelli G. 3D dosimetry in patients with early breast cancer undergoing Intraoperative Avidination for Radionuclide Therapy (IART) combined with external beam radiation therapy. Eur J Nucl Med Mol Imaging 2012; 39:1702-11. [PMID: 22890802 DOI: 10.1007/s00259-012-2197-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Intraoperative Avidination for Radionuclide Therapy (IART) is a novel targeted radionuclide therapy recently used in patients with early breast cancer. It is a radionuclide approach with (90)Y-biotin combined with external beam radiotherapy (EBRT) to release a boost of radiation in the tumour bed. Two previous clinical trials using dosimetry based on the calculation of mean absorbed dose values with the hypothesis of uniform activity distribution (MIRD 16 method) assessed the feasibility and safety of IART. In the present retrospective study, a voxel dosimetry analysis was performed to investigate heterogeneity in distribution of the absorbed dose. The aim of this work was to compare dosimetric and radiobiological evaluations derived from average absorbed dose vs. voxel absorbed dose approaches. METHODS We evaluated 14 patients who were injected with avidin into the tumour bed after conservative surgery and 1 day later received an intravenous injection of 3.7 GBq of (90)Y-biotin (together with 185 MBq (111)In-biotin for imaging). Sequential images were used to estimate the absorbed dose in the target region according to the standard dosimetry method (SDM) and the voxel dosimetry method (VDM). The biologically effective dose (BED) distribution was also evaluated. Dose/volume and BED volume histograms were generated to derive equivalent uniform BED (EUBED) and equivalent uniform dose (EUD) values. RESULTS No "cold spots" were highlighted by voxel dosimetry. The median absorbed-dose in the target region was 20 Gy (range 15-27 Gy) by SDM, and the median EUD was 20.4 Gy (range 16.5-29.4 Gy) by the VDM; SDM and VDM estimates differed by about 6 %. The EUD/mean voxel absorbed dose ratio was >0.9 in all patients, indicative of acceptable uniformity in the target. The median BED and EUBED values were 21.8 Gy (range 15.9-29.3 Gy) and 22.8 Gy (range 17.3-31.8 Gy), respectively. CONCLUSION VDM highlighted the absence of significant heterogeneity in absorbed dose in the target. The EUD/mean absorbed dose ratio indicated a biological efficacy comparable to that of uniform distribution of absorbed dose. The VDM is recommended for improving accuracy, taking into account actual activity distribution in the target region. The radiobiological model applied allowed us to compare the effects of IART® with those of EBRT and to match the two irradiation modalities.
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Affiliation(s)
- Mahila E Ferrari
- Division of Medical Physics, European Institute of Oncology, Milan, Italy
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Porto I, Dato I, Todaro D, Calabrese M, Rigattieri S, Leone AM, Niccoli G, Burzotta F, Trani C, Crea F. Comparison of two- and three-dimensional quantitative coronary angiography to intravascular ultrasound in the assessment of intermediate left main stenosis. Am J Cardiol 2012; 109:1600-7. [PMID: 22424580 DOI: 10.1016/j.amjcard.2012.01.386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 01/22/2012] [Accepted: 01/22/2012] [Indexed: 11/19/2022]
Abstract
Angiographic evaluation of intermediate left main coronary artery stenosis (LMS) is often limited. Three-dimensional (3D) quantitative coronary angiography has recently developed to overcome 2-dimensional (2D) quantitative coronary angiographic (QCA) limitations. In patients with angiographically intermediate LMS, we investigated whether 3D quantitative coronary angiography was superior to 2D quantitative coronary angiography in predicting the presence of a significant LMS, defined as a minimum luminal area <6 mm(2) at intravascular ultrasound (IVUS). 2D and 3D quantitative coronary angiography were compared in their measurements of minimum luminal area, percent area stenosis, minimum luminal diameter, and percent diameter stenosis and in their prediction of an IVUS minimum luminal area <6 mm(2). In total 58 target lesions were interrogated, 25 (43%) of which had an IVUS minimum luminal area <6 mm(2). Correlation between 3D-QCA minimum luminal area and IVUS minimum luminal area was stronger than the correlation between 2D-QCA minimum luminal area (or minimum luminal diameter) and IVUS minimum luminal area (R = 0.67, p = 0.0001, and R = 0.40, p = 0.001, respectively, p = 0.04 for comparison). To predict IVUS minimum luminal area <6 mm(2), the most accurate 2D-QCA measurement was minimum luminal diameter (area under curve 0.81, cutoff 2.2 mm, p = 0.0001), and the most accurate 3D-QCA measurement was minimum luminal area (area under curve 0.86, cutoff 5.6 mm(2), p = 0.0001). 2D-QCA percent diameter stenosis did not significantly predict IVUS minimum luminal area <6 mm(2) (area under curve 0.56, cutoff 38%, p = 0.45). In conclusion, the accuracy of quantitative coronary angiography in predicting LM IVUS minimum luminal area <6 mm(2) is limited. When IVUS is not available or contraindicated, 3D quantitative coronary angiography may assist in the evaluation of intermediate LMS. Among 2D-QCA parameters, minimum luminal diameter is more accurate than percent diameter stenosis in predicting significant LMS.
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Affiliation(s)
- Italo Porto
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Tagliafico A, Rescinito G, Monetti F, Villa A, Chiesa F, Fisci E, Pace D, Calabrese M. Diffusion tensor magnetic resonance imaging of the normal breast: reproducibility of DTI-derived fractional anisotropy and apparent diffusion coefficient at 3.0 T. Radiol Med 2012; 117:992-1003. [PMID: 22580812 DOI: 10.1007/s11547-012-0831-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 08/30/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) may improve the diagnostic performance of conventional breast magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) is an extension of DWI. If DTI-derived measurements are to be clinically useful, particularly for predicting and/or monitoring therapeutic effects, they must be robust and reliable. The purpose of this study was to assess intra- and interobserver reproducibility of DTI-derived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 3.0 T. MATERIALS AND METHODS This prospective study was approved by the Institutional Review Board, and participants provided written informed consent. Sixty normal contralateral breasts of 60 patients (28-85 years, median 57) were analysed with a DWI sequence following a standard MRI protocol. Four authors performed all postprocessing and analyses independently and in different sessions. The same authors, blinded to the initial results, repeated the image postprocessing and analysis 4 weeks after the initial session. RESULTS Mean ADC and FA for DTI sequences were, respectively, 1.92±0.30 and 0.32±0.09. Intra- and interobserver agreement of the four radiologists for ADC and FA were good (acceptable). Kappa values for ADC were intra-R1=0.82; intra-R2=0.84; intra-R3=0.89; intra-R4=0.88; inter-R1-R2=0.73; inter-R1-R3=0.74; inter-R1-R4=0.81; inter-R2-R3=0.76; inter-R2-R4=0.77; inter-R3-R4=0.83. Kappa values for FA were intra-R1=0.60; intra-R2=0.72; intra-R3=0.84; intra-R4 = 0.66; inter-R1-R2=0.64; inter-R1-R3=0.69; inter-R1-R4=0.72; inter-R2-R3=0.80; inter-R2-R4=0.71; inter-R3-R4=0.73. Within-subject coefficient of variation was 15% for ADC and 30% for FA. Repeatability with α=0.05 was 0.37×10-3 mm(2)/s for ADC and 0.112 for FA. CONCLUSIONS ADC and FA measurements obtained with DTI are reproducible and may be valid, reliable and sensitive to change. ADC values obtained with DTI are more reproducible than FA.
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Affiliation(s)
- A Tagliafico
- Department of Experimental Medicine, Institute of Anatomy, Università di Genova, Largo Rosanna Benzi 8, Genoa, Italy.
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Rinaldi F, Calabrese M, Seppi D, Puthenparampil M, Perini P, Gallo P. Natalizumab strongly suppresses cortical pathology in relapsing-remitting multiple sclerosis. Mult Scler 2012; 18:1760-7. [PMID: 22570359 DOI: 10.1177/1352458512447704] [Citation(s) in RCA: 33] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since cortical pathology has been indicated to play a relevant role in the physical and cognitive disability of multiple sclerosis (MS) patients, this study aims to analyze the efficacy of natalizumab in slowing down its progression. METHODS A total of 120 relapsing-remitting MS patients completed a 2-year prospective study: 35 received natalizumab, 50 received interferon beta-1a or glatiramer acetate (immunomodulatory agents - IMA) and 35 remained untreated. Forty healthy subjects constituted the reference population. Clinical and magnetic resonance imaging (MRI) evaluations (including cortical lesions and atrophy) were performed at baseline and after 2 years. RESULTS Natalizumab significantly reduced accumulation of new cortical lesions (0.2±0.6,range 0-3) compared to immunomodulatory agents (1.3±1.1 togli spazio, range 1-6, p=0.001) and no treatment (2.9±1.5, range 1-8, p<0.001). The percentage of patients with new cortical lesions was also lower in natalizumab-treated patients (20%) compared to IMA-treated and untreated patients (68.0% and 74.2%; p<0.001 for both comparisons). Furthermore, the progression of cortical atrophy was significantly reduced by natalizumab (% change=1.7%) compared to IMA (3.7%, p=0.003) and no therapy (4.6%, p<0.001). Finally, a greater percentage (51.4%) of natalizumab-treated patients remained disease-free (no clinical or MRI evidence of disease activity or progression) compared to IMA-treated (18%, p=0.001) and untreated patients (5.7%, p<0.001). CONCLUSIONS Natalizumab treatment significantly decreases cortical lesion accumulation and cortical atrophy progression in severe relapsing-remitting MS. While supporting the inflammatory origin of cortical lesions, our results highlight the significant impact of natalizumab on cortical pathology.
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Affiliation(s)
- F Rinaldi
- The Multiple Sclerosis Centre of Veneto Region, Department of Neurology, University Hospital of Padova, Italy
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Calabrese M, Seppi D, Romualdi C, Rinaldi F, Alessio S, Perini P, Gallo P. Gray matter pathology in MS: a 3-year longitudinal study in a pediatric population. AJNR Am J Neuroradiol 2012; 33:1507-11. [PMID: 22422186 DOI: 10.3174/ajnr.a3011] [Citation(s) in RCA: 18] [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: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE GM pathology is considered a major determinant of disability in MS, but the comprehension of its origin and progression rate is limited by the uncertainty of dating the biologic disease onset. Thus, we planned a longitudinal study aimed at analyzing and comparing cortical pathology in pediatric and adult MS patients at clinical onset. MATERIALS AND METHODS Within 12 months from clinical onset, 35 patients with cMS and 57 with aMS were included in a longitudinal study. At T0, GMf and CL number and volume were analyzed. Percentages of Δ-GMf and number of new CLs were assessed every year for 3 years (T1-T3). Twenty-eight age- and sex-matched NCs constituted the reference population. RESULTS At T0, GMf did not differ between cMS and NC (P = .18), while it was lower in patients with aMS compared with both NCs (P < .001) and patients with cMS (P < .001). The number of patients with CLs, as well as CL number and volume, were higher in patients with aMS than in those with cMS (P < .001). At T3, Δ-GMf was higher in both patients with cMS (1.6% ± 0.5%; range 0.7%-3.4%; P < .001) and aMS (1.6% ± 0.6%; range 0.6%-3.4%; P < .001) compared with NCs (0.7% ± 0.2%; range 0.4%-1.1%), whereas no difference was observed between patients with cMS and aMS (P = .93). Δ-GMf significantly correlated with increased CL volume (cMS: r = 0.46; aMS: r = 0.48) and with the appearance of new CLs (cMS: r = 0.51; aMS: r = 0.49). CONCLUSIONS Our findings suggest that focal (CLs) and diffuse (atrophy) GM damage are strictly associated with the biologic onset of MS, and proceed linearly and partly independently of WM pathology.
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Affiliation(s)
- M Calabrese
- Multiple Sclerosis Centre of Veneto Region-First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Italy.
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Biundo R, Calabrese M, Ricchieri G, Facchini S, Pilleri M, Gallo P, Antonini A. 2.030 PATTERNS OF CORTICAL AND SUB-CORTICAL THINNING IN PARKINSON'S DISEASE. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70463-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Calabrese M, Grossi P, Favaretto A, Romualdi C, Atzori M, Rinaldi F, Perini P, Saladini M, Gallo P. Cortical pathology in multiple sclerosis patients with epilepsy: a 3 year longitudinal study. J Neurol Neurosurg Psychiatry 2012; 83:49-54. [PMID: 21890577 DOI: 10.1136/jnnp-2011-300414] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The cause of epilepsy in multiple sclerosis (MS) has not yet been elucidated. The relevance of cortical pathology (cortical lesions and thickness) in MS patients with and without epilepsy was evaluated in a longitudinal study. METHODS 32 relapsing-remitting MS patients with epilepsy (RRMS/E) and 60 matched RRMS patients without epilepsy were included in a 3 year longitudinal study. The following clinical and MR parameters were analysed: Expanded Disability Status Scale (EDSS), cognitive score (CS), cortical lesion (CL) number and volume, grey matter fraction (GMf), global cortical thickness (CTh), T2 white matter lesion volume (T2WMLV), new CLs and new WM lesions. RESULTS At baseline (T0), CLs were observed in 27/32 (84.4%) RRMS/E and in 26/60 (43.3%) RRMS (p<0.001) patients, and the RRMS/E group had a higher number (10.2 ± 8.9 vs 4.5 ± 2.4; p<0.001) and total volume (2.0 ± 1.3 vs 0.7 ± 0.8 cm(3); p<0.001) of CLs compared with the RRMS group. No significant difference in T2WMLV was observed. Global CTh was lower in RRMS/E (2.12 ± 0.19 vs 2.35 ± 0.14 mm; p<0.001), and this group also showed a decline in cognition (CS 10.9 ± 6.3 vs 6.2 ± 3.5; p<0.001). After 3 years (T1), the RRMS/E group had a higher accumulation of new CLs (3.4 ± 3.2 vs 1.2 ± 1.1; p<0.001) and faster reduction of GMf (p=0.022) while the two groups did not differ in the number of new WM and new Gad+ lesions. DISCUSSION RRMS/E had a more severe and rapidly evolving cortical pathology (CLs and atrophy) compared with RRMS without epilepsy. The RRMS/E group was also characterised by more pronounced cognitive decline, higher EDSS and higher prevalence of men.
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Affiliation(s)
- M Calabrese
- Multiple Sclerosis Centre, First Neurology Clinic, University of Padova, Via Giustiniani 5, Padova 35128, Italy.
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Baracchini C, Perini P, Causin F, Calabrese M, Rinaldi F, Gallo P. Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency. Neurology 2011; 77:844-50. [PMID: 21849656 DOI: 10.1212/wnl.0b013e31822c6208] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Chronic cerebrospinal venous insufficiency (CCSVI) had been suggested to play a major pathogenetic role in multiple sclerosis (MS), but recent data on early stages of MS have not confirmed this theory. Nonetheless, CCSVI could represent a late phenomenon of MS or be associated with progression of disability. Thus, we studied CCSVI prevalence in primary progressive (PP) and secondary progressive (SP) MS, to clarify whether CCSVI characterizes the progressive forms of this disease. METHODS A total of 35 patients with SPMS, 25 patients with PPMS, and 60 age- and gender-matched normal controls (NC) were enrolled into a cross-sectional study. Extracranial and transcranial high-resolution venous echo color Doppler sonography (ECDS-TCDS) was performed in all patients and NC. Those patients having any abnormal ultrasound finding were asked to undergo selective venography (VGF). RESULTS Patients with PPMS (11 women, 14 men; mean age 47 ± 11 years) had a disease duration of 11 ± 7 years and Expanded Disability Status Scale (EDSS) score of 6.0 ± 0.5. Patients with SPMS (22 women, 13 men; mean age 45 ± 14.5 years) had a disease duration of 18 ± 14 years and EDSS score of 6.0 ± 0.8. TCDS was normal in all patients. ECDS showed one or more abnormal findings in 9/60 (15.0%) patients (7/35 [20.0%] SPMS, 2/25 [8.0%] PPMS) and in 14/60 (23.3%) NC (p not significant for all comparisons). CCSVI criteria were fulfilled in 0 NC and 4 (6.7%) patients with MS: 3 SPMS and 1 PPMS. VGF, performed in 6/9 patients, was abnormal only in one case who had bilateral internal jugular vein stenosis. CONCLUSION Our findings indicate that CCSVI is not a late secondary phenomenon of MS and is not associated with disability.
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Affiliation(s)
- C Baracchini
- First Neurology Clinic, Department of Neuroscience, University of Padua, Padova, Italy.
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Calabrese M, Rinaldi F, Mattisi I, Bernardi V, Favaretto A, Perini P, Gallo P. The predictive value of gray matter atrophy in clinically isolated syndromes. Neurology 2011; 77:257-63. [PMID: 21613600 DOI: 10.1212/wnl.0b013e318220abd4] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although gray matter (GM) atrophy is recognized as a common feature of multiple sclerosis (MS), conflicting results have been obtained in patients with clinically isolated syndromes (CIS). Methodologic and clinical constraints may take account for literature discrepancies. METHODS A total of 105 patients presenting with CIS and 42 normal controls (NC) were studied. At baseline, 65/105 patients with CIS met the criterion of dissemination in space of lesions (DIS+). All patients were clinically assessed by means of the Expanded Disability Status Scale every 6 months and underwent MRI evaluation at study entry and then annually for 4 years. Global and regional cortical thickness and deep GM atrophy were assessed using Freesurfer. RESULTS No significant reduction in GM atrophy was observed between the entire CIS group and the NC, excepting for the cerebellum cortical volume. When the 59 patients with CIS (46 DIS+, 13 DIS-) who converted to MS during the follow-up were compared to the NC, a significant atrophy in the precentral gyrus, superior frontal gyrus, thalamus, and putamen was observed (p ranging from 0.05 to 0.001). The multivariate analysis identified the atrophy of superior frontal gyrus, thalamus, and cerebellum as independent predictors of conversion to MS. CIS with atrophy of such areas had a double risk of conversion compared to DIS+ (odds ratio 9.6 vs 5.0). CONCLUSION Selective GM atrophy is relevant in patients with CIS who convert early to MS. The inclusion of GM analysis in the MS diagnostic workup is worthy of further investigation.
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Affiliation(s)
- M Calabrese
- Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Via Giustiniani 5, 35128 Padova, Italy.
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Abstract
Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system. In the last decade, pathological and magnetic resonance imaging (MRI) studies have shown that a significant portion of inflammatory lesions are located in the grey matter, especially in the cerebral cortex, of MS patients. Cortical inflammatory lesions (CL) can be demonstrated in vivo in MS patients by double inversion recovery (DIR) MRI sequence. Neuropsychological deficits constitute a major clinical aspect of MS, being demonstrated in a percentage ranging from 40 to 65% of patients, and have been shown to be associated with cortical demyelination and atrophy. Recent DIR studies in MS patients having different clinical forms of the disease have disclosed that CL burden not only correlates with the severity of physical disability, but is also one of the major structural changes associated with disease-related cognitive impairment.
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Affiliation(s)
- F Rinaldi
- Department of Neurosciences, The Multiple Sclerosis Centre of Veneto Region, University Hospital of Padova, Padua, Italy.
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Tagliafico A, Succio G, Neumaier CE, Baio G, Serafini G, Ghidara M, Calabrese M, Martinoli C. Brachial plexus assessment with three-dimensional isotropic resolution fast spin echo MRI: comparison with conventional MRI at 3.0 T. Br J Radiol 2011; 85:e110-6. [PMID: 21343321 DOI: 10.1259/bjr/28972953] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of our study was to determine whether a three-dimensional (3D) isotropic resolution fast spin echo sequence (FSE-cube) has similar image quality and diagnostic performance to a routine MRI protocol for brachial plexus evaluation in volunteers and symptomatic patients at 3.0 T. Institutional review board approval and written informed consent were guaranteed. METHODS In this prospective study FSE-cube was added to the standard brachial plexus examination protocol in eight patients (mean age, 50.2 years) with brachial plexus pathologies and in six volunteers (mean age, 54 years). Nerve visibility, tissue contrast, edge sharpness, image blurring, motion artefact and acquisition time were calculated for FSE-cube sequences and for the standard protocol on a standardised five-point scale. The visibility of brachial plexus nerve and surrounding tissues at four levels (roots, interscalene area, costoclavicular space and axillary level) was assessed. RESULTS Image quality and nerve visibility did not significantly differ between FSE-cube and the standard protocol (p>0.05). Acquisition time was statistically and clinically significantly shorter with FSE-cube (p<0.05). Pathological findings were seen equally well with FSE-cube and the standard protocol. CONCLUSION 3D FSE-cube provided similar image quality in a shorter acquisition time and enabled excellent visualisation of brachial plexus anatomy and pathology in any orientation, regardless of the original scanning plane.
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Affiliation(s)
- A Tagliafico
- Department of Radiology, National Institute for Cancer Research, Genoa, Italy.
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Calabrese M, Bernardi V, Atzori M, Mattisi I, Favaretto A, Rinaldi F, Perini P, Gallo P. Effect of disease-modifying drugs on cortical lesions and atrophy in relapsing-remitting multiple sclerosis. Mult Scler 2011; 18:418-24. [PMID: 21228025 DOI: 10.1177/1352458510394702] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To measure the effects of disease-modifying drugs (DMDs) on the development of cortical lesions (CL) and cortical atrophy in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS RRMS patients (n = 165) were randomized to subcutaneous (sc) interferon (IFN) beta-1a (44 mcg three times weekly), intramuscular (im) IFN beta-1a (30 mcg weekly) or glatiramer acetate (GA; 20 mg daily). The reference population comprised 50 untreated patients. Clinical and MRI examinations were performed at baseline, 12 months and 24 months. RESULTS One hundred and forty-one treated patients completed the study. After 12 months, 37/50 (74%) of untreated patients developed ≥ 1 new CL (mean 1.6), compared with 30/47 (64%) of im IFN beta-1a-treated patients (mean 1.2, p = 0.021), 24/48 (50%) of GA-treated patients (mean 0.8, p = 0.001) and 12/46 (26%) of sc IFN beta-1a-treated patients (mean 0.4, p < 0.001). After 24 months, ≥ 1 new CL was observed in 41/50 (82%) of untreated (mean 3.0), 34/47 (72%) of im IFN beta-1a-treated (mean 1.6, p < 0.001), 30/48 (62%) of GA-treated (mean 1.3, p < 0.001) and 24/46 (52%) of sc IFN beta-1a-treated patients (mean 0.8, p < 0.001). Mean grey matter fraction decrease in DMD-treated patients at 24 months ranged from 0.7 to 0.8 versus 1.0 in untreated patients (p = 0.023). CONCLUSIONS Disease-modifying drugs significantly decreased new CL development and cortical atrophy progression compared with untreated patients, with faster and more pronounced effects seen with sc IFN beta-1a than with im IFN beta-1a or GA.
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Affiliation(s)
- M Calabrese
- The Multiple Sclerosis Centre of the Veneto Region, Department of Neurology, University Hospital of Padova, Padova, Italy.
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Geurts JJG, Roosendaal SD, Calabrese M, Ciccarelli O, Agosta F, Chard DT, Gass A, Huerga E, Moraal B, Pareto D, Rocca MA, Wattjes MP, Yousry TA, Uitdehaag BMJ, Barkhof F. Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 2011; 76:418-24. [PMID: 21209373 DOI: 10.1212/wnl.0b013e31820a0cc4] [Citation(s) in RCA: 218] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Different double inversion recovery (DIR) sequences are currently used in multiple sclerosis (MS) research centers to visualize cortical lesions, making it difficult to compare published data. This study aimed to formulate consensus recommendations for scoring cortical lesions in patients with MS, using DIR images acquired in 6 European centers according to local protocols. METHODS Consensus recommendations were formulated and tested in a multinational meeting. RESULTS Cortical lesions were defined as focal abnormalities on DIR, hyperintense compared to adjacent normal-appearing gray matter, and were not scored unless ≥ 3 pixels in size, based on at least 1.0 mm(2) in-plane resolution. Besides these 2 obligatory criteria, additional, supportive recommendations concerned a priori artifact definition on DIR, use of additional MRI contrasts to verify suspected lesions, and a constant level of displayed image contrast. Robustness of the recommendations was tested in a small dataset of available, heterogeneous DIR images, provided by the different participating centers. An overall moderate agreement was reached when using the proposed recommendations: more than half of the readers agreed on slightly more than half (54%) of the cortical lesions scored, whereas complete agreement was reached in 19.4% of the lesions (usually larger, mixed white matter/gray matter lesions). CONCLUSIONS Although not designed as a formal interobserver study, the current study suggests that comparing available literature data on cortical lesions may be problematic, and increased consistency in acquisition protocols may improve scoring agreement. Sensitivity and specificity of the proposed recommendations should now be studied in a more formal, prospective, multicenter setting using similar DIR protocols.
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Affiliation(s)
- J J G Geurts
- VU University Medical Center, Department of Anatomy & Neuroscience, MF G-116, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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Bianchi S, Caini S, Renne G, Cassano E, Ambrogetti D, Cattani MG, Saguatti G, Chiaramondia M, Bellotti E, Bottiglieri R, Ancona A, Piubello Q, Montemezzi S, Ficarra G, Mauri C, Zito FA, Ventrella V, Baccini P, Calabrese M, Palli D. Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast 2011; 20:264-70. [PMID: 21208804 DOI: 10.1016/j.breast.2010.12.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/06/2010] [Accepted: 12/09/2010] [Indexed: 12/01/2022] Open
Abstract
Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%-27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%-35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions.
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Affiliation(s)
- S Bianchi
- Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, AOU Careggi, Viale Morgagni 85, Florence, Italy.
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Filippi M, Rocca MA, Calabrese M, Sormani MP, Rinaldi F, Perini P, Comi G, Gallo P. Intracortical lesions: Relevance for new MRI diagnostic criteria for multiple sclerosis. Neurology 2010; 75:1988-94. [DOI: 10.1212/wnl.0b013e3181ff96f6] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [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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Calabrese M, Battaglini M, Giorgio A, Atzori M, Bernardi V, Mattisi I, Gallo P, De Stefano N. Imaging distribution and frequency of cortical lesions in patients with multiple sclerosis. Neurology 2010; 75:1234-40. [DOI: 10.1212/wnl.0b013e3181f5d4da] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [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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