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Lucatelli P, Ciaglia S, Rocco B, De Rubeis G, Bolognesi G, Damato E, Corona M, Nardis PG, Cannavale A, Ricci P, Catalano C. Two-dimensional perfusion angiography permits direct visualization of redistribution of flow in hepatocellular carcinoma during b-TACE. Radiol Med 2024:10.1007/s11547-024-01816-9. [PMID: 38637490 DOI: 10.1007/s11547-024-01816-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To demonstrate in vivo redistribution of the blood flow towards HCC's lesions by utilizing two-dimensional perfusion angiography in b-TACE procedures. MATERIAL AND METHODS In total, 30 patients with 35 HCC nodules treated in the period between January 2019 and November 2021. For each patient, a post-processing software leading to a two-dimensional perfusion angiography was applied on each angiography performed via balloon microcatheter, before and after inflation. On the colour map obtained, reflecting the evolution of contrast intensity change over time, five regions of interests (ROIs) were assessed: one on the tumour (ROI-t), two in the immediate peritumoural healthy liver parenchyma (ROI-ihl) and two in the peripheral healthy liver parenchyma (ROI-phl). The results have been interpreted with a novel in silico model that simulates the hemodynamics of the hepatic arterial system. RESULTS Among the ROIs drawn inside the same segment of target lesion, the time-to-peak of the ROI-t and of the ROI-ihl have a significantly higher mean value when the balloon was inflated compared with the ROIs obtained with deflated balloon (10.33 ± 3.66 s vs 8.87 ± 2.60 s (p = 0.015) for ROI-t; 10.50 ± 3.65 s vs 9.23 ± 2.70 s (p = 0.047) for ROI-ihl). The in silico model prediction time-to-peak delays when balloon was inflated, match with those observed in vivo. The numerical flow analysis shows how time-to-peak delays are caused by the obstruction of the balloon-occluded artery and the opening of intra-hepatic collateral. CONCLUSION The measurements identify predictively the flow redistribution in the hepatic arteries during b-TACE, supporting a proper positioning of the balloon microcatheter.
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Affiliation(s)
- Pierleone Lucatelli
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Simone Ciaglia
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Bianca Rocco
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gianluca De Rubeis
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Guido Bolognesi
- Department of Chemical Engineering, Loughborough University, Loughborough, LE11 3TU, UK
- Department of Chemistry, University College London, London, WC1H 0AJ, UK
| | - Elio Damato
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Mario Corona
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Pier Giorgio Nardis
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandro Cannavale
- Unit of Vascular and Interventional Radiology, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Paolo Ricci
- Unit of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161, SapienzaRome, Italy.
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161, SapienzaRome, Italy
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Pontone S, Nardis PG, Eberspacher C, Mascagni D. A case report of a colouterine fistula treatment: when the patient chooses the steeplechase. Ann Coloproctol 2023; 39:366-370. [PMID: 34376024 PMCID: PMC10475798 DOI: 10.3393/ac.2021.00318.0045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022] Open
Abstract
Colouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Pier Giorgio Nardis
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Napoli A, Alfieri G, De Maio A, Panella E, Scipione R, Facchini G, Albisinni U, Spinnato P, Nardis PG, Tramutoli R, Lenzi J, Ghanouni P, Bazzocchi A, Perotti S, Schoenfeld AJ, Catalano C. CT-guided Pulsed Radiofrequency Combined with Steroid Injection for Sciatica from Herniated Disk: A Randomized Trial. Radiology 2023; 307:e221478. [PMID: 36975815 PMCID: PMC10323291 DOI: 10.1148/radiol.221478] [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] [Received: 06/16/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
Background Evidence regarding effective nonsurgical management of sciatica remains limited. Purpose To determine a difference in effectiveness between combined pulsed radiofrequency (PRF) and transforaminal epidural steroid injection (TFESI) treatment versus TFESI alone for sciatic pain due to lumbar disk herniation. Materials and Methods This prospective multicenter double-blind randomized clinical trial was conducted between February 2017 and September 2019 in participants with sciatica due to lumbar disk herniation lasting 12 weeks or longer that was not responsive to conservative treatment. Study participants were randomly assigned to undergo one CT-guided treatment with combined PRF and TFESI (n = 174) or TFESI alone (n = 177). The primary outcome was leg pain severity, as assessed with the numeric rating scale (NRS) (range, 0-10) at weeks 1 and 52 after treatment. Secondary outcomes included Roland-Morris Disability Questionnaire (RMDQ) score (range, 0-24) and Oswestry Disability Index (ODI) score (range, 0-100). Outcomes were analyzed according to the intention-to-treat principle via linear regression. Results Mean age of the 351 participants (223 men) was 55 years ± 16 (SD). At baseline, NRS was 8.1 ± 1.1 in the PRF and TFESI group and 7.9 ± 1.1 in the TFESI group. NRS was 3.2 ± 0.2 in the PRF and TFESI group and 5.4 ± 0.2 in the TFESI group (average treatment effect, 2.3; 95% CI: 1.9, 2.8; P < .001) at week 1 and 1.0 ± 0.2 and 3.9 ± 0.2 (average treatment effect, 3.0; 95% CI: 2.4, 3.5; P < .001), respectively, at week 52. At week 52, the average treatment effect was 11.0 (95% CI: 6.4, 15.6; P < .001) for ODI and 2.9 (95% CI: 1.6, 4.3; P < .001) for RMDQ, favoring the combined PRF and TFSEI group. Adverse events were reported in 6% (10 of 167) of participants in the PRF and TFESI group and in 3% (six of 176) of participants in the TFESI group (eight participants did not complete follow-up questionnaires). No severe adverse events occurred. Conclusion In the treatment of sciatica caused by lumbar disk herniation, pulsed radiofrequency combined with transforaminal epidural steroid injection is more effective for pain relief and disability improvement than steroid injection alone. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Jennings in this issue.
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Affiliation(s)
- Alessandro Napoli
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Giulia Alfieri
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Alessandro De Maio
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Emanuela Panella
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Roberto Scipione
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Giancarlo Facchini
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Ugo Albisinni
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Paolo Spinnato
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Pier Giorgio Nardis
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Roberto Tramutoli
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Jacopo Lenzi
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Pejman Ghanouni
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Alberto Bazzocchi
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Stefano Perotti
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Andrew J. Schoenfeld
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Carlo Catalano
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
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Nardis PG, Cipollari S, Lucatelli P, Basilico F, Rocco B, Corona M, Cannavale A, Leonardo C, Flammia RS, Proietti F, Vallati G, Gallucci M, Catalano C. Cone-beam CT-guided tagging of endophytic renal tumors with indocyanine green via trans-arterial selective delivery in patients undergoing robot-assisted partial nephrectomy with near infrared fluorescence imaging. J Vasc Interv Radiol 2022; 33:934-941. [PMID: 35487346 DOI: 10.1016/j.jvir.2022.04.016] [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] [Received: 09/15/2021] [Revised: 03/26/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the safety, efficacy, and clinical impact of pre-operative cone-beam CT (CBCT)-guided selective embolization of endophytic renal tumors with the fluorescent dye indocyanine green (ICG) and lipiodol in patients undergoing robot-assisted partial nephrectomy (RAPN) using near infrared fluorescent imaging (NIFI). MATERIALS AND METHODS Patients with renal endophytic tumors eligible for RAPN and trans-arterial embolization with ICG and lipiodol were prospectively included. Technical success was defined as the completion of the embolization procedure. Radiographic success, defined as the lipiodol accumulation into the nodule, was classified as poor, moderate, good, and optimal based on post-embolization CBCT. Surgical visibility of the tumors during RAPN with the use of NIFI was classified as: not visible, visible with poorly defined margins, and visible with well-defined margins. RESULTS Forty-one patients underwent pre-operative selective embolization. Technical success was 100%. Lipiodol accumulation at CBCT was poor in 2/41 (4.9%), moderate in 6/41 (14.6%), good in 25/41 (61.0%), and optimal in 8/41 patients (19.5%). During RAPN with NIFI, tumors were visible with well-defined margins in 26/41 (63.4%), visible with blurred margins in 14/41 (34.1%) and not visible in 1/41 (2.4%) of cases. There were no adverse events following endovascular embolization. CONCLUSION Pre-operative trans-arterial super-selective embolization of endophytic renal tumors with ICG and lipiodol in patients undergoing RAPN is safe and effective, allowing accurate intraoperative visualization and resection of endophytic tumors.
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Affiliation(s)
- Pier Giorgio Nardis
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Fabrizio Basilico
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Bianca Rocco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Mario Corona
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Alessandro Cannavale
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Flavia Proietti
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Giulio Vallati
- Department of Radiology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Maternal-Infant and Urological Sciences, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
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Lucatelli P, De Rubeis G, Rocco B, Basilico F, Cannavale A, Abbatecola A, Nardis PG, Corona M, Brozzetti S, Catalano C, Bezzi M. Correction to: Balloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center retrospective case control study. BMC Gastroenterol 2021; 21:282. [PMID: 34243723 PMCID: PMC8272269 DOI: 10.1186/s12876-021-01861-y] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Gianluca De Rubeis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Bianca Rocco
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Basilico
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Aurelio Abbatecola
- Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Stefania Brozzetti
- Pietro Valdoni Surgery Department, Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Lucatelli P, De Rubeis G, Rocco B, Basilico F, Cannavale A, Abbatecola A, Nardis PG, Corona M, Brozzetti S, Catalano C, Bezzi M. Balloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center retrospective case control study. BMC Gastroenterol 2021; 21:51. [PMID: 33535972 PMCID: PMC7860015 DOI: 10.1186/s12876-021-01631-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/27/2021] [Indexed: 01/27/2023] Open
Abstract
Background To compare oncological results and safety profile of balloon micro-catheter trans-arterial chemoembolization (b-TACE) and drug-eluting-microsphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC).
Methods This is a case–control, retrospective, single-center study. Between January-2015/March-2019, 149 patients (131 males [87.9%]) with 226 HCC were treated, 22 patients (35 HCC; 19 [86.4%] males) with b-TACE and 127 with DEM-TACE (191 HCC, 112 [88.2%] males). Embolization protocol was standardized (sequential 100 ± 25 and 200 ± 25 μm microspheres). Results were evaluated by modified-response-evaluation-criteria-in-solid-tumor [mRECIST] at 1, 3–6 and 9–12 months and time to recurrence after complete response [TTR] at 1 years. Cox’s regression weighted with tumor dimensions was performed. Adverse events (AEs) were recorded. Results mRECIST oncological response at all time points (1, 3–6 and 9–12 months) for both treatments were similar, with the exception of Objective response rate at 9-12 months. Objective response at 1 and 3–6 months between b-TACE vs DEM-TACE [23/35 (65.7%) vs 119/191 (62.3%), 21/29 (72.4%) vs 78/136 (57.4%) (p > 0.05), respectively]. On the contrary, at 9–12 months, it was significantly higher in b-TACE subgroup than DEM-TACE (15/19 [78.9%] vs 48/89 [53.9%], p = 0.05). TTR for complete response at 1 year had a better trend for b-TACE vs DEM-TACE (278.0 days [196.0–342.0] vs 219.0 days [161.0–238.0], OR 0.68 [0.4–1.0], p = 0.10). The use of balloon micro-catheter reduced the relative risk of the event of recurrence by 0.63 [CI95% 0.38–1.04]; p = 0.07). No significant differences were found in AEs rate. Conclusion b-TACE showed a trend of better oncological response over DEM-TACE with and longer TTR with a similar adverse events rate, in patients presenting with larger tumors.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Gianluca De Rubeis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Bianca Rocco
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Basilico
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Aurelio Abbatecola
- Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Stefania Brozzetti
- Pietro Valdoni Surgery Department, Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Lucatelli P, Rocco B, Nardis PG, Cannavale A, Bezzi M, Catalano C, Corona M. Bleeding in COVID Patients: What We Have Understood So Far. Cardiovasc Intervent Radiol 2021; 44:666-668. [PMID: 33511426 PMCID: PMC7843001 DOI: 10.1007/s00270-021-02775-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Bianca Rocco
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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Lucatelli P, De Rubeis G, Ginnani Corradini L, Basilico F, Di Martino M, Lai Q, Ginanni Corradini S, Cannavale A, Nardis PG, Corona M, Saba L, Catalano C, Bezzi M. Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over pre-procedural MRI and MDCT in detection and characterization of HCC in cirrhotic patients undergoing TACE procedure. Eur J Radiol 2019; 124:108806. [PMID: 31945673 DOI: 10.1016/j.ejrad.2019.108806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/18/2019] [Revised: 11/28/2019] [Accepted: 12/19/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was directed to compare diagnostic accuracy of dual-phase cone beam computed tomography (DP-CBCT) vs pre-procedural second line imaging modality (SLIM [multidetector computed tomography and magnetic resonance imaging]) to detect and characterize hepatocellular carcinoma (HCC) in cirrhotic patients with indication for trans-arterial chemoembolization (TACE). METHODS This is a single centre, retrospective, and observational study. Exclusion criteria were not-assisted DP-CBCT TACE, and unavailable follow-up SLIM. We evaluated 280 consecutive patients (January/2015-Febraury/2019). Seventy-two patients were eligible. Three radiologists in consensus reviewed: pre-procedural SLIM, DP-CBCT, and SLIM at follow-up, with 4 months of interval between each reading. Hyper-vascular foci (HVF) were detected and characterized. Diameter was recorded. Radiological behaviour, according to LI-RADS criteria, of HFV throughout follow-up time was the reference standard. Diagnostic accuracy was calculated for pre-procedural SLIM and DP-CBCT and evaluated through receiver operating characteristic curve. HVF only visible on DP-CBCT (defined as occult) were analysed. Tumour diameters were compared. RESULTS Median time between pre-procedural SLIM and DP-CBCT and between DP-CBCT and definitive radiological diagnosis of HVF were 46.0 days (95%CI 36.5-55.0) and 30.5 days (95%CI 29.0-33.0), respectively. DP-CBCT had a better diagnostic performance than pre-examination SLIM (sensitivity 99%vs78%; specificity 89%vs85%; PPV 99%vs99%; NPV 92%vs30%; and accuracy 94%vs79%). DP-CBCT diagnosed 63 occult HVF. Occult HCC were 54/243 (22.2%). Six were occult angiomas. Three were false positive. Mean diameter was significantly higher in DP-CBCT vs pre-procedural SLIM (+7.5% [95%CI 3.7-11.3], p < 0.05). CONCLUSIONS DP-CBCT has a better diagnostic accuracy and NPV than pre-procedural SLIM in cirrhotic patients with indication for TACE.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Gianluca De Rubeis
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Luca Ginnani Corradini
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Fabrizio Basilico
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Michele Di Martino
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Quirino Lai
- Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Stefano Ginanni Corradini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo Di Monserrato, Via Ospedale, 54, 09124 Cagliari CA, Italy.
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale Del Policlinico, 155, 00161 Rome RM, Italy.
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Lucatelli P, Ginnani Corradini L, De Rubeis G, Rocco B, Basilico F, Cannavale A, Nardis PG, Corona M, Saba L, Catalano C, Bezzi M. Balloon-Occluded Transcatheter Arterial Chemoembolization (b-TACE) for Hepatocellular Carcinoma Performed with Polyethylene-Glycol Epirubicin-Loaded Drug-Eluting Embolics: Safety and Preliminary Results. Cardiovasc Intervent Radiol 2019; 42:853-862. [PMID: 30843093 PMCID: PMC6502778 DOI: 10.1007/s00270-019-02192-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/21/2019] [Indexed: 12/26/2022]
Abstract
Purpose To report technical success, safety profile and oncological results of balloon-occluded transcatheter arterial chemoembolization using a balloon micro-catheter and epirubicin-loaded polyethylene-glycol (PEG) microsphere (100 ± 25 µm and 200 ± 50 µm) in patients with hepatocellular carcinoma (HCC). Materials and Methods This is a single-centre, single-arm, retrospective study with 6-month follow-up. Twenty-two patients (Child–Pugh A 68% [15/22], B in 32% [7/22]; age 67.05 ± 14 years) with 29 HCC were treated in 24 procedures. Technical success is defined: ability to place the balloon micro-catheter within the required vascular segment, balloon-occluded arterial stump pressure drops and assessment of microsphere deposition. Laboratory assessment pre/post-procedural and complications were analysed, respectively, according to Common Terminology Criteria for Adverse Events (CTCAEv5) and CIRSE system. Postembolization syndrome (PES) was defined as fever and/or nausea and/or pain onset. Oncological results were evaluated using m-RECIST criteria with CT/MRI imaging at 1 and 3–6 months. In partial responder patients, pre/post-procedural tumour volume was compared. Results Pre-planned feeder was reached in all cases. Pressure drop average was 51.1 ± 21.6 mmHg. Exclusive target embolization was achieved in 14/24 procedures (58.3%). Laboratory test modifications were all grade 1. 4/24 adverse events occurred (17%): pseudo-aneurysm of the feeder (grade 3), liver abscess (grade 2) and 2 asymptomatic segmentary biliary tree dilatations (grade 2). PES occurred in 8/24 (33%). The complete response at 1 and 3–6 months was 44.8% (13/29) and 52.9% (9/17), respectively. The partial response at 1 and 3–6 months was 55% (16/29) and 4/17 (23.5%), respectively. Among partial responder patients, the average percentage of tumour volume reduction was 64.9 ± 27.3%. Conclusion Epirubicin-loaded PEG microsphere b-TACE is technically feasible, safe and effective procedure for HCC treatment.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Luca Ginnani Corradini
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Gianluca De Rubeis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Bianca Rocco
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Basilico
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Alessandro Cannavale
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Pier Giorgio Nardis
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Diagnostic Service, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Lucatelli P, Argirò R, De Rubeis G, Rocco B, Corradini SG, Corona M, Nardis PG, Saba L, Mennini G, Fiorentino F, Corsi A, Catalano C, Bezzi M. Polyethylene Glycol Epirubicin-Loaded Transcatheter Arterial Chemoembolization Procedures Utilizing a Combined Approach with 100 and 200 μm Microspheres: A Promising Alternative to Current Standards. J Vasc Interv Radiol 2019; 30:305-313. [DOI: 10.1016/j.jvir.2018.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
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Francone M, Napoli A, Carbone I, Cavacece M, Nardis PG, Lanciotti K, Visconti S, Bertoletti L, Di Castro E, Catalano C, Passariello R. Noninvasive imaging of the coronary arteries using a 64-row multidetector CT scanner: initial clinical experience and radiation dose concerns. Radiol Med 2007; 112:31-46. [PMID: 17310293 DOI: 10.1007/s11547-007-0118-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 06/24/2005] [Accepted: 04/15/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE We present our initial clinical experience with a recently introduced 64-detector computed tomography (64-MDCT) scanner that makes use of a periodic motion of the focal spot in the longitudinal direction (z-flying focal spot), which enables it to reach a final spatial resolution of 0.4 x 0.4 x 0.4 mm(3) and a temporal resolution of 83 ms. MATERIALS AND METHODS A total of 114 patients (108 men, six women; age range 36-77 years, mean 63.1 years) underwent retrospective electrocardiogram (ECG)-gated examination of the coronary arteries using a 64-MDCT scanner (Somatom Sensation 64, Siemens Medical Solutions, Germany). Acquisition parameters were the following: collimation 64 x 0.6 mm, 800 quality reference milliampere second (mAs), 120 kVp, 0.33-s gantry rotation time and pitch 0.2. Images were acquired in all cases after i.v. administration of 80 ml of contrast agent (Iomeron 400 mgI/dl, Bracco, Italy) + 30 ml of saline at 4 /s and delay time determined using a bolus triggering technique. Oral betablockers were administered to patients with heart rate (HR) >75 bpm. To reduce radiation exposure, an automatic exposure control system was applied in all cases to adapt tube current to patient size and anatomic shape (CARE Dose 4D, Siemens Medical Solutions, Germany). The optimal temporal window for raw data reconstruction was chosen from an initial preview of images reconstructed with different phase settings (range 0%-95% RR interval with 5% gap) at a selected anatomical level in the mid part of the right coronary artery. CT dose index volume and effective dose were quantified in all patients using dedicated software. RESULTS Mean HR recorded during image acquisition was 65.6+/-19.2 bmp (range: 44-96 bmp), and beta-blockers were administered to 16/114 patients (14.0%). Technical adequacy was achieved in all patients but two (2/114; 1.7%). In patients with HR <60 bmp, the best reconstruction intervals were identified in the end-systolic (30%-35% of the RR interval) and end-diastolic (60%-65% of the RR interval) phases; with faster HR (>80 bmp), high image quality was observed in end-systole (30%-35% of the RR interval). Mean CT dose index (CTDI) volume was 36.53+/-8.30 mGy per patient. In comparison with a conventional examination with fixed mAs, the use of the CARE Dose 4D system provided a 33.3% CTDI volume reduction (p<0.001). Mean effective dose was 9.5+/-3.4 millisievert (mSv) per patient (range 7.1-17.7). CONCLUSIONS The 64-MDCT scanner diagnostic performance for coronary CT angiography is further improved with better spatial and temporal resolution and faster scan times; besides, initial clinical results are promising. The use of dose-reducing acquisition techniques is mandatory to limit radiation exposure to the patient.
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Affiliation(s)
- M Francone
- Dipartimento di Scienze Radiologiche, Università degli Studi di Roma La Sapienza, Policlinico Umberto I, Viale Regina Elena 324, I-00161 Rome, Italy,
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Catalano C, Napoli A, Nardis PG, Fraioli F, Passariello R. Incidental finding of lung cancer in patients studied by MDCT for atherosclerotic disease. Eur Radiol 2005; 15:2031-3. [PMID: 15761714 DOI: 10.1007/s00330-005-2705-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 01/21/2005] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
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