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Scialpi M, Martorana E, Trippa F, Di Marzo A, Battista Scalera G, Cristina Aisa M, D’Andrea A, Maria Mancioli F, Nicola R, Scialpi P, Di Blasi A. Prostate Imaging for Local Recurrence Reporting and Data System for Biparametric Magnetic Resonance Imaging: A Proposal. Urol Res Pract 2023; 49:233-240. [PMID: 37877824 PMCID: PMC10544277 DOI: 10.5152/tud.2023.22228] [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: 09/25/2022] [Accepted: 06/05/2023] [Indexed: 10/26/2023]
Abstract
We investigated a novel dedicated Prostate Imaging for Local Recurrence Reporting and Data System (PI-RRADS) in biochemical recurrence after radiotherapy (RT) and rad- ical prostatectomy (RP) evaluating biparametric magnetic resonance imaging (bpMRI) exams, at 3T MRI of 55 patients. Associating bpMRI and biochemical recurrence data, we calculated bpMRI diagnostic accuracy. Four probability categories, from 1 (very low) to 4 (very high), were distinguished. In 20 patients with radiotherapy, 25% and 75% of lesions were reported as PI-RRADS 3, and 4, respectively. In 35 patients with radi- cal prostatectomy, 7.7% of lesions were included in PI-RRADS 1-2, whereas 40.4% and 51.9% in PI-RRADS 3 and 4 categories, respectively. Excellent agreement and significant correlation between bpMRI and biochemical recurrence were found. BpMRI showed sensitivity, specificity, positive predictive value, negative predictive value, false-posi- tive value, false-negative value, and total diagnostic accuracy of 96.15%, 86.7%, 97.4 %, 81.25%, 13.3%, 3.8% and 94.6%, respectively. BpMRI-based PI-RRADS allows the detection and localization local recurrence in biochemical recurrence after RT and RP contributing in clinical management and treatment.
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Affiliation(s)
- Michele Scialpi
- Department of Medicine and Surgery, Division of Diagnostic Imaging, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Fabio Trippa
- Radiation Oncology Centre, Ospedale Santa Maria, Terni, Italy
| | | | | | - Maria Cristina Aisa
- Department of Medicine and Surgery, Division of Obstetric and Gynaecology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | | | - Refky Nicola
- Department of Radiology, Syracuse, SUNY Upstate Medical, State University of New York Upstate Medical University, USA
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | - Aldo Di Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
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Scialpi M, Martorana E, Scalera GB, Scialpi P, Di Blasi A. Apparent Diffusion Coefficient and Lesion Volume to Detect Prostate Cancer. Radiology 2023; 307:e222177. [PMID: 36853177 DOI: 10.1148/radiol.222177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, Italy
| | - Eugenio Martorana
- Department of Urology, New Civilian Hospital of Sassuolo, Modena, Italy
| | - Giovanni Battista Scalera
- Division of Diagnostic Imaging, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, Italy
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | - Aldo Di Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
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Scialpi M, Martorana E, Scialpi P, Scalera GB, Belatti E, Aisa MC, D'Andrea A, Mancioli FM, DI Marzo A, Trippa F, DI Blasi A. S-PI-RADS and PI-RRADS for Biparametric MRI in the Detection of Prostate Cancer and Post-treatment Local Recurrence. Anticancer Res 2023; 43:297-303. [PMID: 36585156 DOI: 10.21873/anticanres.16163] [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: 10/30/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 01/01/2023]
Abstract
The application of biparametric magnetic resonance imaging (bpMRI) [T2-weighted (T2W) and diffusion weighted imaging (DWI)/apparent diffusion coefficient (ADC)] using dedicated structured methods, such as Simplified Prostate Imaging Reporting and Data System (S-PI-RADS) for the detection, categorization, and management of prostate cancer (PCa) is reported. Also, Prostate Imaging Reporting for Local Recurrence and Data System (PI-RRADS) for the detection and assessment of the probability of local recurrence after radiotherapy (RT) or radical prostatectomy (RP) in patients with biochemical recurrence (BCR) is proposed. Both S-PI-RADS and PI-RRADS assign to DWI/ADC a main role for the above purpose. S-PI-RADS identifies four categories and, on the basis of the qualitative and quantitative analysis of the restricted diffusion on ADC map and lesion volume, distinguishes two categories of lesions: category 3 (moderately homogeneous hypointense on ADC map) and category 4 (markedly homogeneous or inhomogeneous hypointense on ADC map). Ιn category 3, two subcategories (3a: volume <0.5 cm3 and 3b: volume ≥0.5 cm3) suggesting clinical management. PI-RRADS distinguishes four assessment categories and suggests the stratification of the probability (ranging from very low for category 1 to very high for category 4) of local disease recurrence. In clinical practice, S-PI-RADS and PI-RRADS, based on bpMRI represent a potential valid approach that may facilitates the detection and management of PCa and for detecting local recurrence after treatment improving communication with other professionals.
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Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy;
| | | | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | - Giovanni Battista Scalera
- Division of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Eugenio Belatti
- Division of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maria Cristina Aisa
- Division of Obstetrics and Gynaecology, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | | | | | - Fabio Trippa
- Radiation Oncology Centre, Ospedale Santa Maria, Terni, Italy
| | - Aldo DI Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
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Martorana E, Cristina Aisa M, Grisanti R, Santini N, Maria Pirola G, Datti A, Gerli S, Bonora A, Burani A, Battista Scalera G, Scialpi P, Di Blasi A, Scialpi M. Lesion Volume in a Bi- or Multivariate Prediction Model for the Management of PI-RADS v2.1 Score 3 Category Lesions. Turkish Journal of Urology 2022; 48:268-277. [PMID: 35913442 PMCID: PMC9612700 DOI: 10.5152/tud.2022.22038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: This study aimed at improving the discrimination of Prostate Imaging – Reporting and Data System version 2.1 (PI-RADS v2.1) score 3 suspicious prostate cancer lesions using lesion volume evaluation. Material and methods: Two hundred five PI-RADS v2.1 score 3 lesions were submitted to transperineal MRI/TRUS fusion-targeted biopsy. The lesion volumes were estimated on diffusion-weighted imaging sequence and distributed in PI-RADS 3a (LV < 0.5 mL) and PI-RADS 3b (LV ≥ 0.5 mL) subcategories, using a 0.5 mL cutoff value. Data were retrospectively matched with histopathological findings from the biopsy. Assuming that lesions with LV < or ≥ 0.5 mL were respectively not eligible (benign and indolent PCa lesions) or eligible for biopsy (significant PCa lesions), the diagnostic accuracy of lesion volume in determining clinically significant PCa at biopsy was evaluated using a bi- or multivariate model. Results: About 55.1% and 44.9% of lesions were distributed in subcategories 3a and 3b, respectively. The overall PI-RADS score 3 detection rate was 273%. 3.5% (1.95% of total), and 25% (11.7% of total) significant PCa were found in PI-RADS 3a and 3b subcategory, respectively. The method showed 85.2% sensitivity, 61.2% specificity, 25% positive predictive value, and 96.5% negative predictive value and avoided 55.1% of unnecessary biopsies. The diagnostic accuracy in determining significant PCa at biopsy was 73.2% or 86.5% depending on whether lesion volume was used alone or in combination with prostate volume and patient age in a multivariate model. Conclusion: 0.5 mL lesion volume cutoff value significantly discriminates fusion-targeted biopsy need in PI-RADS v2.1 score 3 lesions and its diagnostic accuracy improves when it combines with prostate volume and age in a multivariate model.
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Affiliation(s)
- Eugenio Martorana
- Department of Urology, New Civilian Hospital of Sassuolo, Modena, Italy
- Corresponding authors: Eugenio Martorana or Maria Cristina AisaE-mail: or
| | - Maria Cristina Aisa
- Division of Gynaecology, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
- Corresponding authors: Eugenio Martorana or Maria Cristina AisaE-mail: or
| | - Riccardo Grisanti
- Department of Urology, New Civilian Hospital of Sassuolo, Modena, Italy
| | - Nicola Santini
- Department of Radiology, New Civilian Hospital of Sassuolo, Modena, Italy
| | | | - Alessandro Datti
- Division of Biochemistry, Department of Agricultural, Food, and Environmental Sciences, Perugia University, Perugia, Italy
| | - Sandro Gerli
- Division of Gynaecology, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | | | - Aldo Burani
- Department of Radiology, New Civilian Hospital of Sassuolo, Modena, Italy
| | - Giovanni Battista Scalera
- Division of Diagnostic Imaging, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, Italy
| | - Pietro Scialpi
- Division of Urology, Portogruaro Hospital, Venice, Italy
| | - Aldo Di Blasi
- Division of Radiology, Tivoli Hospital, Tivoli, Italy
| | - Michele Scialpi
- Division of Radiology 2, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
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Affiliation(s)
- Michele Scialpi
- Full Professor of Radiology, Department of Surgical and Biomedical Sciences, Chairman of Diagnostic Imaging Division, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Ewa Barbara Sielaszuk
- Full Professor of Radiology, Department of Surgical and Biomedical Sciences, Chairman of Diagnostic Imaging Division,, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maria Emanuela Vitale
- Full Professor of Radiology, Department of Surgical and Biomedical Sciences, Chairman of Diagnostic Imaging Division,, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Giovanni Battista Scalera
- Division of Radiology 1, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Refky Nicola
- Department of Radiology, Roswell Park Cancer Institute, Radiology, Buffalo, NY, USA
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Scialpi M, Russo P, Piane E, Gallo E, Scalera GB. First case of retroperitoneal hematoma in COVID-19. Turk J Urol 2020; 46:407-409. [PMID: 32915717 DOI: 10.5152/tud.2020.20302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Perugia University, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Pasquale Russo
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Perugia University, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Ernesto Piane
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Perugia University, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Gallo
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Perugia University, Santa Maria della Misericordia Hospital, Perugia, Italy
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Scialpi M, Scialpi S, Piscioli I, Battista Scalera G, Longo F. Pulmonary thromboembolism in critical ill COVID-19 patients. Int J Infect Dis 2020; 95:361-362. [PMID: 32339717 PMCID: PMC7180352 DOI: 10.1016/j.ijid.2020.04.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022] Open
Abstract
•COVID-19 in critically ill patients causes death not only from pneumonia but also from multiple organ injuries. •In critically ill COVID-19 patients with pneumonia, pulmonary thromboembolism may be considered. •In critically ill COVID-19 patients, contrast-enhanced computed tomography of the chest is mandatory to assess parenchymal patterns and to diagnose pulmonary thromboembolism.
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Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Sara Scialpi
- Department of Anaesthesia and Intensive Care, University Hospital Pisa, Pisa, Italy
| | | | - Giovanni Battista Scalera
- Division of Radiology 1, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Fernando Longo
- Department of Anaesthesia and Intensive Care, University Hospital Perugia, Perugia, Italy
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Scialpi M, Piscioli I, Scalera GB, Piane E. Safety and role of chest CT in COVID-19 patients. Diagn Interv Radiol 2020; 26:606. [PMID: 32441652 DOI: 10.5152/dir.2019.20247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michele Scialpi
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | | | - Ernesto Piane
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Pusiol T, Franceschetti I, Bonfioli F, Barberini F, Scalera GB, Piscioli I. Middle ear metastasis from dormant breast cancer as the initial sign of disseminated disease 20 years after quadrantectomy. Ear Nose Throat J 2013; 92:121-4. [PMID: 23532648 DOI: 10.1177/014556131309200310] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe an unusual case of breast cancer metastatic to the middle ear in a 71-year-old woman. The metastasis was the initial sign of disseminated disease 20 years after the patient had undergone a quadrantectomy for her primary disease. Computed tomography (CT) demonstrated the presence of an intratympanic mass with a soft-tissue density that was suggestive of chronic inflammation. The patient underwent a canal-wall-down tympanoplasty. When a brownish mass was found around the ossicles, a mastoidectomy with posterior tympanotomy was carried out. However, exposure of the tumor was insufficient, and therefore the posterior wall of the ear canal had to be removed en bloc. Some tumor was left on the round window membrane so that we would not leave the patient with a total hearing loss. Our case highlights the limitations of CT and magnetic resonance imaging in differentiating inflammatory and neoplastic lesions.
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Affiliation(s)
- Teresa Pusiol
- Institute of Pathology, S. Maria del Carmine Hospital, Piazzale S. Maria 6, 38068 Rovereto (TN), Italy
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Pirro M, Manfredelli MR, Schillaci G, Helou RS, Bagaglia F, Melis F, Scalera GB, Scarponi AM, Gentile E, Mannarino E. Association between circulating osteoblast progenitor cells and aortic calcifications in women with postmenopausal osteoporosis. Nutr Metab Cardiovasc Dis 2013; 23:466-472. [PMID: 22366195 DOI: 10.1016/j.numecd.2011.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 03/15/2011] [Revised: 07/08/2011] [Accepted: 08/11/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Ectopic artery calcification has been documented in women with postmenopausal osteoporosis, in whom an imbalance in the number of circulating osteoprogenitor cells (OPCs) has been identified. Circulating OPCs form calcified nodules in vitro; however, it remains unknown whether an association exists between the number of circulating OPCs and aortic calcifications. We investigated the relationship between OPCs and aortic calcifications in women with postmenopausal osteoporosis. METHODS AND RESULTS The number of circulating OPCs was quantified by FACS analysis in 50 osteoporotic postmenopausal women. OPCs were defined as CD15-/alkaline-phosphatase(AP)+ cells coexpressing or not CD34. Participants underwent measurement of markers of bone metabolism, bone mineral density and abdominal aortic calcium (AAC) by 64-slice computed tomography. Patients with AAC were older, had lower 25(OH)vitamin D levels and higher circulating CD15-/AP+/CD34- cells than those without AAC. Significant correlates of AAC included age (rho = 0.38 p = 0.006), calcium (rho = 0.35 p = 0.01), 25(OH)vitamin D (rho = -0.31, p = 0.03) and the number of CD15-/AP+/CD34- cells (rho = 0.55 p < 0.001). In regression analyses, the log-transformed number of CD15-/AP+/CD34- cells was associated with the presence (OR = 6.45, 95% CI 1.03-40.1, p = 0.04) and severity (β = 0.43, p < 0.001) of AAC, independent of age, 25(OH)vitamin D, calcium and other potential confounders. Patients with low 25(OH)vitamin D and high CD15-/AP+/CD34- cells had higher median AAC than other patients (1927/μL, 862-2714/μL vs 147/μL, 0-1665/μL, p = 0.003). CONCLUSION In women with postmenopausal osteoporosis, the number of circulating CD15-/AP+/CD34- cells is significantly associated with increased aortic calcifications, that appear to be correlated also with reduced 25(OH)vitamin D levels.
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Affiliation(s)
- M Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Hospital Santa Maria della Misericordia, Piazzale Menghini, 1, 06129 Perugia, Italy.
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Scialpi M, Cappabianca S, Rotondo A, Scalera GB, Barberini F, Cagini L, Donato S, Brunese L, Piscioli I, Lupattelli L. Pulmonary congenital cystic disease in adults. Spiral computed tomography findings with pathologic correlation and management. Radiol Med 2010; 115:539-50. [PMID: 20058095 DOI: 10.1007/s11547-010-0467-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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: 03/04/2009] [Accepted: 04/03/2009] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to assess the computed tomography (CT) features of intrapulmonary congenital cystic diseases in adults and to correlate the imaging features with the pathological findings, with emphasis on the oncogenic potential of the lesions. MATERIALS AND METHODS We retrospectively reviewed the CT scans in three institutions from August 1996 to December 2008, of nine patients (six men, three women; mean age 48.6 years; range 26-75 years) who had histological diagnosis of pulmonary cystic disease after surgery. Six patients had a diagnosis of intrapulmonary bronchogenic cyst (IBC), and three had a type-I cystic adenomatoid malformation (CAM). In one case, intralobar sequestration (ILS) was associated with type-I CAM. RESULTS Three patients were symptomatic and six were asymptomatic. On CT scans, IBCs showed homogeneous fluid attenuation (n=2), air-fluid level (n=2), air attenuation (n=1) or soft-tissue attenuation (n=1). The surrounding lung tissue showed areas of band-like linear attenuation in three IBCs, atelectasia in two and mucocele-like areas in one. On CT, type-I CAM appeared as a unilocular cystic lesion with air-fluid level (n=1) or air content (n=1). Both cases had thin walls surrounded by normal lung parenchyma. ILS appeared as a fluid-filled cyst with afferent and efferent vessels. Of the six IBCs, one occurred in the upper right lobe, two in the middle lobe and three in the lower right lobe. Of the three type-I CAMs, one was in the upper left lobe and one in the middle lobe. The type-I CAM associated with ILS was located in the left lower lobe. CONCLUSIONS The similar CT patterns preclude differentiation between IBC and type-I CAM. Surgical resection of all intrapulmonary cystic lesions detected in adults is mandatory because type-I CAM is a precursor of mucinous bronchioloalveolar carcinoma.
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Affiliation(s)
- M Scialpi
- Department of Surgical, Radiologic and Odontostomatologic Sciences, Section of Diagnostic and Interventional Radiology, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156, Perugia, Italy.
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Losito A, Errico R, Santirosi P, Lupattelli T, Scalera GB, Lupattelli L. Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition. Nephrol Dial Transplant 2005; 20:1604-9. [PMID: 15870215 DOI: 10.1093/ndt/gfh865] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [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: 11/14/2022] Open
Abstract
BACKGROUND Patients with atherosclerotic renovascular disease (ARVD) are almost invariably treated by revascularization. However, the long-term outcomes of this approach on survival and progression to renal failure have not been investigated and have not been compared with that of a purely medical treatment. The aim of this observational study was to investigate factors affecting long-term (over 5 years) outcome, survival and renal function of patients with ARVD treated invasively or medically. METHODS ARVD was demonstrated angiographically in 195 patients who were consecutively enrolled into a follow-up study. Patient age was 65.6+/-11.2 years, serum creatinine was 1.74+/-1.22 mg/dl and renal artery lumen narrowing was 73.5+/-17.5%. A revascularization was performed in 136 patients, whereas 54 subjects having comparable characteristics were maintained on a medical treatment throughout the study; five patients were lost during follow-up. RESULTS The main follow-up was 54.4+/-40.4 months. The assessment of cardiovascular survival and renal survival at the end of follow-up revealed 46 cardiovascular deaths, 20 patients with end-stage renal disease (ESRD) and 41 patients with an increase in serum creatinine of over one-third. The multivariate analysis showed that renal revascularization did not affect mortality or renal survival compared with medical treatment. Revascularization produced slightly lower increases in serum creatinine and a better control of blood pressure. A longer survival was associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) (P = 0.002) in both revascularized and medically treated patients. The only significant predictor of ESRD was an abnormal baseline serum creatinine. CONCLUSIONS On long-term follow-up, ARVD was associated with a poor prognosis due to a high cardiovascular mortality and a high rate of ESRD. In our non-randomized study, revascularization was not a major advantage over medical treatment in terms of mortality or renal survival. The use of ACEIs was associated with improved survival.
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Affiliation(s)
- Attilio Losito
- Unità Operativa Nefrologia e Dialisi, Policlinico Monteluce, Università di Perugia, Italy.
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Lupattelli T, Fischer MJ, Scalera GB, Maselli A, Mosca S, Pozzilli P, Varzini F, Cao PG, Lupattelli L. Percutaneous treatment of carotid stenosis with protection system: preliminary experience. Radiol Med 2004; 108:255-64. [PMID: 15343139] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE To assess the feasibility, safety, and efficacy of carotid artery stenting with filter device. MATERIALS AND METHODS Between May 2001 and July 2002, a total of 96 consecutive patients (100 lesions) who presented with symptomatic >70% diameter stenosis, asymptomatic >90% diameter stenosis or post-endarterectomy as well as post-radiotherapy hemodynamically significant stenosis underwent carotid artery stenting with filter protection at our institute. The mean age of the patients was 72 (range 51-91). There were 22 female (23%), and 74 male (77%). Of the 96 patients, 62 patients (65%) did not filled the NASCET surgical criteria and 24 (26%) were classified as ASA 4. All the patients underwent pretreatment with antiplatelet agents. All procedures were performed with a standardized monitoring system by a multidisciplinary team. Filtration system for cerebral protection was consistently used. Outcome measures were procedural atheroembolic events, including all-stroke and death rates up to 30 days. RESULTS A protection system type "TRAP" (Microvena, Italy) or a protection system type "EPIFILTER" (Boston Scientific, USA) were employed in 28% and 67% of cases, respectively. In the remaining 5% it was not possible to cross the stenosis with the filter. The stent placement was achieved in 95 of the procedures (95%). In 86% of cases a primary stenting technique was performed, with balloon pre-dilation of the lesion and subsequent stent advancement through the stenosis accounting for 9% of cases. At the time of protection system removal, 21 filter (21%) showed presence of macroscopic particles. We recorded 8 (8%) homolateral neurological events: two major strokes, one minor stroke and five TIAs (all the patients with TIA fully recovered within 2 hours). General complications (5%) included one lesion of the median nerve, two groin haematomas (one with disability for the patient, and one requiring surgery), one myocardial infarct and one lower limb ischaemia requiring surgical intervention. All major complications (4%) (two major strokes, one myocardial infarct and one lesion of the median nerve) occurred within the first 31 cases, the 69 following procedures not showing any neurological or non-neurological major events. At 30 days all patient were still alive. CONCLUSIONS Filter protection during carotid artery stenting seems technically feasible as well as reasonably safe and effective. The EPIFILTER system turned out to be of easier employment due to its "monorail" system and because it does not usually need a catheter of dedicated recovery. Further studies in larger groups of patients are required to best characterize criteria guiding the choice for the right protection system.
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Affiliation(s)
- Tommaso Lupattelli
- S. C. di Radiologia Diagnostica e Interventistica, Università degli Studi di Perugia
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