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G F Gualdi

Publications and source records attributed to G F Gualdi.

At least 19 recordsLinked to original sources
PubMed2006

Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature.

PURPOSE: The aim of this study was to identify and classify the ultrasonographic and computed tomography (CT) signs of simple and complicated acute cholecystitis and to define the correct diagnostic protocol. MATERIALS AND METHODS: We retrospectively reviewed 35 patients (23 men and 12 women; mean age 66.6 years) presenting with acute cholecystitis who were assessed by emergency ultrasonography (US) (30/35 cases) and spiral CT (12/35 cases); all patients underwent emergency surgery. The US signs were analysed and classified as major criteria (wall thickening and stratification, distension, Murphy's sign), minor criteria (bile stones, sludge, and biliary tract dilatation), and complication signs (gas collections, aerobilia, fluid collection, difficult or missed identification of the gallbladder). Imaging results were compared with histological findings (gold standard), and accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) were assessed for each modality. Concordance between the US and CT findings was also evaluated for cases undergoing both examinations; additional findings provided by one or the other modality were also assessed. RESULTS: US had an accuracy of 66.6%, a sensitivity of 37.5%, a specificity of 70%, a PPV of 100%, and an NPV of 58.3%. CT had 100% accuracy, sensitivity, and specificity. Concordance between US and CT was observed for diagnosis of complications, but CT provided additional findings in all cases. The majority of complicated cases undergoing US examination (68.7%) revealed more than two major criteria and one minor criterion or at least one sign of complication. CONCLUSIONS: If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.

Acute Disease↗
PubMed2004

[Imaging update in geriatric oncology].

The cancer is a problem that plagues all the ages but the greater part of the malignant tumors hits the old persons. The more elevated incidence sites of primary tumor in geriatrical age are the prostate, the lung and the colon-rectum in the men and the breast, the colon-rectum, the lung and the stomach in the women. The imaging has made steps of giant in the last few decades, with the introduction of new equipment and methodical news so as to assure everybody early and accurated diagnosis. For the lung carcinoma great advantages have been bring to us with the introduction of CT-PET and the multislice CT, that has concurred the execution of virtual bronchoscopy. The virtual endoscopy has been applied with happening also in the screening of the carcinoma of colon-rectum, executed through CT or MR. New MR technologies have allowed perform spectroscopic studies in such organs as prostate and breast, bringing the biochemical diagnosis beyond that morphologic. The MR then turns out fundamental in the appraisal of the Patient with bone metastases thanks also to the new whole body examinations. Finally the recent technology has allowed the execution of multiorgan CT screening bringing in this way new possibilities but also new questions.

Aged↗
PubMed2004

[Neuroimaging of Alzheimer disease: current role and future potential].

Alzheimer disease (AD), the most common cause of dementia in the elderly, is a progressive neurodegenerative disorder, associated with deterioration in cognition and behaviour. With the availability of newer drugs for symptoms treatments there is a general agreement to the need of an early diagnosis and an the development of new sensitive tools, to identify and/or monitor early cerebral changes, suggestive for AD. CT and MRI are recommended for routine evaluation, in order to exclude treatable causes of dementia and to exactly evaluate the degree of cerebral atrophy and the presence of parenchymal signal abnormalities. Functional imaging, including PET, SPECT and functional MR techniques, are able to investigate physiological cerebral function, such as blood perfusion, metabolism, activation, molecular composition and water diffusibility, and have the potential to detect subtle pathological changes earlier during course of disease. MRI can provide both an accurate morphological assessment and a functional evaluation. Further investigations are needed to precisely define which will be the role of the different MR techniques. Most likely an exhaustive evaluation of AD will include information obtained by conventional and functional imaging, combined with clinical, laboratory and genetic findings.

Alzheimer Disease↗
PubMed2001

[Conventional colonoscopy and colonography with magnetic resonance in the diagnosis of endoluminal lesions of the colon].

The diagnostic ability of Magnetic Resonance Colonography (MRC) in detecting colonic endoluminal masses was compared with that of conventional colonoscopy (CC) and related to the findings from histologic examination. In seventy consecutive patients MRC achieved a diagnostic accuracy similar to CC. Therefore MRC could be useful in screening patients at high risk for colonic cancer. However every patient with MRC-detected endoluminal lesion must undergo CC for histologic diagnosis.

Colonoscopy↗
PubMed2000

Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings.

PURPOSE: The aim of the present study was to compare the accuracy of endorectal coil magnetic resonance imaging with transrectal ultrasound in staging rectal carcinoma. METHODS: Twenty-six consecutive patients with rectal carcinoma, histologically proven by endoscopic biopsy, were staged with both endorectal coil magnetic resonance imaging and transrectal ultrasound and then underwent radical surgery. The preoperative staging was compared with histologic findings of the operative specimen according to TNM classification. RESULTS: Endorectal coil magnetic resonance imaging showed better results but was not statistically significantly different from transrectal ultrasound in evaluating T (accuracy, 84.6 vs. 76.9 percent): four overstaged and no understaged cases for the former and five overstaged cases and one understaged case for the latter. Both procedures showed similar results in evaluating N: 81 percent sensitivity and 66 percent specificity for endorectal coil magnetic resonance imaging and 72 percent sensitivity and 80 percent specificity for transrectal ultrasound. CONCLUSIONS: An accurate locoregional staging of rectal cancer is essential for the planning of optimal therapy for rectal cancer. Endorectal coil magnetic resonance imaging and transrectal ultrasound showed similar results; the former is more expensive, whereas the latter is operator dependent. At present the use of endorectal coil magnetic resonance imaging seems to be justified only in selected low rectal cancers where transrectal ultrasound yielded doubtful results. However, a more extensive study is necessary to compare the advantages of these diagnostic techniques.

Aged↗
PubMed2000

Magnetic resonance colonography versus conventional colonoscopy for the detection of colonic endoluminal lesions.

BACKGROUND & AIMS: The most effective prophylaxis for colorectal cancer is endoscopic polypectomy. Prompted by the disadvantages of conventional colonoscopy (CC), we assessed the diagnostic ability of a promising alternative technique for detecting endoluminal masses: magnetic resonance colonography (MRC). METHODS: Seventy consecutive patients referred for CC underwent preliminary MRC. The diagnostic ability of this technique in detecting colonic endoluminal lesions was determined, compared with that of CC, and related to the findings from histologic examination. RESULTS: In detecting endoluminal lesions, MRC achieved a diagnostic accuracy similar to CC (sensitivity, 96%; specificity, 93%; positive predictive value, 98%; and negative predictive value, 87.5%). CONCLUSIONS: MRC could be useful in screening programs of patients at high risk for colon cancer. Patients with MRC-detected endoluminal lesions must undergo CC for histologic diagnosis.

Adenocarcinoma↗
PubMed1999

Association of trisomy 9p and band heterotopia.

Patients with the trisomy 9p syndrome and CNS abnormalities have been poorly assessed. We report a patient with trisomy 9p who showed band heterotopia on MRI. Abnormal neuronal migration is sufficiently frequent in patients with the trisomy 9p syndrome that brain MRI should be routinely considered in all patients with this syndrome.

Adult↗
PubMed1999

[Virtual cystoscopy of bladder neoplasms. Preliminary experience].

PURPOSE: We investigated the comparative sensitivity of virtual and conventional cystoscopy in patients with urinary bladder cancer. MATERIAL AND METHODS: Twelve patients (8 men and 4 women; mean age: 61 years, range: 49-73) with findings of bladder cancer at conventional cystoscopy were submitted to volumetric spiral CT of the urinary bladder. Before the examination, the urinary bladder was distended with 180-200 mL of air. CT findings were then sent to an independent workstation to generate interactive intraluminal views of the bladder. The findings of virtual cystoscopy were compared with those of conventional cystoscopy in 11 patients and with the findings of transurethral resection after urethrotomy in one patient. All lesions had pathologic confirmation. RESULTS: Eighteen (90%) of 20 masses detected on conventional cystoscopy were visualized with virtual cystoscopy. The latter allowed readers to identify 13 of 13 masses (100%) > 1 cm and only 5 of 7 (71%) < 1 cm; three 4-mm masses were missed. Although only a subjective evaluation of lesion size was possible on conventional cystoscopy, there seemed to be good agreement on mass size and site with both techniques. DISCUSSION: Cystoscopy plays a key role in the diagnosis of urinary bladder carcinoma. However cystoscopy is invasive, has a limited field of view and lacks an objective scale; moreover, it is not indicated in patients with severe urethral strictures or active vesical bleeding. In our study, virtual cystoscopy depicted all the masses > 1 cm, and a lesion in a diverticulum with a small opening. Virtual cystoscopy was also very useful in a patient with urethral stricture (who could no be submitted to conventional cystoscopy) where it showed the lesion before transurethral resection after urethrotomy. The virtual technique could also be complementary to conventional cystoscopy in evaluation of bladder base and anterior bladder neck, as well as for postchemotherapy follow-up. Unfortunately virtual cystoscopy does not allow biopsy of suspicious lesions.

Aged↗
PubMed1998

[Locoregional staging of prostatic carcinoma: accuracy of magnetic resonance with endorectal coil in 75 patients treated with radical prostatectomy].

INTRODUCTION: We investigated the accuracy of MRI of the prostate with an endorectal surface coil in determing penetration of the prostatic capsule and invasion of seminal vescicles in prostate carcinoma. MATERIAL AND METHODS: Endorectal coil MRI (1 Tesla) was performed in 300 patients with biopsy-proved cancer. The PSA levels were always calculated and all the patients were examined with transrectal ultrasound. The imaging protocol included Turbo Spin Echo T2-weigthed (3900/150 TR/TE) axial and coronal images and T1-weigthed (650/15 TR/TE) axial images, 4 mm thick interleaved sections with .4 mm intersection gap, FOV 180 mm, 256 x 256 matrix (reconstruction 512). Seventy-five patients underwent radical prostatectomy and MR images were compared with pathologic findings of capsular penetration and invasion of seminal vescicles. The MR signs specific for capsular penetration were: deformation (irregularity) of capsular profile, capsular retraction with irregular margins, capsular interruption, obliteration of periprostatic adipose tissue, asymmetry of neurovascular bundles. RESULTS: MRI correctly depicted 37 of 45 pathologic stage T2 lesions and correctly depicted macroscopic capsular penetration (T3) in 18 of 23 cases. Microscopic capsular penetration was overestimated in all 7 cases. Sensitivity, specificity, accuracy, for microscopic and macroscopic capsular penetration were 60, 82, 73% respectively. Sensitivity, specificity, accuracy for macroscopic capsular penetration were 78, 82, 80% respectively. Sensitivity, specificity, accuracy for depiction of seminal vesicle involvment were 80, 100, 93%, respectively. The most reliable signs of capsular penetration were capsular interruption and invasion of periprostatic adipose tissue, while asymmetry of the neurovascular bundle was not seen. CONCLUSIONS: MRI provides accurate preoperative local staging. The two main limitations of MRI were the high rate of microscopic capsular penetration and the difficulty in detecting capsular penetration of tumor when the lesions are in the prostate apex. Prostate enlargement also made diagnosis more difficult.

Aged↗
PubMed1998

[Triphasic spiral computerized tomography of the liver: vascular models of non-cystic focal lesions].

PURPOSE: The purpose of this study was to investigate if Triphasic Spiral CT (arterial, portal and equilibrium phases) can improve the characterization of noncystic focal lesions. MATERIAL AND METHODS: Sixty-six patients with suspected focal liver disease underwent Triphasic Spiral CT. After the injection of 120-140 ml contrast material at 3 ml/s the liver was imaged in the arterial (scanning delay: 20-27 s), portal (scanning delay: 45-80 s) and equilibrium (scanning delay: 5-8 min) phases. The enhancement of each lesion was evaluated in each phase and the lesions were grouped by enhancement pattern (11 patterns in all). The reference standards in our 66 patients were surgery (12), biopsy (43), MRI (9), follow-up (9), somatostatin receptor scintigraphy (6). RESULTS: One hundred and twenty-six liver lesions were detected in 66 patients, four of 11 enhancement patterns (hypo/hyper/hyper, hyper/iso/iso, hyper/hyper/iso, hyper/hyper/hyper) were always referrable to benign disease (hemangioma, focal nodular hyperplasia-FNH-adenoma). Four of 11 enhancement patterns (iso/hypo/hypo, iso/iso/hypo, hyper/hypo/hypo, hyper/hyper/hypo) were always referrable to malignant disease (hepatocellular carcinoma-HCC-metastases). The other two patterns (hypo/hypo/hypo, hypo/hypo/hyper) were seen in both benign and malignant diseases. CONCLUSIONS: Triphasic Spiral CT improves the characterization of HCC, FNH, adenoma and hemangioma. The arterial and the equilibrium phases add no information to the yield of the portal venous phase in metastases, except for those from pancreas neuroendocrine tumors in the arterial phase. In our experience, patients with unclassified lesions at US or conventional CT, suspected HCC and metastases from pancreas neuroendocrine tumors should be submitted to Triphasic CT of the liver. This technique however does not appear to be indicated in the study of liver metastases from hypovascular tumors, while it improves the detection of FNH and adenoma.

Female↗
PubMed1997

MRI in Smith-Lemli-Opitz syndrome type I.

We describe a single case of a polymalformational syndrome in which the MR findings were of great help in the final diagnosis of Smith-Lemli-Opitz syndrome (SLOS) type I. MRI was performed for evaluation of the brain morphology since the clinical and laboratory findings were suggestive but not unequivocally indicative of SLOS. MRI findings of frontal lobe hypoplasia, cortical migration defect, and abnormalities of median line structures prompted the final diagnosis of SLOS.

Agenesis of Corpus Callosum↗
PubMed1997

[Radiologic staging after surgical, chemical, and radiation treatment of non-seminomatous tumors of the testis].

The aim of this work was to evaluate the clinic usefulness of Computed Tomography (CT) and Magnetic Resonance (RM) in the staging after surgery, radiotherapy and chemotherapy of the nonseminomatous germ cells tumours of the testis. The Authors discussed the CT and MR dimensional criteria for the diagnosis of retroperitoneal metastases of the nonseminomatous germ cells tumours and delineated their CT and MR morphologic appearances in detail. The density of the residual mass on CT was classified as solid, cystic and half-cystic. The retroperitoneal hematoma and lymphocele formed as a complication respectively of orchiectomy and retroperitoneal lymphadenectomy can be misinterpreted to represent metastatic disease on post operative staging CT scans. Early recognition of this complication are crucial if unnecessary treatment is to be avoided. Finally the Authors evaluated, in patients affected from nonseminomatous germ cells tumours of the testis, the possibility to characterize with CT and MR imaging the retroperitoneal mass. The density and character of the residual mass on CT scan did not reliably predict the histology. On the basis of tumor consistency and signal intensity in T1 and T2 weighted images, MR cannot yet warrant any conclusion about the ultimate effect of chemotherapy.

Germinoma↗
PubMed1997

[Non-seminomatous tumors of the testis: problems of radiological staging before and after treatment].

The aim of this work was to evaluate the usefulness of Computed Tomography and Magnetic Risonance in the staging of the nonseminomatous germ cells tumours of the testis. The authors discussed the role of CT and MR imaging to value the detection of retroperitoneal metastases of the nonseminomatous germ cells tumours of the testis pre and post treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Imaging technics in the evaluation of malformations, traumatic and expansive disorders of the orbital region].

In this paper the authors evaluate the usefulness of the new radiological techniques in the study of the orbital region. They describe the role of modern computerized imaging in the planning of their correction of malformative and traumatic diseases of the orbit. Furthermore, the authors evaluate the usefulness of US, CT, and MR imaging in the differential diagnosis of growing masses of the orbit.

Diagnosis, Differential↗
PubMed1997

[The role of MRI in the valuation of disorders involving the bone marrow].

MR is the most accurate imaging technique in bone marrow evaluation since it allows to recognize and distinguish its red and yellow components. MR shows high sensitivity but low specificity. At present, its role in bone marrow diseases evaluation is that of depicting the extent of the disease process and monitoring the effects of treatment.

Bone Marrow↗
PubMed1997

[Sensitivity of spiral volumetric TC in the diagnosis of hepatic metastases: advantages of the dual phase technic].

In this report the diagnostic possibilities of volumetric Spiral CT in hepatic metastases detection are discussed. Spiral CT presents numerous advantages when compared to the conventional one; these increase its sensitivity in hepatic metastases diagnosis of approximately 10% (Conventional CT sensitivity 80-85%; Spiral CT sensitivity 90-95%). "Dual phase" technique allows hypervascular metastases diagnosis, often isodense during portal venous phase, hence not detectable with conventional CT. Nonetheless, helical CT for hepatic metastases detection is not yet common, due to high exams costs and more often due to the limited availability of equipment.

Humans↗
PubMed1996

Involvement of the limbic system in multiple sclerosis patients with depressive disorders.

This study investigates the relationship between depression and both anatomic and cerebral blood flow abnormalities in multiple sclerosis (MS) patients. Ten nondepressed MS patients were compared with 10 depressed MS patients matched for age, sex, and functional disability. Both groups were evaluated by means of neuropsychological tests, magnetic resonance imaging, and single-photon emission tomography imaging. There was no difference between the two groups with regard to the global cognitive score. Magnetic resonance imaging data showed no significant differences in the number, side, location, and area of the demyelinating lesions between the two groups; however, regional cerebral blood flow asymmetries in the limbic cortex did distinguish the two groups. Analysis of variance showed a significant effect of depression on the perfusion asymmetries in the limbic cortex. Finally, perfusion asymmetries in limbic cortex significantly correlated with depression test scores. Our findings suggest that depression in MS patients could be induced by a disconnection between subcortical and cortical areas involved in the function of the limbic system.

Adult↗