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L Bonomo

Publications and source records attributed to L Bonomo.

At least 55 records · Page 3Linked to original sources
PubMed1998

Carotid stenosis: a comparison between MR and spiral CT angiography.

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0% vs 80.8%, 98.2% vs 96.4%, 96.3% vs 91.3% and 96.0% vs 88.0%, respectively). MRA gave rise to a 5.0% overestimation rate, whereas SCTA occasioned a 7.5% underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70% stenosis.

Aged↗
PubMed1998

Bronchioloalveolar carcinoma of the lung.

Bronchioloalveolar carcinoma is a histologically distinct form of pulmonary adenocarcinoma representing an estimated 2-10 % of all primary lung cancers. Its varied appearances include focal masses, nodular patterns, and pneumonic and diffuse forms so that bronchioloalveolar carcinoma should be considered in the differential diagnosis of solitary or multiple pulmonary nodules and acute or chronic alveolar diseases. In this article we describe the different radiographic manifestations of bronchioloalveolar carcinoma with particular emphasis on CT findings and those signs that may help in identifying the lesion as bronchioloalveolar carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1998

High-resolution magnetic resonance angiography of the internal carotid artery: 2D vs 3D TOF in stenotic disease.

The aim of this study was to compare high-resolution 2D TOF with high-resolution 3D TOF in the study of internal carotid artery disease. Sixty-four patients with clinical signs of cerebrovascular insufficiency were studied with a superconductive 1.5 T magnet using two techniques: 2D and 3D TOF. Digital subtraction angiography (DSA) was the gold standard. The 2D TOF technique was performed using the following parameters: TR/TE/FA/MA 49 ms/9 ms/60 degrees/512 x 256; the 3D TOF was performed with the following parameters: TR/TE/FA/MA 50 ms/8 ms/20 degrees/512 x 256. The 2D TOF agreed with DSA in 116 of 128 diagnostic judgments (90%) and overestimated seven times. The 3D TOF technique agreed with DSA in 125 of 128 diagnostic judgments (97%) with one overestimation and two underestimations. There was no statistically significant difference (P < 0.05) between the two different techniques. Our study confirms the high reliability of the methodology carried out with the high-resolution 2D and 3D technique.

Angiography, Digital Subtraction↗
PubMed1998

MR angiography in carotid stenosis: a comparison of three techniques.

PURPOSE: To compare the accuracy of three different magnetic resonance angiography (MRA) techniques for studying steno-occlusive disease of carotid arteries. METHODS: 64 patients were evaluated with three MRA techniques- three-dimensional (3D) time-of-flight (TOF), two-dimensional (2D) TOF, and 3D Phase-Contrast (PC); the acquisition was in the axial plane, the volume included the carotid bifurcation. Digital subtraction angiography (DSA) was considered the 'gold standard'. The MRA images were reprojected with a maximum intensity pixel ray-tracing (MIP) algorithm. The three MRA techniques were blindly graded as normal, mildly stenotic (0-29%), moderately stenotic (30-49%), severely stenotic (70-99%), or occluded. RESULTS: DSA provided 128 diagnostic judgments: 92 were negatives and 36 positives. 2D TOF was in agreement with angiography in 116 of 128 cases (90%), but overestimated the results in seven cases and underestimated in five cases. 3D TOF agreed with angiography in 125 of 128 cases (97%), with one overestimation and two under estimations. 3D PC was concordant in 116 of 128 cases (90%), overestimating in six cases, underestimating in six cases. The sensitivity, specificity and diagnostic accuracy for 2D TOF was, respectively 84%, 94%, and 92%, while for 3D TOF was 94%, 100%, and 98%, and for 3D PC 86%, 98%, and 95%. The comparison of the three different MRA techniques provided no statistically significant difference (Friedman test P < 0.05). CONCLUSION: The high degree of diagnostic accuracy of MRA found in the study of the steno-occlusive disease of the carotid arteries confirms the high degree of reliability of this methodology carried out with the 3D TOF technique, compared to 2D TOF and 3D PC.

Carotid Arteries↗
PubMed1998

The clinico-ophthalmological spectrum of antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is a hypercoagulable disorder with highly variable symptomatology including ocular manifestations. Antiphospholipid antibodies (aPL) are the serologic markers of this clinical entity. Our aim was to note the main associated ocular features of APS and elucidate which pathogenic mechanisms may participate. Retinal vascular thrombosis and different neuro-ophthalmologic manifestations, such as optic neuropathy and amaurosis fugax, may be considered as the ocular hallmarks of this syndrome. Ocular features due to aPL-induced thrombosis should be treated with anticoagulant drugs. Conversely, for the treatment of ocular features due to immunological mechanisms such as vasculitis, immunosuppressive regimes seem to be more appropriate.

Animals↗
PubMed1998

Segmental pulmonary arteries: two-dimensional and three-dimensional time-of-flight magnetic resonance angiography.

The authors compared two-dimensional (2D) and three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography in ten healthy volunteers to establish which of two techniques is more effective in representing the pulmonary segmental arteries. No respiratory trigger or electrocardiogram gating was used. Presaturation pulses were used to eliminate venous flow. Images acquired in the sagittal planes were processed using maximum intensity projection. A total of 200 segmental arteries were evaluated with each technique by three observers (M.S., C.S., A.R.) in terms of vessel visibility. There was no significant difference among the observers' interpretations (p > 0.05). On average, 2D fast, low-angle shot breath-hold TOF sequences showed 136.1 of 200 (68%) segmental arteries, 74.1 of 100 in the right lung and 62 of 100 in the left lung. Three-dimensional fast imaging with steady state precession showed 171.6 of 200 (85.8%) segmental arteries, 94 of 100 in the left lung and 77.6 of 100 in the left lung. Three-dimensional imaging appeared to be better than 2D MRA for demonstration of segmental pulmonary arteries.

Adult↗
PubMed1998

[Angiography compared to high resolution magnetic resonance and digital angiography in atherosclerosis of the iliac-femoral arteries].

INTRODUCTION: Magnetic Resonance Angiography (MRA) potentials in all vascular districts have been largely applied also to peripheral vessels, where however there is no agreement as to the best type of sequence. We investigated the sensitivity, specificity and diagnostic accuracy of 2D TOF travel-sat MRA in the study of iliac-femoral artery stenoses. The gold standard was digital subtraction angiography (DSA). MATERIAL AND METHODS: Twenty patients (14 men and 6 women, mean age: 65 years with suspected atheromasic disease were examined. Diagnostic MRA and DSA were carried out within 48 hours of each other. A super-conductive 1 T magnet (Siemens Impact) and a body coil were used. 2D TOF travel-sat sequences were carried out with the following parameters: FA 40 degrees, TR 31 ms, ST 10 mm, overlap 1 mm, MA 128 x 512. The images acquired on the axial plane were postprocessed with MIP on the z axis from -15 degrees to 15 degrees. Two different radiologists evaluated MRA and DSA images and graded the stenoses on a multiple choice card: 1) negative, 2) 1-40%, 3) 41-70%, 4) 71-99%, 5) occlusion. RESULTS: MRA diagnosed 90 positives and 110 negatives: 60 were true positives, 92 true negatives, 30 false positives and 18 false negatives. MRA overestimated 8 cases and underestimated 4 cases. DSA findings were negative in 122 cases and positive in 78 cases: 4 grade 2, 10 grade 3, 28 grade 4 and 36 grade 5. Relative to DSA, MRA sensitivity, specificity and diagnostic accuracy were 72%, 75% and 74%, respectively; MRA diagnostic accuracy, sensitivity and specificity in hemodynamically severe stenoses (> 71%) were 80%, 78% and 71.8%, respectively. CONCLUSION: Our study confirms the usefulness of 2D TOF travel-sat MRA in the study of iliac-femoral stenoses.

Adult↗
PubMed1998

[Stenosis-occlusion of the carotid bifurcation. Angiography with MR and contrast media versus digital angiography].

PURPOSE: To evaluate the comparative sensitivity, specificity and diagnostic accuracy of contrast enhanced magnetic resonance angiography (CE MRA) and digital subtraction angiography (DSA) in the study of carotid bifurcation stenoses. MATERIAL AND METHODS: Twenty-three patients with suspected cerebrovascular insufficiency by carotid stenosis were examined with CE MRA and DSA within 24 hours of each other. A 1.5 superconductive unit (Signa, General Electric) was used for CE MRA; fast spoiled gradient echo recalled (SPGR) images were acquired on the coronal plane 12 s after contrast medium injection, with the following parameters: TR/TE/FA 8/1/60, MA 256 x 128, NEX 1, FOV 18 x 13, slices/slab 28, slice thickness 1 mm, TA 32 s. The images were postprocessed with the maximum intensity projection (MIP) and the targeted MIP algorithms. A Siemens Politron 1000 VR unit was used for DSA examinations. RESULTS: DSA diagnosed 21 true positives, namely 4 grade II, 4 grade III, 10 grade IV and 3 grade V stenoses. CE MRA scored 100% in stenosis identification and grading, accurately diagnosing all the true negatives and the true positives and was always in agreement with DSA as to stenosis site. CONCLUSION: CE MRA can be considered the technique of choice to study stenosis occlusion in the epiaortic vessels, because it permits a rapid panoramic study of the neck vessels and accurate stenosis grading with similar patterns to those of DSA. Thus, CE MRA appears to be a valid alternative to DSA.

Aged↗
PubMed1998

Neoplastic extension across pulmonary fissures: value of spiral computed tomography and multiplanar reformations.

To assess the value of spiral computed tomography (CT) with multiplanar reformations for detection of neoplastic extension across pulmonary fissures, 51 patients with a lung neoplasm near a fissure underwent spiral CT, followed by multiplanar reformations, and spaced thin-section CT scans through the area of contact between tumor and fissure. The CT studies were evaluated for visibility of fissures and their relationship to the tumor. Imaging findings were compared with surgical results in 31 patients who underwent thoracotomy. Visibility of fissures on multiplanar reformations was either good or acceptable in 47 (92.2%) patients, and poor in four. Surgical findings of neoplastic extension across the major or the minor fissure were present in seven and eight patients, respectively. Thin-section CT scans were 83.3% sensitive in assessing neoplastic involvement of the major fissure, axial CT scans were 57.1% sensitive, and spiral CT multiplanar images were 100% sensitive. In the evaluation of the minor fissure, thin-section CT and axial spiral CT scans were considered inconclusive in six patients whereas multiplanar reformations enabled correct assessment of the fissure/neoplasm relationship in all but one patient. Spiral CT multiplanar images are accurate for detection of transfissural neoplastic extension, and are superior to axial CT scans for evaluation of tumors near the minor fissure.

Aged↗
PubMed1998

[On De Bella's therapy].

Explore the source record for details and available documents.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

[Angiography with magnetic resonance of the body with contrast media. Experience with a 0.5 tesla device].

INTRODUCTION: We optimized the technique of contrast-enhanced Magnetic Resonance Angiography (MRA) with a .5 T superconductive magnet. MATERIAL AND METHODS: Forty patients with normal blood pressure and heart rate gave their informed consent to MRA studies with contrast agent administration. The carotid arteries were studied in 10 patients, the pulmonary arteries in 10, the thoracic aorta in 10 and the abdominal aorta and renal arteries in 10. All the examinations were performed with a .5 T superconductive magnet (Philips T5) acquiring 3D T1-weighted GE sequences with contrast agent administration. The parameters were: TR/TE/FA 13 ms/4 ms/60 degrees; 256 x 256 MA; 2 mm slice thickness; 1 NEX. The contrast agent was administered with an automatic injector (.2 mmol/kg at 1.5 flowrate) after a bolus test to evaluate circulation time. The images were studied by a radiologist rating artery visualization as "good" or "poor" on a multiple choice card. The signal-to-noise ratio was evaluated using regions of interest positioned on the examined vessels (signal) and muscles (noise). RESULTS: The mean start delay was 12.2 s for the abdominal aorta, 10.3 s and 8.7 s for the thoracic aorta and pulmonary arteries, and 10.3 for the carotid arteries. Fifty-eight of 70 vessels were well visualized and 12 were poorly visualized. The signal-to-noise ratio exceeded 1 in all districts. CONCLUSIONS: Our experience shows that enhanced MRA provides diagnostic images of body arteries even at .5 T.

Adult↗
PubMed1998

Vasodilating in MR-angiography: a comparison of techniques.

PURPOSE: To verify the hypothesis that a drug that causes vasodilation can contribute to improvement in MRA spatial resolution. To test this hypothesis, a comparison was made between the images obtained using the high resolution time-of-flight (TOF HR 3D) technique and the TOF 3D MTC TONE technique. METHODS: From November 1993 to December 1994, we studied 40 patients, of which 20 patients (16 males and 4 females; average age of 10 years; range from 3 to 20 years) we examined after they had inhaled Isoflurane (experimental group), and 20 patients (16 males and 4 females; average age 9.7 years; range from 3 to 12 years) were examined with standard MRA (control group). RESULTS: The vasodilator in both HR MRA and MTC TONE MRA permits a better spatial visualization with respect to the clinical routine MRA. On the other hand, it is true that MTC TONE gives better visualization of the small vessels. DISCUSSION: In our experience, this preliminary study indicates that with respect to routine MR, the spatial resolution is notably increased when Isoflurane is used. The signal-to-noise ratio is increased but, moreover, the ability to visualize small vessels is increased. CONCLUSION: The preliminary results obtained in this study indicate that a pharmacological drugs is capable of increasing the vascular detail of MRA images of the intracranial vessels and that continued research this direction is called for.

Adolescent↗
PubMed1997

Predictors of long-term response to high-dose interferon therapy in type II cryoglobulinemia associated with hepatitis C virus infection.

We have prospectively studied patients with type II cryoglobulinemia since 1985 to assess the efficacy of treatment with interferon-alpha at cumulative doses ranging from 234 to 849 MU. In the present study we retrospectively evaluated in this cohort parameters associated with complete response to therapy in 31 consecutive patients with type II cryoglobulinemia associated with hepatitis C virus (HCV) infection. Prevalence of complete response of cryoglobulinemia (disappearance of symptoms and signs of vasculitis and decrease of cryocrit below 10% of the initial value) was 62%, with a median response duration of 33 months and a range of 3 to 100 months. Three patients were putatively cured, as they remained in complete remission for more than 5 years off therapy. Eighteen patients (58%) had liver disease evidenced by histopathology and/or raised transaminase levels. Prevalence of normalization of transaminase levels was 100%, with a median response duration of 36 months. Relapse of hypertransaminasemia occurred in 100% and 8% of patients receiving less than or greater than 621 MU, respectively. By logistic regression analysis, the only pretherapy parameter that associated significantly (P = .0393) with complete response of cryoglobulinemia was the solitary anti-C22 (HCV core) antibody pattern, which was observed in 29% of patients. Association with older age and low cryocrit approached statistical significance (P = . 06), while no significant correlations were found with serum IgM levels, duration of disease, HCV genotype, NS5a gene mutations, liver histology, HLA-DR phenotype, or WA cross-idiotype. Complete responses were also associated, on univariate statistical analysis, with low pretherapy HCV viremia. Responses were accompanied by decrease of viremia, of anti-HCV antibody levels and cryocrit. The usefulness of a high dose regimen is underscored by the higher rates of sustained responses of cryoglobulinemia and transaminase levels compared with previous studies.

Adult↗
PubMed1997

Long-term treatment of systemic lupus erythematosus with cyclosporin A.

OBJECTIVE: To evaluate the efficacy of long-term treatment with cyclosporin A (CSA) in systemic lupus erythematosus (SLE). METHODS: Thirty patients with SLE whose condition was either poorly responsive or unresponsive to treatment with steroids and/or cytotoxic drugs were enrolled in a prospective, nonrandomized study of CSA. Patients with hypertension or hypercreatinemia were excluded. Disease activity was evaluated according to the systemic lupus activity measure. Assessments were made prior to study entry and after 6, 12, 18, and 24 months. RESULTS: Twenty-seven patients completed at least 24 months of treatment with CSA. The mean disease activity score significantly decreased after 6 months of therapy (P < 0.01); this result was maintained throughout the study. A conspicuous steroid-sparing effect was observed following administration of CSA (P < 0.01). Side effects included hypertrichosis (63% of patients), paresthesias (23%), gastrointestinal symptoms (20%), gingival hyperplasia (17%), hypertension (10%), tremors (7%), and nephrotoxicity (13%). No significant changes in serum creatinine levels were observed. CONCLUSION: CSA represents a helpful second-choice treatment for patients with active SLE. Administration of CSA necessitates expert and careful followup of patients.

Adolescent↗
PubMed1997

Staging of thoracic lymphoma by radiological imaging.

Thoracic lymphomas, which are very common especially in Hodgkin's disease patients, are characterised by enlargement of mediastinal lymph nodes, parenchymal abnormalities, and pleural, pericardial and chest wall involvement. The use of several imaging techniques has been proposed in order to assess the extent of the disease correctly and to plan therapy. The most relevant results in this field, especially those using computed tomography (CT), magnetic resonance imaging (MRI) and gallium scanning, are summarised in this review. Presently CT is widely and successfully used in staging patients, whereas MRI seems to be preferable, as a second-step technique, if pericardial, pleural and chest wall involvement are suspected. The role of gallium scanning is limited in the staging, although it could be relevant in the follow-up of treated patients.

Adult↗
PubMed1997

Magnetic resonance angiography and colour-Doppler sonography in the evaluation of abdominal aortic aneurysms.

This prospective study was aimed at comparing the diagnostic accuracy of magnetic resonance angiography (MRA) with colour-Doppler ultrasonography (colour-Doppler US) in the assessment of abdominal aortic aneurysms (AAA). Twenty patients with abdominal aortic aneurysms underwent MRA, colour-Doppler US, digital subtraction angiography (DSA) and CT. The MRA technique and colour-Doppler findings were compared with DSA as well as surgical and pathological findings, which were considered as the gold standard. In 6 patients who refused surgery, CT and DSA were considered as the gold standard. The MRA technique always correctly assessed the size and site of the aneurysms, the involvement of the renal and common iliac arteries, the course of the left renal vein, the thrombotic component and the calcifications. Colour-Doppler US always correctly assessed the size and site of the aneurysms, the thrombotic component and calcifications and the involvement of the iliac arteries. Our preliminary results suggest that MRA together with colour-Doppler US represents a valid alternative to invasive imaging in the assessment of AAA.

Aged↗
PubMed1997

Systemic lupus erythematosus and multiple myeloma: a rare association.

OBJECTIVE: The association of systemic lupus erythematosus (SLE) and multiple myeloma (MM) is an uncommon event. We report the relapse of SLE in a patient with a previous history of MM, treated with chemotherapy and, subsequently, with alpha-2b interferon (alpha-2b IFN) as a maintenance therapy. The case is discussed in light of past relevant literature. METHODS: The history and clinical, laboratory and radiographic findings of the patient, as well as the subsequent therapeutic approach are discussed. In our review of the literature, journal articles are identified by Medline search. RESULTS: We describe the case of a woman who developed a multiple myeloma 14 years after a diagnosis of SLE. A careful literature review confirms that the association of these two diseases has been reported only in a few cases. When the plasma cell neoplasia occurred, SLE had been quiescent for several years; the patient was treated with prednisone-melphalan and, subsequently, with alpha-2b IFN as a maintenance therapy. On admission to our department, SLE was in a relapse phase, probably because of IFN treatment. The disease was poorly responsive to steroid therapy and required the use of cytotoxic drugs. CONCLUSIONS: The coexistence of SLE and MM is very rare and the possible pathogenetic mechanisms underlying this association remain unclear. The use of interferon in a patient with an autoimmune disease always invites caution.

Antineoplastic Agents↗