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Biomedical subjects

M G Brizi

Publications and source records attributed to M G Brizi.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Magnetic resonance pancreatography (MRP): morphology and function.

MRCP is able to non-invasively assess the pancreatic ducts, with moderate/high agreement with ERCP: There is however a high number of false negative results, mainly due to the small size of the main pancreatic duct, especially in the tail, and side branches. Secretin stimulates the exocrine pancreas with accumulation of fluid and bicarbonates in the ductal system, and subsequent enlargement. This increase in caliber improves the assessment of the morphology of pancreatic ducts and their abnormalities. MRCP accuracy in assessing ductal abnormalities, improves after secretin administration. Furthermore, dynamic MRCP during secretin administration is also able to afford the functional evaluation of the pancreatic flow dynamics. Papillary stenosis, either idiopathic or due to Santorinicele, is easily diagnosed by means of S-MRCP. Furthermore a noninvasive assessment of the pancreatic exocrine reserve can be performed with dynamic MRCP during secretin administration.

Cholangiography↗
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Imaging of acute pancreatitis.

Pancreatitis is one of the most complex and clinically challenging of all abdominal disorders. It is classified according to clinical, morphologic and histologic criteria. The primary role of radiologic imaging in patients with suspected pancreatitis is to confirm or exclude the clinical diagnosis of pancreatitis. Second, if possible, the cause of the disease is established with the assessment of disease severity and detection of complications. Imaging can also provide guidance for percutaneous therapy. Sonography in acute pancreatitis is a good screening test in patients with suspected biliary pancreatitis and a mild clinical course. Contrast-enhanced CT is preferred for patients with acute pancreatitis because it can accurately diagnose and stage the disease and the necessary information for percutaneous management is provided. The diagnosis of acute pancreatitis on MRI relies on the presence of morphologic and peripancreatic changes. Pancreatic necrosis and complications of acute pancreatitis such as hemorrhage, pseudocysts or abscesses are well-examined by MRI.

Acute Disease↗
PubMedDate not supplied

Imaging of chronic pancreatitis.

Chronic pancreatitis is characterized by progressive, irreversible morphologic changes whose most common cause is excessive alcohol intake. Radiologic imaging plays a major role in the diagnosis, staging of disease severity, detection of complications and selection of treatment options. The sensitivity of US ranges from 60% to 70% while its specificity is higher reaching 80%-90% in the detection of abnormalities of main pancreatic duct. As for CT, its sensitivity and specificity in the diagnosis of chronic pancreatitis, in recent studies is 74% and 85% respectively. The performance of Magnetic Resonance cholangiopancreatography was shown to be enhanced by secretin stimulation with better visualization of ductal and parenchymal changes. However, endoscopic retrograde cholangiopancreatography is the most sensitive indicator of the presence and extent of the disease. Ductal abnormalities can be used to classify chronic pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Staging of pancreatic ductal adenocarcinoma with spiral CT and MRI.

Detection of pancreatic adenocarcinoma is crucial for accurate staging both with spiral CT and dynamic MRI; consequently an accurate technique is required and so-called pancreatic phase is recognized as the best one for tumor conspicuity. For vascular involvement optimal results have been achieved in assessing unresectability; vein involvement seems more difficult to be defined as it is sustained by a different spread compared to arterial involvement. Grading of vessel circumference contact represents the best tool in "venous" staging, but shape deformation and collateral veins dilation are also important signs. Lymph node staging is less accurate, lacking in specificity, but spiral CT demonstrated better results if compared with dynamic MRI. Assessment of liver metastases has been improved by the advent of spiral CT and dynamic contrast enhanced MRI, while peritoneal staging seems to be unaffected. In conclusion, both spiral CT and dynamic contrast enhanced MRI are accurate in pancreatic adenocarcinoma staging, mainly for vessels and liver involvement; no definite differences have been established, because only a few studies have compared them both with state-of-art techniques. Therefore standardized multicentric trials are desirable. Up to now, the choice of which technique to employ should be based on local expertise; moreover, the aggressive approach of surgical equipes should be kept in mind.

Carcinoma, Pancreatic Ductal↗
PubMedDate not supplied

Clinical correlations of small bowel CT and contrast radiology findings in Crohn's disease.

BACKGROUNDS AND OBJECTIVE: Aim of the present study was to evaluate the clinical correlates of small bowel CT patterns in patients with Crohn's disease (CD), as compared to barium studies and endoscopic findings, as far as parameters of disease activity are concerned. MATERIAL AND METHODS: Thirty five patients with pathologically proven CD were studied by means of helical single detector CT (13) or multidetector CT (22), after administration of low density contrast by mouth (13) or by nasojeunal tube (22). Eight hours later, all patients were studied with barium administered by mouth (13) or with barium and methilcellulose administered by nasojeunal tube (22). Clinical activity was assessed by CDAI score, ESR, CRP, alpha1 glycoprotein and fibrinogen levels. In twenty one patients, colonoscopy was also performed. RESULTS: Sensitivity of small bowel CT versus endoscopy was of 88% while sensitivity of barium studies was of 77% versus endoscopic findings, and it reached 100% for the combination of both exams. We found positive correlations between the detection at CT of "target sign" and a CDAI score > 150 or abnormal values of CRP, ESR, alpha1 glycoprotein. Abnormal ESR or fibrinogen levels were correlated with the detection of fistulas at CT scans. The diameter of enlarged mesenteric lymph nodes was correlated with alpha1 glycoprotein values. No similar correlations were detected for contrast radiology findings. DISCUSSION: This study underscores the clinical usefulness of performing small bowel CT in adjunct to conventional diagnostic studies in Crohn's disease patients. CT findings (either by oral route or nasojeunal tube) correlate with parameters of disease activity.

Adult↗
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Staging rectal cancer with CT: methodology, signs and parameters.

Computed Tomography plays a major role in the staging of rectal carcinoma even if discordant results are reported in literature. The use of more sophisticated procedures has markedly improved its accuracy which is still high in advanced tumors and is irreplaceable, though with considerable limitations, in the assessment of distant lymphadenopathy. The methods, the indications and limitations of computed tomography are reported. Attention is focused on the pathological findings for the definition of TNM, which is mandatory to plan a correct therapeutic approach.

Humans↗
PubMedDate not supplied

Carcinoma of the pancreatic head area. Diagnostic imaging: ultrasound.

At present ultrasound (US) is performed as first choice exam in the diagnostic approach to the patient with suspected carcinoma of the pancreatic head area. The role of US is limited because of the difficult assessment of the infiltration of peripancreatic fat, of hollow viscera and of adjacent vascular structures. Lymph node invasion is better shown by CT than by US. A significant improvement in the diagnostic accuracy may be possible with the clinical application of the new US procedures as color-Doppler US, endoscopic US and laparoscopic US.

Humans↗
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Carcinoma of the pancreatic head area. Diagnostic imaging: computed tomography.

CT is at present considered the most accurate procedure in the staging of tumors of the pancreatic head area. Accuracy is based on a rigorous exam performed either with a conventional equipment or with spiral CT. Basic signs and symptoms and staging criteria according to TNM classification are analyzed. Comparison with other imaging methods is made based on a review of the literature. The role of a high resolution procedure is stressed especially in case of vascular infiltration, the determining factor to indicate resectability. In this respect CT is still to be considered the most reliable method.

Humans↗
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Carcinoma of the pancreatic head area: follow-up.

Preliminary results of a planned follow-up schedule based on periodic clinicoinstrumental controls applied to a population of 73 patients with pancreatic cancer undergoing combined modality treatments modulated according to the different prognosis, are reported. The following considerations are stressed: 1) the feasibility of scheduled controls is confirmed by the low rate (1.4%) of patients lost to follow-up in spite of the rapidly fatal course of the disease, characterized by the deteriorating performance status in most patients; 2) radiologic exams should be performed in the same center where the patients were initially staged by a team experienced in the natural history of this disease and aware of the difficulties in assessing the treatment, surgery in particular; 3) supportive care plays a major role in patients followed-up for the frequent onset of symptoms which impact on the quality of life; 4) the interdisciplinary collaboration between surgeons, oncologists, radiotherapists, endoscopists and experts in nutrition and pain relief plays a major role.

Aged↗
PubMedDate not supplied

Diagnostic imaging of abdominal tuberculosis: gastrointestinal tract, peritoneum, lymph nodes.

Abdominal tuberculosis is usually associated to pulmonary tuberculosis. The most frequent gastrointestinal form is ulcerative illeocecal tuberculosis. Esophageal, gastric and duodenal locations are rare; jejunal and proximal ileal tuberculosis are rare during tuberculous peritonitis. The most common form with liver and spleen involvement is miliary tuberculosis, the macronodular form being rare. Tuberculous peritonitis is a common manifestation of abdominal tuberculosis with various aspects according to the presence of ascitis and the predominant fibrotic reaction. Most common abdominal manifestation is represented by lymph node involvement with four patterns recognized on CT. In AIDS patients together with Mycobacterium tuberculosis infection, there may be Mycobacterium avium complex infection with often indistinguishable imaging findings. Patterns are similar to those of immunocompetent patients, except for markedly immunocompromised subjects in whom disseminated forms are observed.

AIDS-Related Opportunistic Infections↗