Biomedical subjects
Publications and source records attributed to P Marano.
A rare case of a woman with the adult form of medullary cystic disease associated with pancreatic cysts in pancreas divisum is described, which suggests that specific attention should be paid to computed tomography findings in the presence of pancreatic and renal cysts.
PURPOSE: To assess the accuracy of time-of-flight MR Angiography (MRA) with bolus tracking in evaluating mean blood velocity and flowrate in the portal vein in patients with chronic hepatitis versus healthy volunteers. MATERIAL AND METHODS: Fifteen patients with clinically-defined post-viral chronic hepatitis (viruses B and C) were examined with bolus tracking MRA and color Doppler US to evaluate portal blood flow. Both examinations were performed before and after a 1500 kcal meal. We evaluated mean blood flow velocity and flowrate in the portal vein. MRA results were compared with color Doppler findings; the results in chronic hepatitis patients were compared with those of healthy volunteers. RESULTS: The correlation between mean portal blood velocity, as measured with MRA and color Doppler US, was r = .82 before and r = .79 after the meal. There was no significant difference in mean velocity between the chronic hepatitis patients and the healthy volunteers. The correlation between portal flowrate, as measured with MRA and color Doppler US, was r = .87 before and r = .91 after the meal. There was no significant difference in mean flowrate between the chronic hepatitis patients and the healthy volunteers. In contrast, there were significant differences in mean velocity and portal flowrate, as measured with MRA before the meal, between the chronic hepatitis patients and the healthy volunteers. DISCUSSION AND CONCLUSIONS: Bolus tracking MRA is superior to color Doppler US in quantitating blood flow in the portal vein and evaluating changes after a meal. Decreased mean velocity and flowrate may indicate impaired function, as it happens in early chronic hepatitis.
PURPOSE: The natural history of human breast cancer shows that lesion size correlates directly with nodal metastases and distant spread. Nodal metastases are found in only 6% of cases in the preclinical stage of the tumor and therefore imaging must detect a breast cancer before it becomes palpable. We reviewed 215 nonpalpable breast lesions studied in the last 10 years to assess observers performance and ultimately improve the interpretation of suspicious mammograms, evaluating "cost" in terms of the ratio between benign and malignant lesions (B/M). MATERIAL AND METHODS: From 1988 to October 1998, two hundred and fifteen women with nonpalpable breast lesions suspected at mammography were examined. The lesions were removed after stereotaxic or US location and a radiograph of the surgical specimen was always performed. Mammographic patterns were interpreted retrospectively by two blinded radiologist experienced in breast imaging and specialized in locating nonpalpable breast lesions. Mammographic patterns were classified as poorly/highly suspicious calcifications, regular/irregular masses, spiculated masses, masses with calcifications and parenchymal distortions. Radiographic findings were compared with surgical results and the data used to calculate the B/M, positive predictive value (PPV) for malignancy and the trend of operator's performance. RESULTS: Modern techniques permit to detect a very high number of in situ breast carcinomas. Nineteen of 22 lesions (86%) were detected by mammography as highly suspicious calcifications, 2/22 as spiculated masses and 1/22 as a mass with calcifications. No in situ carcinoma was detected as an irregular mass. All regular masses were proven to be benign at histology. B/M analysis showed a decreasing trend (from 1.94 in the first 3 years to .57 in 1994-96, to .83 in 1997-98) and an overall value of .90. The PPV for malignancy was 83.33% for spiculated masses, 65.5% for highly suspicious calcifications, 63.63% for irregular masses, 47.05% for masses with more or less dysmorphic calcifications, 32.65% for poorly suspicious calcifications, 8.33% for parenchymal distortions and 0% for regular masses. DISCUSSION AND CONCLUSIONS: All spiculated masses and highly suspicious calcifications and microcalcifications should be removed. Biopsy is recommended in parenchymal distortions, despite its low predictive value for malignancy, because these lesions are uncommon and the cost of biopsy is therefore acceptable. Needle aspiration or long-term monitoring can be reconsidered for irregular masses and poorly suspicious microcalcifications. Finally, relative to possible different interpretations of mammographic patterns by center and operator's experience, we suggest that the PPV for every single pattern be continually reassessed based on personal case records rather than on literature data. This holds true especially for microcalcifications.
PURPOSE: To evaluate the possible optimization of a well-tolerated and versatile method of intestinal preparation able to adequately free the lumen and consequently improve diagnostic results with a lower risk of prolonged hospital stay for incorrectly prepared patients. MATERIAL AND METHODS: We examined 40 patients, namely 20 men (mean age 70 years, range 52-87) and 20 women (mean age 68 years, range 49-81) referred to the Institute of Radiology of the Università Cattolica del Sacro Cuore, Gastrointestinal tract Unit, to undergo double contrast colonic enema. The patients were divided into two groups by one-to-one randomization: group 1 was prepared with the conventional method and group 2 with the new protocol for intestinal preparation. On the two days before the examination a low-residue diet was administered; the day before the examination a phial of Fosfo-soda fleet was administered in two times (at 8 am and 4.30 pm), which was diluted with half a glass of water. Bread, pasta and vegetables were strictly forbidden at lunch and soup or milk at supper; the patients were fasted on the examination day. Two evaluations were performed: one to assess tolerance to the preparation and the other, a radiographic study, to assess the grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting. RESULTS: Of the 20 patients given X-prep, 3 had to discontinue it and 4 exhibited severe side-effects, but completed the treatment; tolerance was satisfactory in the remaining 13 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 9, 17 and 16 patients respectively. None of the patients given Fosfo-soda fleet had to discontinue it and tolerance was satisfactory in 19 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 15, 18 and 18 patients respectively. The statistical analysis of all data was performed with Wilcoxon test. DISCUSSION: Intestinal preparation with Fosfo-soda fleet appeared to be definitely better than the conventional method relative to tolerance (p = .02, a statistically significant difference), while providing similarly satisfactory data relative to the other parameters. CONCLUSIONS: Our results, coupled with the versatility of Fosfo-soda fleet (possible application in colonoscopy) and its ease of use recommend this preparation not only for inpatients but also for outpatients in whom self-administration is feasible.
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OBJECTIVES: To describe the radiological features of primitive neuroectodermal tumour (PNET) of the chest wall (Askin tumour) at diagnosis and to analyse the radiological changes occurring as a consequence of treatment and during follow-up. MATERIALS AND METHODS: Nine children with histologically proven PNET were studied. At diagnosis, all patients underwent chest X-ray (CXR), chest CT and bone scintigraphy; three patients also had MR and three had US. During treatment and follow-up, CT was performed in all patients. RESULTS: CT demonstrated a solid heterogeneous chest wall mass in all children at diagnosis and six had a rib lesion. Small nodular densities in the extra-pleural fat were identified in three patients at diagnosis. US, performed in three patients, excluded tumour infiltration of the lung or diaphragm, which had been suspected on CT. On MR, the lesions showed high signal intensity in T1-weighted/proton-density images and intermediate/high signal intensity in T2-weighted images compared with muscle. Minimal chest wall involvement was demonstrated in one case by MRI. Extensive necrosis of tumour mass with pseudo-cystic appearance was documented in the five patients who underwent chemotherapy. Macroscopically complete resection was performed in five patients but there was early local recurrence after surgery in two, identified by CT in one and by MR in the other. CONCLUSIONS: PNET of the chest wall should be considered in a child with a chest wall mass. CT is valuable for evaluating tumour extension at diagnosis, the effects of chemotherapy and assessing tumour recurrence after surgery. However, CT can overestimate pleural, lung or diaphragmatic infiltration, which are better evaluated by US. MR was superior to CT in the evaluation of tumour extension in one of three patients and may be considered complementary to CT, particularly in very large chest wall tumours.
We report an unusual evolution of turpentine-induced pneumonia due to accidental aspiration in a 21-month-old child. Chest X-rays demonstrated patchy alveolar densities evolving into large pneumatoceles. Follow-up CT optimally depicted the number, site and extent of pneumatoceles. To our knowledge, pneumatoceles developing in turpentine-induced pneumonia have never been reported in turpentine aspiration.
PURPOSE: To determine the accuracy of magnetic resonance (MR) imaging in evaluating the invasive cervical carcinoma response to concurrent chemotherapy and radiation therapy. MATERIALS AND METHODS: MR imaging was performed before and after concurrent chemotherapy and radiation therapy in 18 patients with locally invasive cervical carcinoma. Surgery followed neoadjuvant therapy in all patients. The presence of a lesion, signal intensity, zonal anatomy integrity, vaginal and parametrial invasion, and lymph node enlargement was determined. Posttreatment MR and histopathologic findings were correlated. RESULTS: Fourteen patients had histopathologic confirmation of MR findings: Twelve had true-negative and two had true-positive findings. (Two had microscopic neoplastic foci beyond the spatial resolution of MR images; these foci do not change surgical treatment planning and probably do not influence prognosis. Therefore, these two patients were considered to have complete response). Four patients had false-positive findings; the hyperintense lesion on posttreatment MR images was due to a tunnel cluster pattern (focal hyperplasia of the endocervical glands with inflammation) in three patients and necrosis in one patient, without any evidence of neoplastic tissue. Thirty-three of 36 parametrial halves and 67 of 72 vaginal fornices were correctly interpreted on posttreatment images. Involvement of three parametrial halves and five fornices was overestimated at MR, because edema or inflammation was not distinguishable from tumor. CONCLUSION: MR imaging is 78% accurate in evaluation of tumor response; in 22% of patients, however, benign conditions were not distinguishable from tumor.
INTRODUCTION: The spreading of interventional procedures and the frequent use and replacement of central venous catheters have contributed to a relative increase in the occurrence of intravascular foreign bodies (FBs). Their retrieval is justified by potential complications related to their characteristics, location and permanence. The high morbidity related to surgical retrieval, especially in case of intravenous FBs (often located in the right cardiac chambers or the pulmonary artery) has contributed to the spreading of interventional retrieval procedures. The purpose of percutaneous retrieval is: 1) to hook the FB to stop its migration to more critical districts; 2) to extract it through the percutaneous access route or, if the latter is unfeasible, 3) to simplify surgical retrieval. MATERIAL AND METHODS: We report our experience with 15 patients presenting an FB [intravenous (i.v.) in 11 cases and intra-arterial (i.a.), in 4]. Retrieval was performed mainly with snare-loop catheters (13 cases, together with a pig-tail catheter in 3 patients) and also with Dormia baskets (3 cases, together with a snare loop in 1 case). To ensure the percutaneous retrieval, we used introductors with a greater caliber than that of the FB, the latter generally being a 6-7 F intravenous catheter. The percutaneous approach was mostly transfemoral (right femoral in 9 cases and bilateral femoral, left femoral, axillary and left jugular in 1 case each). RESULTS: Percutaneous retrieval was successful in all the i.v. cases and in 1 ia case. The other 3 ia cases required surgical removal under local anesthesia after percutaneous hooking and displacement of the FB to a more accessible site. No major complications were observed during retrievals. CONCLUSIONS: Based on our personal results and in agreement with the major international reports, we believe that percutaneous retrieval should be considered the treatment of choice for FBs. The procedure success depends on an accurate diagnostic approach, good knowledge of materials and techniques and the operator's experience, as well as the possibility of an interdisciplinary collaboration of the interventional radiologist with the surgeon and anesthesist.
AIM OF THE STUDY: Magnetic Resonance pancreatography (MRP) was performed before and after the intravenous injection of secretin to assess the improvement in pancreatic duct visualization and to perform a dynamic study of the pancreatic exocrine function. MATERIAL AND METHODS: 20 MRP examinations were performed in 18 patients with suspected or known chronic pancreatitis. Coronal T2-weighted half-Fourier SSFSE images were obtained with a phased array surface coil. Images were obtained before and up to 10 minutes after the injection of 1 cu/kg b.w. secretin. Quantitative image analysis included main pancreatic duct enlargement over time after secretin injection and the amount of duodenal filling. Qualitative image analysis included: overall image quality improvement, number of pancreatic duct segments visualized, secondary ducts dilation, intraductal filling defects, the presence of pancreas divisum. RESULTS: After secretin injection the overall image quality was judged sufficient in 2 patients and satisfactory in 18 patients. The number of pancreatic duct segments visualized increased from 40/57 (79%) to 57/57 (100%); secondary ducts were visualized in 4 patients before secretin compared to 18 after secretin. The number of stenosis visualized increased from 6 to 9, while intraluminal filling defects increased from 2 to 6. Pancreas divisum was detected in 2 patients after secretin versus 0 before secretin. The main pancreatic duct enlargement was statistically significant in the head of the pancreas (p < .05). Duodenal filling was normal in 13 patients and decreased in 7. DISCUSSION AND CONCLUSIONS: Secretin injection extends the capabilities of MRP in visualizing the morphologic features of pancreatic ducts. The depiction of pancreatic ducts, stenosis, filling defects and pancreas divisum was improved after secretin injection. The exocrine function of the pancreas can be evaluated analyzing the entity and the timing of the duodenal filling.
PURPOSE: The goal of this trial was to determine the maximum tolerable dose when carboplatin (CBDCA) was administered in continuous infusion concurrently with radiotherapy in patients with nonsmall cell lung cancer. METHODS AND MATERIALS: From October 1989 to July 1993, 54 patients were studied (male/female ratio: 44 to 10), median age was 62 years. Two patients had Stage II cancer, 22 had Stage IIIA, 24 had Stage IIIB, and 6 had Stage IV. Carboplatin was given for 96 h, starting at a dose of 30 mg/m2/day: 13 patients received 30 mg/m2/day (group A), 12 patients received 50 mg/m2/day (group B), 12 patients received 70 mg/m2/day (group C), 10 patients received 90 mg/m2/day (group D), and 7 patients 110 mg/m2/day (group E). The radiation dose was 50.40 Gy delivered to the target volume in 5.3 weeks. RESULTS: Fifty-three of 54 patients were evaluable for toxicity and 52 out of 54 for response. Toxicity (Miller score): Myelotoxicity: in groups A and B it was almost absent; in groups C and D it was moderate (leukopenia G1-2: 45.4% patients; trombocytopenia G1-2: 22.7%, G3: 9%; anemia G1-2: 9%); only in group E was it severe (leukopenia G1 and G3 16.6% respectively; trombocytopenia G3: 33.3%, G4: 16.6%; anemia G1-2: 50%). Nephrotoxicity was present only in one patient of group E and was Grade 3. Nausea and vomiting were related to CBDCA dose. One patient in Group E died of intractable toxicity 3 days after the end of infusion; then the study was closed. The limiting toxicity dose was shown to be 110 mg/m2/day given for 96 h. Clinical response rate: Twenty-six of 52 patients had major response, 24 had minor response, and only 2 patients had progression of disease. SURGERY: Twenty-one of 52 tumors were judged resectable: 18 patients had complete tumor resection, 1 had exploratory thoracotomy, and 2 patients refused surgery. Pathological response rate: Five patients had pathologic state T0 or Tis. CONCLUSIONS: These results indicate that the maximum tolerable dose of CBDCA infusion for 96 h is 90 mg/m2/day, and this schedule seems to produce an appreciable response rate. Therefore, we have started a Phase II trial, which will permit us to define the true efficacy of this schedule.
PURPOSE: To determine the types and prevalence of lumbosacral junction injuries associated with an unstable pelvic fracture and to assess the diagnostic value of conventional radiographic and computed tomographic (CT) findings. MATERIALS AND METHODS: Anteroposterior, inlet, and outlet radiographs and CT scans in 97 patients with pelvic disruption were retrospectively reviewed. RESULTS: Unstable pelvic fractures were seen on radiographs in 73 patients, 42 of whom had a sacral fracture. Fourteen of these 42 patients had an associated L5-S1 facet joint injury (three extraarticular, nine articular, and two complex). In three of these 14 patients, the L-5 body was laterally bent by more than 10 degrees, with asymmetric L5-S1 intervertebral space. The diagnosis in nine of the 14 patients with an associated lumbosacral junction injury was rendered on the basis of CT findings only. CONCLUSION: Lumbosacral junction injury must be considered in patients with an unstable pelvic fracture, especially in those with an associated sacral fracture. CT is necessary because these conditions may be overlooked on radiographs, although outlet radiographs are better than CT scans for depicting the possibly associated L5-S1 intervertebral disk lesion.
PURPOSE: Magnetic resonance angiography (MRA) can be used to measure flow velocity in the portal vein noninvasively. Our study was aimed at measuring mean flow velocity in the portal vein and section area and overall portal flow with bolus tracking MRA versus color Doppler US. MATERIAL AND METHODS: Twenty healthy volunteers were submitted to presaturation bolus tracking MRA and color Doppler US before and after a 1500 Kcal meal. The images were acquired during breath-holding and analyzed prospectively for the following parameters: mean flow velocity, portal vein caliber and flow, before and after a meal. MRA measurements were made on both baseline images and MIP reconstructions. RESULTS: Before the meal, mean portal flow velocity was 17.07 +/- 3.01 cm/s with MRA versus 17.46 +/- 3.12 cm/s with color Doppler US (r = .85). After the meal, mean velocity was 24.52 +/- 3.8 cm/s with MRA and 24.8 +/- 4.0 cm/s with color Doppler US (r = .85). After the meal, portal velocity increased by 44% with MRA and by 42% with color Doppler US. Before the meal, the portal vein section area was 1.27 +/- .32 cm2 with MRA and 1.17 +/- .29 cm2 with color Doppler US (r = .86), versus 1.52 +/- .30 cm2 with MRA and 1.44 +/- .27 cm2 with color Doppler US (r = .85) after the meal. Portal vein flow was 1248.4 +/- 302.46 mL/min with MRA and 1202.85 +/- 316.12 mL/min with color Doppler US before the meal, versus 2252.45 +/- 523.90 mL/min with MRA and 2202 +/- 576.74 mL/min with color Doppler US (r = .91) after the meal. Portal vein flow increased by 78% with MRA versus 83% with color Doppler US after the meal. DISCUSSION AND CONCLUSIONS: Bolus tracking MRA is an accurate method to quantitate mean velocity, section area and blood flow in the portal vein.
PURPOSE: To evaluate intraluminal brachytherapy (ILBT) in patients with extrahepatic bile duct or pancreatic cancers. MATERIALS AND METHODS: Thirty-one patients (aged 33-87 years) with unresectable extrahepatic bile duct (n = 18) or pancreatic (n = 13) cancer received ILBT exclusively or as part of a definitive treatment regimen. ILBT was performed with transhepatic percutaneous drainage in four patients and with endoscopic retrograde cholangiopancreatography in 27. Fourteen patients with no metastases, an Eastern Cooperative Oncology Group performance score of < or = 2, and good hematologic parameters received combined modality treatment: 30-Gy ILBT and 45-Gy external-beam radiation therapy with continuous infusion of fluorouracil. Seventeen patients underwent 50-Gy ILBT alone for palliation. RESULTS: No direct treatment-related acute toxic reactions were seen. Three patients had cholangitis early in the study. Three patients had late gastrointestinal bleeding. Jaundice was palliated in all patients (n = 29); pain, in 11 of 13 patients. The survival rate in patients with extrahepatic bile duct cancer was 62% (five of eight) at 2 years for combined modality treatment. No patient with pancreatic cancer lived for longer than 2 years. CONCLUSION: ILBT is an effective palliative treatment of unresectable extrahepatic bile duct and pancreatic cancers. Results suggest a possible "curative" role in specific clinical settings when properly integrated with other treatments.
In the last years, lung transplantation has become a widely accepted treatment for the patients suffering from end-stage chronic lung disease. This study was aimed at investigating the role of diagnostic imaging techniques before and after lung transplantation, in the light of the physiopathological changes occurring in transplanted lungs. Our study included 4 patients (3 men and 1 woman, age range: 33-58 years): 3 of them underwent single lung transplantation and one double lung transplantation. All the operations were successful. Chest radiographs and HRCT showed the main early and late complications that occurred after transplantation. In the early postoperative period, the reperfusion syndrome was observed in 2 patients and acute rejection in the 3 patients submitted to single lung transplantation. In the late postoperative period, chronic rejection occurred in the patient submitted to left lung transplantation. None of our patients presented any infection or such airway complications as bronchial dehiscence or strictures. Both literature data and our personal experience show that preoperative diagnostic imaging allows the assessment of lung conditions, which helps choose the better side for transplantation. Moreover, lung size must be studied to match the donor's lung to the recipient's chest. In the postoperative period, both early and late complications must be investigated, all of them characterized by aspecific radiologic findings. Currently, time plays a major diagnostic role but we hope that more accurate interpretation of radiologic findings will improve the clinical assessment of lung transplant recipients.
UNLABELLED: Revascularization and prognosis after acute myocardial infarction (AMI) depend on the assessment of myocardial viability. Thus, after AMI, the myocardium may still be viable, though with contractile dysfunction. This study was aimed at comparing three tomographic methods, that is, dobutamine echocardiography (DE), thallium scintigraphy after i.v. nitrate bolus (SPET) and MRI at rest, in the assessment of viable tissue. The viability standard was post-revascularization functional recovery, as assessed with echocardiography at rest. Twenty-four patients with previous AMI (3-6 months earlier) were examined: 384 segments in all; 106 segments were a-dyskinetic and they make up our study group. At first follow-up (30-45 days), 38 segments exhibited functional recovery and were considered viable; sensitivity and specificity rates follow: 68% and 75% for DE, 75% and 55% for SPET, and 95% and 34% for MRI, respectively. IN CONCLUSION: 1) this is the first study comparing three different tomographic methods with the same myocardial segmentation for viability assessment; 2) MRI exhibited very high sensitivity, which means no false negatives; 3) SPET and MRI exhibited low specificity, due to their intrinsic limitations, but also to the inadequacy of functional recovery as a viability parameter, as indicated by PET; 4) the authors expect better results from MRI with low-dose dobutamine and first-pass ultrafast MRI with Gd-DTPA for the assessment of myocardial perfusion.
T2-weighted spin echo MR images are widely used in the detection and characterization of focal liver lesions. The main pitfall of this technique is its relatively long acquisition time. Fast spin echo sequences can provide the same contrast as conventional T2-weighted SE images in a shorter scanning time. Our study prospectively compared the effectiveness of T2-weighted conventional spin echo (CSE) versus fast spin echo (FSE) sequences in MRI of focal liver lesions. We examined 24 patients with this condition. All lesions were submitted to percutaneous biopsy and to the diagnostic gold standard technique, which was intraoperative US (13 patients), Lipiodol CT (10 patients) or 6-month follow-up (1 patient). MR images were analyzed from both a quantitative (signal-to-noise and contrast-to-noise ratios) and a qualitative viewpoints (overall image quality, lesion detection rate, number of lesions as compared with the gold standard, lesion conspicuity, internal features and the absence of artifacts). There was no statistically significant difference in contrast-to-noise ratio between the two sequences (p = 0.713). In the qualitative analysis, CSE sequences were superior to FSE for overall image quality in 50% of cases, for lesion conspicuity in 41.5% of cases and for internal features and the absence of artifacts in 46% of cases, FSE sequences had a higher detection rate in 17% of cases, even though both types of sequences underestimated the number of lesions in 29% of cases, as compared with the gold standard. To conclude, FSE sequences were inferior to CSE for image quality, lesion conspicuity, internal features and the absence of artifacts. FSE sequences were superior in the detection and characterization of fluid and nearly fluid lesions.
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