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R Passariello

Publications and source records attributed to R Passariello.

At least 19 recordsLinked to original sources
PubMed2003

Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn's disease.

BACKGROUND AND AIMS: Recently, magnetic resonance imaging (MRI) has been introduced in the diagnosis of patients with inflammatory bowel disease (IBD). However, it is still rarely reported in paediatric IBD. We studied the diagnostic value of gadolinium enhanced MRI in revealing inflammation of the distal ileum in children with Crohn's disease (CD) and in differentiating them from patients with other inflammatory diseases of the gut. MRI was performed using a polyethylene glycol (PEG) solution as oral contrast agent to distend the small bowel (CE-PEG-MRI). SUBJECTS AND METHODS: Seventy five consecutive patients (median age 13.6 years, range 8-17) with suspected CD underwent ileocolonoscopy with biopsy and CE-PEG-MRI. CD activity was measured by the paediatric Crohn's disease activity index (PCDAI). CE-PEG-MRI was evaluated with an overall score calculated, taking into account both wall thickness and contrast enhancement. RESULTS: Active CD with distal ileitis was diagnosed in 26 cases, active ulcerative colitis (UC) in 18, and spondyloarthropathy and indeterminate ileocolitis in 11; 20 children served as controls. In all CD patients, CE-PEG-MRI revealed a marked ileal involvement with increased wall thickness and parietal contrast enhancement and showed a high concordance with endoscopy and histology, whereas the test was negative in all controls. Of the 18 UC patients, CE-PEG-MRI was negative in 15 and showed a mild parietal contrast enhancement of the terminal ileum in only three of seven patients with backwash ileitis. Among the group of spondyloarthropathy patients, six had mucosal erosions and five mild superficial ileitis: CE-PEG-MRI was negative in four and revealed only mild parietal contrast enhancement of the ileal wall in seven. CE-PEG-MRI did not show an increase in wall thickness of the distal ileum in any of the UC or spondyloarthropathy patients. The sensitivity and specificity of CE-PEG-MRI related to the presence of erosive ileitis, as documented by endoscopy, were 84% and 100%, respectively. In addition, the test correlated markedly with endoscopy and histology in the entire population (r=0.94; r=0.95, respectively) as well as with the PCDAI in CD patients (r=0.91). CONCLUSIONS: In children with active CD, CE-PEG-MRI is a very sensitive and specific test for the detection of distal ileitis and for differentiation from other inflammatory diseases of the gut. The test could also be useful for the firstline diagnostic approach in children with suspected CD. The high correlation of CE-PEG-MRI with ileal endoscopy and histology as well as with PCDAI makes this test of great interest for future studies as a tool for monitoring the clinical course and the effect of therapy in CD patients.

Adolescent↗
PubMed2003

High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma.

OBJECTIVE: The purpose of our study was to evaluate the accuracy of multidetector CT (MDCT) using a high-resolution protocol in the preoperative assessment of patients with renal cell carcinoma who are possible candidates for nephron-sparing surgery. MATERIALS AND METHODS: Forty patients with suspected renal cell carcinoma underwent MDCT. Contrast-enhanced acquisitions were obtained during arterial, nephrographic, and urographic phases using a thin-slice protocol. One-millimeter-thick source images were evaluated by two observers on a dedicated workstation for the identification and characterization of the tumor, presence of a pseudocapsule or invasion of perirenal fat, involvement of adrenal glands or surrounding tissues, presence of satellite lesions within Gerota's fascia, infiltration of renal vein and inferior vena cava, involvement of lymph nodes, and presence of distant metastases. Imaging findings were compared with surgical specimens using criteria from the Robson and TNM classification systems. RESULTS: The presence and size of all lesions were correctly shown in all patients. In evaluating Robson stage I of renal cell carcinoma, we were able to diagnose fat infiltration on 1-mm scans with 96% sensitivity, 93% specificity, and 95% accuracy; the positive and negative predictive values were, respectively, 100% and 93%. One hundred percent accuracy was achieved in staging high-grade lesions. CONCLUSION: High-resolution MDCT is accurate in the preoperative evaluation of patients with renal cell carcinoma.

Adult↗
PubMed2002

Multislice spiral computed tomography in diagnosis and staging of pancreatic carcinoma: preliminary experience.

BACKGROUND: Computed tomography has become the modality of choice for preoperative evaluation of patients with suspected pancreatic carcinoma, although some limitations are well known. AIMS: To evaluate use of multislice spiral computed tomography in preoperative assessment of patients with suspected pancreatic carcinoma using volume-rendering as image reconstruction algorithm. PATIENTS: A total of 27 patients with suspected pancreatic carcinoma underwent multislice spiral computed tomography examination. METHODS: All studies were performed on a multislice computed tomography scanner with the following parameters: slice collimation, 1 mm; slice thickness, 1.25 mm; reconstruction interval, 1 mm; scan time, 22-25 sec; mAs, 165. Scans were acquired with a biphasic technique with a 30-sec (pancreatic phase) and a 70-sec (portal venous phase) delay time after start of contrast material injection. Diagnostic confirmation was obtained with surgical exploration, percutaneous biopsy, or with a combination of follow-up imaging studies. RESULTS: Multislice spiral computed tomography yielded correct diagnosis of pancreatic carcinoma in 20 cases (sensitivity, 95%; specificity, 100%). Positive predictive values for resectability and unresectability were 80% and 93.3%, respectively. Three-dimensional volume-rendered images improved diagnostic confidence in the depiction of major vascular structures. Two cases of anomalous origin of hepatic artery were also identified with volume-rendered images. CONCLUSIONS: Multislice technology improves accuracy of spiral computed tomography for diagnosis and staging of pancreatic carcinoma.

Algorithms↗
PubMed2002

Computed tomographic colonography (virtual colonoscopy): blinded prospective comparison with conventional colonoscopy for the detection of colorectal neoplasia.

BACKGROUND AND STUDY AIMS: Computed tomographic colonography (CTC), also known as virtual colonoscopy, is a recently introduced imaging modality for the detection of colorectal neoplasia. The aim of our study was to evaluate the performance of CTC in a blinded comparison with conventional colonoscopy. PATIENTS AND METHODS: A total of 66 consecutive, symptomatic patients underwent spiral computed tomography (CT) examination after standard bowel preparation. CT images were analyzed and subsequently compared with conventional colonoscopy findings. RESULTS: Conventional colonoscopy detected 15 colorectal carcinomas and 52 polyps. CTC correctly identified all carcinomas, 13 of 14 polyps greater than 10.0 mm (sensitivity 92.8 %; 95 % confidence interval (95 % CI); 77 - 100), 11 of 13 polyps between 6.0 and 9.0 mm (sensitivity 84.6 %; 95 % CI; 62 - 100), and six of 25 polyps smaller than 5.0 mm (sensitivity 24 %; 95 % CI; 6 - 42). The per-patient sensitivity and specificity were 93.7 % and 94.1 %, respectively. CONCLUSIONS: Computed tomographic colonography is an accurate imaging modality for the detection of colorectal neoplasia, especially for lesions larger than 6.0 mm in diameter.

Adult↗
PubMed2002

Multiphase multislice spiral CT for liver assessment: optimization in cirrhotic patients.

PURPOSE: The aim of our study was to optimize a multiphase study protocol with double arterial phase acquisition in a patient population with cirrhosis using a multislice spiral CT scanner. MATERIAL AND METHODS: Thirteen patients (10 males, 3 females, mean age 58 years) with known cirrhosis were selected for the study. All examinations were performed with a multislice spiral CT scanner (Somatom Plus 4 Volume Zoom; Siemens, Erlangen, Germany). Images were acquired using the following parameters: slice collimation, 2.5 mm; slice thickness, 3.0 mm; table feed, 10.8 mm/sec; mAs, 165; kVp, 120. Four scans of the hepatic parenchyma were obtained after the administration of contrast material. The first pass (early arterial phase) was acquired in a cranio-caudal direction; the second pass (late arterial phase) was acquired in a caudo-cranial direction. Early and late arterial phases were obtained during a single breath-hold of 24 sec. The third pass (portal-venous phase) was acquired with a 60-sec delay time after contrast material injection. The fourth pass (equilibrium phase) was obtained with a 180-sec delay time. Optimal delay time to start CT acquisition was assessed by means of injecting a 20-ml minibolus of contrast material and by performing serial dynamic scans every two sec at the level of the hepatic hilum. The time of peak aortic enhancement was used as the start time for the early arterial phase. Attenuation values of aorta, portal vein, and liver parenchyma were calculated in all the acquisitions. CT data from the early arterial phase were used to produce three-dimensional angiographic images of the hepatic and mesenteric circulation. RESULTS: The enhancement of liver parenchyma progressively increased from pre-contrast phase to portal-venous and equilibrium phases. The highest difference in attenuation values between aorta and hepatic parenchyma was observed during the second acquisition (early arterial phase, 247.78+/-106.29 HU) rather than during the third acquisition (late arterial phase, 185.72+/-109.23 HU); this difference was statistically significant (p<0.01). DISCUSSION: Results from our study emphasize the potential of multiphase acquisition in the evaluation of cirrhotic patients; in particular, the use of an early arterial phase is useful for studying the hepatic and mesenteric vascular anatomy, whereas the late arterial and the portal-venous phases are of paramount importance for adequate evaluation of liver parenchyma and focal lesions. Further studies are needed to evaluate whether the benefits deriving from double arterial phase acquisition would justify the increase in cost and patient radiation exposure.

Contrast Media↗
PubMed2002

Esophagogram and CT vs endoscopic and surgical specimens in the diagnosis of esophageal carcinoma.

PURPOSE: Aim of our study was to assess the accuracy of diagnostic imaging in establishing site, morphology and size of the neoplasm comparing surgical specimens or endoscopic examination with esophagograms and CT in patients with esophageal cancer. CT accuracy in defining TNM staging was also evaluated. MATERIAL AND METHODS: From 1993 to 2000 we examined 39 patients with esophageal cancer: 30 males (77%) and 9 females (23%), age range 41-85 years. All patients underwent esophagogram, digestive endoscopy, and chest and abdominal CT. In 22 patients who underwent surgery, we evaluated the correlation between diagnostic imaging and surgical specimens. Patients were divided into 3 groups on the basis of discrepancy between pathological and radiological measurements: =/<1 cm (considered as no discrepancy); 1 to 3 cm; > 3 cm. RESULTS: Esophagogram identified neoplasm in 38 patients out of 39, while CT identified neoplasm in all patients. Location and morphology of the neoplasm established at endoscopy were confirmed in all patients. Lesion length measured at esophagogram corresponded to length of surgical specimens in 13 of the 22 surgically treated patients (59%). In this group there was a dominance of polypoid and stenotic tumor forms. In the remaining 9 cases there was a dominance of ulcerative tumor forms. CT measurement corresponded in 7 patients (32%) with a dominance of polypoid and stenotic tumor forms. T staging performed with CT corresponded to surgical specimens in 12 patients (54%, T3-T4). N staging correlated in 19 patients (86%). CT identified distant metastases in 6 patients (27%). DISCUSSION AND CONCLUSIONS: Our study proves a high sensitivity of esophagogram and CT in the diagnosis of esophageal carcinoma. Esophagogram presented a higher accuracy in establishing tumor length (59% of cases, as compared to CT 32%). Tumor morphology influenced the accuracy of the esophagogram, and highest accuracy was obtained in polypoid and stenotic tumors. T staging performed with CT corresponded to surgical specimens in advanced stages (T3-T4), while accuracy was poorer in smaller superficial lesions (T1-T2) due to the inability of CT to differentiate the layers of the esophageal wall. N understaging in 14% of cases did not modify surgical management. CT presented a high sensitivity in the identification of loco-regional lymph nodes and identified distant metastases in 6 patients. In conclusion, these techniques are accurate and non-invasive and their role in establishing the correct management is therefore important.

Adult↗
PubMed2002

Magnetic Resonance Imaging of the anal canal using high resolution sequences and phased array coil: visualization of anal sphincter complex.

PURPOSE: To assess the normal anatomy of the anal sphincter complex using high-resolution MR imaging with phased -array coil. MATERIAL AND METHODS: Twenty patients, 13 males and 7 females, ranging in age between 27 and 56 years underwent MRI evaluation of the pelvic region, using a superconductive 1.5 T magnet (maximum gradient strength, 25 mT/m; minimum rise time 600 microseconds, equipped with phased-array coil. High-resolution T2-weighted Turbo Spin Echo sequences (TR, 4055 ms; TE, 132 ms; matrix 390x512; in-plane resolution, 0.67x0.57 mm) were acquired on multiple axial, sagittal and coronal planes. Images were reviewed by two experienced gastrointestinal radiologists in order to evaluate the normal anal sphincter complex. RESULTS: Optimal image quality of the anal sphincter complex was obtained in all cases. Different muscular layers were observed between the upper and lower aspects of the anal canal. In the lower part of the anal canal, internal and external sphincter muscles could be observed; in the upper part, puborectal and internal sphincter muscles were depicted. Good visualization of intersphincteric space, levator ani muscle and ischioanal space was also obtained in all cases. CONCLUSIONS: High-resolution MR images with phased-array coil provide optimal depiction of the anal canal and the anal sphincter complex.

Adult↗
PubMed2001

Multislice spiral computed tomography angiography of mesenteric arteries.

The introduction of multislice technology has improved and expanded the clinical applications of computed tomography angiography (CTA), and it is now possible to detect subtle vascular abnormalities. We optimised a high resolution CTA protocol to study the anatomy of mesenteric arteries with a multislice spiral CT scanner. We showed that multislice CTA produces images of high quality, with excellent anatomical visualisation of the main mesenteric trunks, and small collateral vessels. CTA may facilitate the diagnosis of vascular diseases, such as chronic mesenteric ischaemia, as well as acute disorders such as gastrointestinal bleeding.

Adult↗
PubMed2001

Multislice CT colonography: technical developments.

The introduction of multislice spiral computed tomography (CT) offers increased spatial resolution along the longitudinal axis, resulting in improved image quality, and dramatically reduced acquisition times, with the capability of examining large anatomic regions in a single breath hold. Dedicated protocols are still under optimization to reduce radiation exposure and to take full advantage of the new technology. This article presents a review of the literature; the impact of multislice CT on virtual colonoscopy is also discussed.

Colon↗
PubMed2001

[Diffusion-weighted echo-planar sequences for the evaluation of the upper abdomen: technique optimization].

PURPOSE: To optimize the technique for the evaluation of molecular diffusion in the abdomen. MATERIAL AND METHODS: Fifteen healthy volunteers, 6 males and 9 females, ranging in age between 24 and 31 years underwent an MRI evaluation of the upper abdomen, using a superconductive 1.5T magnet (maximum gradient strength, 25 mT/m; minimum rise time 600 ms), equipped with phased array abdominal multicoil. Diffusion study was performed with a single-shot Inversion Recovery Spin-Echo Echo-planar sequence (IR-SE-EPI) with the following parameters: TR = infinite; TE=101 ms; matrix 128 yen 128; receiver bandwidth 2080 Hz/pixel; slices: n.20; slice thickness: 8 mm; acquisition time: 5.41 s. For diffusion weighting the following b values were employed: b=30 mm/s2, b=300 mm/s2 e b=500 mm/s2. Both qualitative and quantitative (calculation of linear regression analysis and of apparent diffusion coefficient) image analysis was performed. RESULTS: Image quality was graded as diagnostic in all the cases. Image quality decreased with the increase of b values: at low b values, the anatomy of upper abdominal organs was easily recognized, whereas, at high b values, the same organs could not be adequately assessed unless the images were compared with those obtained with low b values. Magnetic susceptibility artifacts were observed in all the cases; no significant chemical-shift artifacts were observed as the fat saturation pre-pulse was employed. Quantitative analysis demonstrated an apparent diffusion coefficient of 1.58 s/mm2 for the liver, 1.61 s/mm2 for the spleen and 5,14 s/mm2 for the gallbladder. A statistically significant difference (p<0.001) was observed between parenchymatous organs (liver and spleen) and gallbladder, presenting as a stationary fluid. CONCLUSIONS: Diffusion-weighted MR sequences may be implemented for abdominal studies, but the optimization of same parameters is slightly different compared with neuroradiologic applications. The potential applications are interesting above all as regards the characterization of focal liver lesions. Further developments are awaited in both sequence optimization (greater stability and lower sensitivity to magnetic susceptibility artifacts) and data analysis, with more complex algorithms able to better quantify the real diffusion coefficient.

Abdomen↗
PubMed2001

[Role of color Doppler US in the evaluation of renal transplant].

AIM: To assess the role of Ultrasound (US), US Color Doppler (CD) and Power Doppler (PD) in the diagnosis and in the follow-up of renal graft pathology by evaluating morphological and functional features of the vasculature and comparing these to other clinical parameters. MATERIAL AND METHODS: From January 1990 to June 2000, four hundred and thirty-six renal allograft recipients (mean age 45 years) underwent periodical US, CD and PD (mean follow-up 48 months) to evaluate morphology and perfusion of the graft. Resistive index (RI) and pulsatility index (PI) were measured in order to monitor flow variations from the renal to the arcuate arteries. PD was used mainly to study the morphology of the cortical vessels. The examinations were performed on an Esaote Biomedica AU-4/5 (Genoa, Italy) using a convex 3.5 MHz probe and a linear 7.5 MHz probe. On the basis of clinical data the patients were divided into 3 groups: A) Normal, B) Acute graft dysfunction, C) Chronic allograft nephropathy. In 87 patients (20%) percutaneous biopsy or FNAB was performed. RI and PI mean values +/-SD were calculated and compared to the other diagnostic parameters considered: serum creatinine level, US morphology, CD and PD vascularization. Finally RI and PI for each group were compared using the t -test in order to determine the statistical significance of the correlation between these indices and the patients clinical conditions. RESULTS: The 436 patients were divided as follows: Group A) 170 patients (39%); Group B) 105 patients (24%); Group C) 161 patients (37%). Urological and surgical complications were ruled out in all patients. RI and PI showed a similar trend exceeding cut-off values in Group B) and C) with highest peaks in Group B. Statistical analysis demonstrated the efficacy of this method in the differentiation between normal and pathological grafts, but there was a reduced statistical difference between the two pathological groups. Histological analysis performed on 87 patients (20%) showed good correlation with RI. DISCUSSION AND CONCLUSIONS: CD is a non-invasive diagnostic method which provides flow-metric quantitative parameters for the hemodynamic assessment of the renal transplant. These values present a certain sensitivity but are not specific of renal graft dysfunction, as there is no reliable differentiation between acute rejection and other parenchymal pathologies. During the follow-up, RI and PI have no predictive value. RI variations from renal artery to cortical vessels (hylum-cortical ratio) show a good correlation with the clinical evolution of the transplant. The evaluation of RI and PI can generally be limited to renal and interlobar arteries as arcuate sampling is necessary only when the hylum-cortical ratio shows reduction or inversion. Integration of clinical and instrumental diagnoses can reduce the number of biopsies.

Acute Disease↗
PubMed2001

[Bifid median nerve in the carpal tunnel: integrated imaging].

PURPOSE: Carpal Tunnel Syndrome (CTS) is a neuropathy caused by compression of the median nerve at the level of the wrist, which is caused by different pathologic conditions. In some cases it has been associated with anatomic variations of the median nerve, mainly with the early duplication of the nerve inside the carpal tunnel (III Group of Lanz). The treatment of CTS is mainly surgical consisting in decompression by transection of the transverse carpal ligament, which is better performed by endoscopic release. The aim of our study was to evaluate the possibility to detect this anatomic variant by integrated imaging and assess the value of this information for planning treatment. MATERIAL AND METHODS: We report 6 cases of bifid median nerve examined by Ultrasonography (US) using mechanic sectorial and linear array transducers operating at 10 to 13 MHz, and by MR imaging using 0.2 T equipment. RESULTS: In all cases US transverse scans showed two adjacent oval formations with a structure similar to that of the median nerve. CONCLUSIONS. MR imaging confirmed the sonographic findings in all cases. All patients underwent open surgical treatment by decompression of the median nerve; in all cases an early duplicated median nerve was confirmed.

Carpal Tunnel Syndrome↗
PubMed2001

[Multislice spiral CT angiography in the evaluation of the anatomy of splanchnic vessels: preliminary experience].

PURPOSE: The aim of this study was to optimize the protocol for multislice spiral CT angiography and to assess the ability of the technique to detect the anatomy of splanchnic vessels, using volume rendering as reconstruction algorithm. MATERIAL AND METHODS: The anatomy of splanchnic vessels was studied in 19 patients (11 men, 8 women, age range 38-83 years) undergoing CT of the abdomen and pelvis. All examinations were performed with a multislice spiral CT scanner (Somatom Plus 4 Volume Zoom; Siemens, Erlangen, Germany) using the following parameters: collimation, 1 mm; slice width, 1 mm; table feed, 8 mm/sec; reconstruction interval, 1 mm; mAs, 120; kVp, 120. Before the study, the patients received 800 ml of water as oral contrast agent to opacify the stomach and small bowel. A nonionic contrast medium (130-140 ml; Xenetix 350, Guerbet, Aulnay-Sous-Bois, France) was infused intravenously at a rate of 3-5 ml/sec. Two scans of the abdomen and pelvis were obtained at 20-25 sec (arterial phase) and 60-65 sec (venous phase) after starting contrast medium injection. Image elaboration was performed using Vitrea 2.2 (Vital Images; Minneapolis, Minn., USA), a software with volume-rendering capabilities. RESULTS: All major arterial (celiac trunk, superior mesenteric artery, and inferior mesenteric artery) and venous (portal vein, superior mesenteric vein, inferior mesenteric vein, and splenic vein) vessels could be evaluated with excellent detail in all patients. Side branches, including small collaterals, could also be easily visualized. Volume rendered images always provided better understanding of the 3D anatomic relationships among splanchnic vessels and surrounding organs. DISCUSSION AND CONCLUSIONS: Multislice spiral CT angiography allows for optimal depiction of the anatomy of splanchnic vessels. It can be anticipated that the clinical applications of this imaging modality in the study of splanchnic vessels will be greatly expanded. However, further studies are necessary to rigorously compare the results of multislice spiral CT angiography with conventional angiography in terms of diagnostic accuracy.

Adult↗
PubMed2000

Computed tomography of the small bowel in adult celiac disease: the jejunoileal fold pattern reversal.

The aim of this retrospective study was to establish whether the distinctive intestinal fold pattern of celiac disease (CD), known by barium studies as jejunoileal fold pattern reversal (JFPR) may be recognized at CT. The number of intestinal folds per 2.5 cm, seen at CT, were counted in the jejunum and in the ileum of 22 adult patients with CD and compared with the folds of 30 consecutive subjects in whom an intestinal disease had been excluded. The results were submitted to statistical analysis by Student's t-test. In the control group the number of folds per 2.5 cm were 4.88 (SD +/- 0.78) in the jejunum and 2.84 ( +/- 0.62) in the ileum; in the CD group the number of folds were 2.42 ( +/- 1.61) in the jejunum and 5.11 ( +/- 1.24) in the ileum. There was a statistically significant difference in the number of jejunal and ileal folds between the CD patients and the control group (in both cases p < 0.001). The JFPR was seen in 15 patients with CD (68.2 %) but in none of the controls. Our study shows that JFPR is not a normal finding and can be demonstrated by CT in the majority of patients with CD.

Adult↗
PubMed2000

Contrast-enhanced color Doppler US in malignant portal vein thrombosis.

PURPOSE: To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis. MATERIAL AND METHODS: Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis. RESULTS: Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%. CONCLUSION: Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.

Aged↗