Biomedical subjects

A A Stabile Ianora

Publications and source records attributed to A A Stabile Ianora.

8 recordsLinked to original sources

PubMed2000

[Aortic intramural hematoma: aspects with spiral computerized tomography].

PURPOSE: To evaluate the signs of aortic intramural hematoma with helical CT and the diagnostic role of this technique in patients with this condition. MATERIAL AND METHODS: We reviewed the CT findings of 396 patients submitted to emergency examinations for suspected aortic dissection from 1995 to 1999. Only 18 patients (6 women and 12 men) had CT signs of aortic intramural hematoma. Helical CT studies were carried out with the following parameters: slice thickness 10 mm, reconstruction index 10, feed 1.5 mm, conventional algorithm with minimum values of 130 kV and 125 mA. All patients were examined with dynamic contrast-enhanced CT, before and after a power injection of 130 mL ionic contrast material. We studied: hematoma localization and longitudinal extension; thickness and density of aortic wall; presence and location of intimal calcifications; integrity of intimal wall; hemomediastinum and/or hemothorax. RESULTS: Aortic wall thickening appeared as a high density crescent-shaped area at baseline CT and had low density on enhanced images in all patients. Thickening was eccentric in 14/18 patients and concentric in 4/18 only; it always exceeded 4 mm. We found some intimal calcifications in 8 patients and hemothorax and/or hemomediastinum in 9 patients. A patient with type A hematoma died of cardiac tamponade a few hours after CT diagnosis. Six patients (5 type B and 1 type A) underwent anti-hypertensive treatment and radiological follow-up. Eleven patients (6 type A and 5 type B) underwent prosthesis replacement and 5 of them (3 type A and 2 type B) died of postoperative complications. In the 5 type B patients surgery was performed because of treatment-resistant pain and of the onset of ischemic complications to abdominal organs caused by involvement of the main collateral branches of the aorta. One patient with type A hematoma was submitted to drug treatment because it was judged unresectable. DISCUSSION AND CONCLUSIONS: Intramural hematoma of the aorta is a distinct pathological entity, which should not be confused with aortic dissection. The imaging techniques (TEE, CT, MRI) have an important role in the final diagnosis of aortic hematoma. Presently Helical CT and MR angiography are the main tools in the early diagnosis of this condition before the development of complications. In our experience helical CT, before and after the administration of contrast material, was accurate in identifying the hematoma localization and extension.

Aged↗

PubMed2000

[Pre- and postoperative study of the bile ducts with spiral computerized tomography].

PURPOSE: To investigate the capabilities of Helical CT in imaging the biliary tract after administration of an oral cholecystographic contrast agent. MATERIAL AND METHODS: Forty-five adult patients and one 8-year-old child were examined with Helical CT 12 hours after the oral administration of hyopanoic acid (3 g). All the examinations were performed with the following parameters: thickness 5 mm, pitch factor 1.5, standard reconstruction algorithm, acquisition time 20-30 s, image index 2.5 mm, 130 kV, 125 mA. In 37 cases CT was performed in patients candidate to laparoscopic cholecystectomy, in 8 cases to assess the positioning of surgical clips in patients with postcholecystectomy syndrome and in 1 case (the 8-year-old child) to confirm the US diagnosis of choledochal cystic dilatation. Helical CT images were reconstructed with a Volume Rendering (VR) software. RESULTS: The extrahepatic biliary tract was visualized in all the cases with CT and VR. II grade biliary ducts were visualized in 87% (CT) and 91% (VR), III grade ducts in 76% (CT) and 78% (VR), IV grade ducts in 28% and 35%, respectively. No statistically significant difference was found between CT and VR in the visualization of the biliary structures (p > 0.05), while three-dimensional VR reconstructions improved the evaluation of the anatomical relations in the biliary tract in comparison with CT both in normal cases and in patients with congenital abnormalities of the biliary tract. Also, three-dimensional VR reconstructions were superior in assessing the correct positioning of surgical clips in patients with postcholecystectomy syndrome (p < 0.05). DISCUSSION AND CONCLUSIONS: Cholecysto-cholangio-CT with VR reconstructions is a reliable imaging technique for the biliary tract in patients candidate to laparoscopic cholecystectomy, to diagnose choledochal cystic dilatation and to assess the positioning of surgical clips.

Administration, Oral↗

PubMed1999

[Vascular complications in intestinal obstructions. The role of computed tomography].

INTRODUCTION: We investigated CT capabilities in showing vascular complications (ischemia, infarction) secondary to intestinal obstruction. SUBJECTS AND METHODS: 32 patients with small bowel obstruction, subdivided in two groups, were examined with CT. The first group consisted of 12 patients with small bowel obstruction complicated by ischemic injury. It was due to loop strangulation in 10 cases and loop distension secondary to colon carcinoma in 2 cases. At surgery the loop strangulation was caused by adhesions in 9 cases and by jejunal hernia in 1 case. Vascular complications were segmentary small bowel infarction in 7 cases, colonic infarction in 2 cases and ischemia, which was resolved after loop debridement, in 3 cases. The second group consisted of 20 patients with intestinal occlusion due to adhesions complicated by a closed loop in 4 cases. All patients were examined with(out) i.v. contrast agent administration. Filling of the intestinal loops by oral contrast agent was never performed. RESULTS: CT identified the vascular injury secondary to intestinal obstruction in 11/12 patients (91%). In one case it was not possible to diagnose mild ischemia, which was found of surgery. CT findings were: loops distention in all the cases; wall thickening in 11 cases with intramural gas in 8 cases and slight contrast enhancement in 1 case; ascites in 2 cases; mesenteric edema in 9 cases; gas at the mesenteric root in 1 case. In the control group, small bowel obstruction was diagnosed with CT in all cases based on the presence of distended loops up to the occlusion site. Parietal alterations above the lesion were never found. CONCLUSION: CT is a sensitive tool for diagnosing small bowel obstruction and for assessing the site and cause of obstruction. CT plays a pivotal diagnostic role in vascular complications, giving very important indications for a correct treatment.

Humans↗

PubMed1998

[Computerized tomography findings in intestinal carcinoid].

INTRODUCTION: We studied the CT patterns of abdominal carcinoid tumors. MATERIAL AND METHODS: Eight patients with carcinoid tumors were examined with CT. The tumors were in the ileum (2 patients), duodenum (1), colon (1), and mesentery (4). Pathologic confirmation was obtained at surgery in all patients. The symptoms were the carcinoid syndrome in 2 patients, abdominal pain in 4, jaundice in 1 patient and a right lower quadrant mass in 1. All patients were examined with(out) i.v. contrast agent administration; 6 patients received oral contrast material and 2 were submitted to water enema, to enhance visualization of the distal ileum and colon. RESULTS: CT identified the tumor in all patients but correctly defined its site in 7 cases only. CT showed a small mass in the distal common bile duct in 1 case, which postoperative histology diagnosed as a malignant carcinoid tumor of the duodenum. The CT findings of carcinoid tumors were a rounded mesenteric mass displacing bowel loops in 4 cases, an infiltrating colonic tumor in 1 case, an apparently intracholedochal mass in 1, a large necrotic mesenteric mass in 1 case. CT showed lymph node involvement in 2 cases, but no liver metastases were found. A carcinoid tumor was diagnosed in 4 patients based on the typical CT finding of a mesenteric mass with radiating soft-tissue density bands resulting in a stellate pattern. No preoperative diagnosis was possible in some other cases because the CT patterns were aspecific and mimicked those of other lesions, namely of tumor of the distal common bile duct, adenocarcinoma of the right colon, submucosal tumor of the distal ileum, large necrotic mesenteric mass. CONCLUSIONS: CT is a useful tool in the detection of carcinoid tumors. The correct diagnosis can be made based on the characteristic CT finding of a rounded mesenteric mass. In our experience, however, carcinoid tumors may present with other CT patterns mimicking those of other tumors.

Aged↗

PubMedDate not supplied

Hepatic involvement in hereditary hemorrhagic telangiectasia: CT findings.

Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease, is an autosomal-dominant vascular disease characterized by mucocutaneous or visceral angiodysplastic lesions (telangiectases and arteriovenous malformations) that may be widely distributed throughout the cardiovascular system. The recognition of mucocutaneous telangiectases, the occurrence of spontaneous and recurrent episodes of epistaxis, the presence of visceral involvement, and a family history of this disease are the clinical criteria that allow diagnosis. In comparison with skin, lungs, gastrointestinal tract, and brain involvement, hepatic involvement defined by clinical criteria alone has long been considered uncommon. Our experience with a large group of HHT patients, even those asymptomatic for liver involvement, demonstrates that it is more frequent than reported and is characterized by the presence of intrahepatic shunts, disseminated intraparenchymal telangiectases, and other vascular lesions. Congestive cardiac failure, portal hypertension, portosystemic encephalopathy, cholangitis, and atypical cirrhosis have been reported as possible serious complications related to this condition. Thus, a correct diagnosis is important, and diagnostic imaging has a fundamental role in detecting alterations involving the liver. The possibilities to perform a multiphasic study and to provide high-quality multiplanar and angiographic reconstructions, gives multidetector row helical computed tomography the ability to detect and characterize the complex anatomopathologic alterations typical of this disease.

Humans↗

PubMedDate not supplied

[Computerized tomography in the study of the diabetic kidney].

PURPOSE: We investigated whether any morphometric or densitometric changes are detectable in the kidneys of type 2 diabetic patients. MATERIAL AND METHODS: We retrospectively reviewed the CT findings of 40 diabetic patients and of 20 non-diabetics (the control group) submitted to triphasic helical CT for different abdominal conditions. The type 2 diabetic patients were 23 men and 17 women, mean age 62 years, while the nondiabetic controls were 12 men and 8 women, mean age 58 years. All the CT images were analyzed using the Multiplanar Reconstruction (MPR) software. We classified the diabetic patients as either nephropathic or non-nephropathic based on laboratory signs of renal disease, and divided them into three groups based on the duration of their diabetes (0-5 years, 5-10 years, > 10 years). We evaluated morphometric features, such as the presence of parenchymal or vascular calcifications, axial and coronal renal diameters, coronal renal area, and corticomedullary ratio, and densitometric and functional features, such as unenhanced renal density, cortical and medullary density in the arterial phase, parenchymal density in the nephrographic phase, and contrast elimination. We also compared the results in our subgroups of patients with those in the controls. RESULTS: Both renal diameters on axial sections and cortical density in the arterial phase were significantly lower in the nephropathic group (p < 0.05) than in nonnephropathic patients and controls. The patients with shorter duration of their diabetes had significantly greater axial diameters (p < 0.05); a longer-standing disease correlated significantly (p < 0.05) with smaller axial diameters of kidneys and lower cortical density in the arterial phase. No significant correlation was found for any other parameter. CONCLUSIONS: Renal diameters on axial and coronal sections and cortical density in the arterial phase can be useful indices of early nephropathy in diabetic patients. Further studies are warranted to make these findings suitable for use in clinical practice.

Adult↗

PubMedDate not supplied

[Benign and malignant gastric ulcer: CT findings].

PURPOSE: To evaluate the differential CT aspects of benign and malignant gastric ulcers. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 54 patients with gastric ulcerative lesions, 47 with malignant lesions (38 adenocarcinomas, 9 lymphomas) and 7 with benign lesions. All patients underwent histological examination. CT scanning was performed with a helical scanner Picker PQ 2000, before and after intravenous contrast material administration and after adequate stomach distension, achieved by drinking at least 400 ml of water; 2 ml/kg of intravenous contrast was injected at a rate of 3.5 ml/s. After contrast administration two-phase dynamic scans were performed with a scan delay of 30O and 50O. The parameters considered were: lesion size and localization, extension of the ulcer into or beyond the body of the stomach, focal wall thickness, contrast enhancement of the ulcer, perigastric tissue morphology, presence of lymphoadenopathies and liver metastases. RESULTS: The ulcer size and localization were not significative in the differential diagnosis of benign or malignant ulcers. In 46 patients the ulcer extended within the body of the stomach (38 adenocarcinomas and 8 lymphomas), in 8 cases beyond (7 benign ulcers and 1 initial lymphoma). In 46 cases of malignant ulcers there were focal wall thickenings (> 5mm), in 1 case of initial lymphoma and in all cases of benign ulcers the thickness of the wall was normal. Contrast enhancement of the lesion was observed in 25 cases, all of which were adenocarcinomas. 33 patients had perigastric tissue abnormalites (32 with malignant lesions and 1 with benign ulcer). Lymphoadenopathies and liver metastases were detected in 30 cases and always associated to malignant ulcers. DISCUSSION AND CONCLUSIONS: The improved CT technology allows to recognize gastric ulcer. Ulcer extension into stomach body; focal wall thickening; contrast enhancement of the lesion, lymphoadenopaties and liver metastases are significative in malignant gastric ulcers. The lack of these abnormalities is characteristic of benign gastric ulcers but can be also observed in early malignant lesions.

Adult↗

PubMedDate not supplied

Hereditary haemorrhagic telangiectasia: study of hepatic vascular alterations with multi-detector row helical CT and reconstruction programs.

PURPOSE: To evaluate hepatic alterations in patients affected by Hereditary Haemorrhagic Telangiectasia (HHT) by using multidetectorrow helical CT (MDCT) and new reconstruction programs. MATERIALS AND METHODS: An MDCT multiphasic study of the liver was performed in 105 consecutive patients: 89 considered to be affected by HHT and 16 with suspicion of disease alone. The scan delay was determined by using a test bolus of contrast material. The CT examination was performed with a triphasic technique (double arterial phase and portal venous phase). Multiplanar and angiographic reconstructions were then obtained, and the images checked for the presence of shunts, hepatic perfusion disorders, vascular lesions (telangiectases and large confluent vascular masses), indirect signs of portal hypertension, and anatomical vascular variants. RESULTS: Hepatic vascular alterations were found in 78/105 cases (67/89 patients affected by HHT and 11/16 patients with clinical suspicion alone). Therefore HHT diagnosis was excluded in 5 patients. 78/100 (78%) patients with HHT had intrahepatic vascular alterations: arterioportal shunts in 40/78 (51.2%), arteriosystemic shunts in 16/78 (20.5%), and both shunt types in 22/78 (28.3%). Intraparenchymal perfusion disorders were found in 46/78 (58.9%) patients. Telangiectases were recognised in 50/78 (64.1%) patients. Large confluent vascular masses (LCVMs) were identified in 20/78 (25.6%) patients. Indirect signs of portal hypertension were found in 46/78 (58.9%) cases. Variant hepatic arterial anatomy was present in 38/100 cases (38%). CONCLUSIONS: Multiphasic MDCT and the new reconstruction programs enable the identification and characterisation of the complex vascular alterations typical of HHT.

Adolescent↗