Biomedical subjects

Antonella Filippone

Publications and source records attributed to Antonella Filippone.

8 recordsLinked to original sources

PubMed2007

Inflammatory chronic disease of the colon: how to image.

Inflammatory bowel disease, including Crohn's disease and UC, is a chronic disorder of the gastrointestinal tract. The inflammatory process in UC is confined to the mucosa and submucosa and it involves only the colon. In contrast, in Crohn's disease the inflammation process extends through the bowel wall layers and it can involve any part of gastrointestinal tract. Moreover, inflammatory bowel disease of the colon may be associated with complications, such as toxic megacolon, fulminant colitis, acute bleeding, fistulas and abscesses. Radiographic imaging studies are useful for the diagnosis of inflammatory bowel disease, and may be used to assess the extent and severity of disease, rule out complications, and monitor the response to therapy. The double-contrast barium study is a valuable technique for diagnosing inflammatory bowel disease colonic alterations, even in patients with early mucosal abnormalities. The earliest finding of UC is characterized by a fine granular appeareance of the colonic mucosa, usually involving the rectosigmoid junction. In chronic UC double-contrast enema may reveal marked colonic shortening with tubular narrowing of the bowel and loss of haustration. The earliest radiographics findings of Crohn's disease are represented by aphthous ulcers. As disease progresses, aphthous ulcers may enlarge and coalesce to form stellate or linear areas of ulceration. In advanced Crohn's disease, transmural ulceration may lead to the development of fissures, sinus tracts, fistulas, and abscesses. Cross sectional studies such as computed tomography, magnetic resonance imaging and sometimes ultrasound, are useful alternative tools not only in the assessment of bowel wall abnormalities, but also for the assessment of extraluminal alterations in patients with advanced disease.

Barium Sulfate↗

PubMed2006

Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection?

PURPOSE: To retrospectively determine the sensitivity and specificity of unenhanced, delayed enhanced phase (DEP), and arterial enhanced phase (AEP) multi-detector row computed tomography (CT) for depicting endoleaks during follow-up of endovascular aneurysm repair. MATERIALS AND METHODS: Fifty patients (two women, 48 men; mean age, 72 years) underwent follow-up multi-detector row CT 1, 6, and 12 months after endovascular aneurysm repair. Unenhanced CT was performed with 2.5-mm collimation; 1-mm collimation was used with AEP and DEP examinations. Two independent readers assessed the presence of endoleak in three reading sessions: AEP (session A), unenhanced and AEP (session B), and AEP and DEP (session C). At 6- and 12-month follow-up, a fourth set was included: 1-month unenhanced and AEP (session D). Sensitivity, specificity, and positive predictive value of each session were calculated. Triple-phase multi-detector row CT was the reference standard. RESULTS: At 1 month, sensitivity, specificity, and positive predictive value, respectively, were 79%, 75%, and 55% for session A; 93%, 97%, and 93% for session B; and 93%, 78%, and 62% for session C. At 6 months, sensitivity, specificity, and positive predictive value, respectively, were 92%, 68%, and 48% for session A; 92%, 100%, and 100% for session B; and 100%, 84%, and 67% for session C. At 12 months, sensitivity, specificity, and positive predictive value, respectively, were 80%, 80%, and 50% for session A; 90%, 98%, and 90% for session B; and 100%, 80%, and 56% for session C. Sensitivity did not significantly differ (P > .05) among reading sessions A, B, and C, whereas specificity and positive predictive values in session B were significantly higher (P < .001). For 6- and 12-month follow-up, no significant differences (P > .05) were found between sessions D and B. CONCLUSION: The combination of AEP and unenhanced imaging performed at 1-month follow-up offers improved specificity and positive predictive values compared with AEP alone. DEP imaging does not significantly increase sensitivity for detection of endoleaks, but it does depict low-flow endoleaks not seen at AEP.

Aged↗

PubMed2006

Bowel obstruction: comparison between multidetector-row CT axial and coronal planes.

Acute obstruction of bowel is a common reason for presentation to the emergency department. Causes of obstruction are multiple (tumorous, inflammatory, postoperative, or congenital), but the clinical presentation is usually not specific. The abdominal radiographs are sometimes inconclusive, and cause of obstruction is rarely detected. Computed tomography (CT) has been shown to be useful in revealing the site and the cause of obstruction. Although radiologists are skilled in the interpretation of CT scans in the axial plane, the development of multidetector-row CT coupled with fast reconstruction hardware and software has stimulated interest in viewing abdomen in coronal plane. In the evaluation of small bowel obstruction, coronal plane serves as a useful adjunct for the identification of the point of transition from dilated to decompressed bowel. On the other hand, in the evaluation of large bowel obstruction, coronal planes could replace axial images in the evaluation of the site and cause of obstruction, although the best values of confidence level in the diagnosis are reached when interpreting axial combined with coronal images.

Contrast Media↗

PubMed2005

Clinical management of hepatic malignancies: ferucarbotran-enhanced magnetic resonance imaging versus contrast-enhanced spiral computed tomography.

This study compares ferucarbotran-enhanced magnetic resonance (MR) imaging with spiral computed tomography (CT) in the clinical management of patients with suspected hepatic malignancy. One hundred fifty-nine patients with suspected liver malignancy were included in a prospective, multicenter, phase IIIB clinical trial. Patients were examined with baseline plus contrast-enhanced spiral CT and with baseline plus ferucarbotran-enhanced MR imaging. For each patient, four maps of liver lesions were constructed by a trusted blind party on the basis of (a) baseline plus contrast-enhanced spiral CT, (b) baseline MR imaging, (c) baseline plus ferucarbotran-enhanced MR imaging, and (d) final diagnosis. Three blinded experts evaluated the treatment options for each map. The concordance of the treatment choice based on imaging with the treatment choice based on final diagnosis was verified. The final therapeutic decision was radical therapy for 85 patients, palliative therapy for 49 patients, and no treatment for 25 patients who had a final diagnosis of benign lesion. Proper treatment allocation was achieved in 121 (76%) of 159 patients when the evaluation was based on liver maps obtained from spiral CT, in 97 (61%) of 159 patients when the evaluation was based on liver maps obtained from baseline MR imaging, and in 136 (85%) of 159 patients when the evaluation was based on liver maps obtained from baseline plus ferucarbotran-enhanced MR imaging. MR imaging with ferucabotran was significantly superior to spiral CT for correct treatment allocation (P = 0.0167). Ferucarbotran-enhanced MR imaging is superior to spiral CT in clinical management of patients with suspected hepatic malignancy.

Adult↗

PubMed2004

Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography--initial experience.

PURPOSE: To evaluate the accuracy of contrast material-enhanced multi-detector row computed tomographic (CT) colonography for preoperative staging of colorectal cancer. MATERIALS AND METHODS: Forty-one patients with colorectal carcinoma underwent preoperative contrast-enhanced multi-detector row CT colonography. Images were obtained in the arterial (start delay of 35 seconds) and portal venous (start delay of 70 seconds) phases. The arterial phase was focused on the suspected region of neoplasm, whereas the venous phase included the whole abdomen and pelvis. Two radiologists independently evaluated the depth of tumor invasion into the colorectal wall (T) and regional lymph node involvement (N) on transverse CT images alone and in combination with multiplanar reformations (MPRs). Disagreements were resolved by means of consensus. CT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were assessed. Differences in accuracy for T and N staging were assessed by using the McNemar test. RESULTS: In T staging, overall accuracy was 73% when transverse images were evaluated alone and 83% when they were evaluated in combination with MPRs. This difference was not significant. N staging was associated with an overall accuracy of 59% with transverse images alone and 80% with combined transverse and MPR images (P <.01). CONCLUSION: Contrast-enhanced multi-detector row CT colonography is an accurate technique for preoperative local staging of colorectal tumors.

Adult↗

PubMed2002

Which continuous US scanning mode is optimal for the detection of vascularity in liver lesions when enhanced with a second generation contrast agent?

OBJECTIVES: Microbubble echo-enhancers help in the assessment of focal liver masses by enhancing the signal from blood vessels. A variety of linear and nonlinear scanning modes are now available, but it is unclear which is optimal. A controlled comparison was performed during the infusion of such an agent (SonoVue: Bracco, Milan, Italy). METHODS AND MATERIALS: Ten patients with known focal liver lesions were studied. The diagnoses, confirmed on dual phase helical computed tomography (CT) at the same attendance were metastasis (n = 7), haemangioma (n = 2) and focal nodular hyperplasia FNH (n = 1). A dose of 12 ml SonoVue concentrated at 5 mg/ml was infused intravenously at a rate of 1 ml/min. The enhancement level was monitored with a continuous wave (CW) Doppler probe over the right radial artery and the intensity of the signal was registered at 1 s intervals. When a plateau of enhancement was reached, a single lesion in each patient was imaged using five different continuous scanning modes, fundamental grey scale (FGS); fundamental colour Doppler (FCD); fundamental power Doppler (FPD); second harmonic grey scale (HGS); and pulse inversion mode (Pim) using an HDI5000 scanner and C5-2 probe (ATL, Bothell, WA). The order of scanning modes was varied between patients using a predefined randomisation protocol. The videos (super video home system (SVHS)) were analysed offsite by two blinded readers, both experienced in contrast ultrasound of the liver. The readers were asked to score each mode in terms of its ability to detect vessels within/around the lesion at optimal enhancement. This was done using a ranking system (1, worst; 5, best) for each patient. RESULTS: Both observers scored FPD as the optimal imaging method, followed by Pim. (Scores summed across all patients, observer 1: FPD 48, Pim 42, FCD 37, HGS 21, FGS 10; observer 2: FPD 49, Pim 40, FCD 38, HGS 21, FGS 10). The differences from FPD were significant for FCD, HGS and FGS using a unpaired analysis of variance (ANOVA) comparison, with Bonferroni multiple corrections, (P<0.01, both observers). The differences between FPD and Pim were also significant both for observer 2 and for both observers combined (P<0.01), but did not reach significance for observer 1 (P = 0.19). CONCLUSIONS: In this study, FPD performed best, and the non-linear modes, performed continuously (pulse inversion and second HGS), showed no clear advantage.

Adult↗

PubMedDate not supplied

Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremity arteries: a retrospective review study.

PURPOSE: To assess the frequency and clinical impact of extravascular incidental findings on routine CT angiography of abdominal aorta or lower extremity arteries. MATERIALS AND METHODS: From January 2002 to July 2004, a total of 692 patients underwent CT angiography of abdominal aorta and lower extremity arteries. Two radiologists retrospectively reviewed by consensus cross-sectional images for the presence and clinical impact definition of extravascular findings. The revision of hospital charts, medical records, and all procedures' reports performed before and after CT angiography represented the standard of reference (SOR). RESULTS: Only 373 out of 605 patients in whom extravascular findings were found had a SOR; in these patients CT angiography obtained a true-positive incidental rate of 98.9% (369/373). For the clinical impact definition of CT-angiography incidental findings, a concordance with SOR was obtained in 56.3% of patients, whereas a subsequent investigation was required in 183 patients (183/369, 49.6%). Among clinically relevant incidental findings, a total of 35 malignancies (35/894, 3.9%) were detected in 20 patients (20/423, 4.7%); in 15 patients (15/423, 3.5%) malignancy was unknown before CT-angiography exam. CONCLUSIONS: A careful observation of cross-sectional images, even if "time consuming", is mandatory not only to assess vascular findings but also to avoid a misdiagnosis of clinical relevant extravascular findings.

Aged↗

PubMedDate not supplied

Clinical impact of MR cholangiopancreatography in patients with biliary disease.

PURPOSE: To evaluate the role of MR Cholangiopan-creatography (MRCP) as a first imaging modality in patients with suspected biliary tree pathology and indications to endoscopic retrograde cholangiopancreatography (ERCP). MATERIAL AND METHODS: Eighty-eight patients, with clinical signs of biliary tree pathology underwent MRCP, performed with a 1.5 T unit and a phased-array coil. Surgery, intraoperative cholangiography, percutaneous transhepatic cholangiography (PTC) or ERCP were regarded as the gold standard in patients with obstruction; the remaining patients underwent follow-up MRCP examinations at 6-9 months. The MR examination was performed with baseline T1w 2D FLASH and T2w TSE sequences, followed by the MRCP study (single-slab breath-hold RARE and multislice breath-hold HASTE sequences). The MR images were independently evaluated by two radiologists. RESULTS: MRCP showed normal findings in 20 patients; 68 patients had biliary duct dilatation. In 11 out of 68 patients MRCP did not identify any obstruction (9/11 were true negative cases). A diagnosis of benign obstruction was expressed in 36/59 patients (4 chronic pancreatitis, 29 choledocolithiasis, 4 inflammatory obstruction, 2 primary sclerosing cholangitis), with 1 false positive and 5 false negatives (sensitivity, specificity and diagnostic accuracy of 86%, 95% and 90%, respectively). MRCP identified 23 neoplastic stenoses (20/23 were true positives): the sensitivity, specificity and diagnostic accuracy values were 100%, 87% and 95%, respectively. MRCP correctly identified the level of obstruction in 100% of cases. CONCLUSIONS: MRCP may be considered as a first-step imaging method in patients with clinical signs of biliary disease. The workload of ERCP in the diagnostic stage could therefore be reduced and its use be reserved for therapeutic indications.

Adult↗