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B Cusati

Publications and source records attributed to B Cusati.

At least 19 recordsLinked to original sources
PubMed2004

Unusual migration in abdomen of a wire for surgical localization of breast lesions.

We report a case of migration of a surgical localization wire from the breast to the abdomen. A 41-year-old female underwent presurgical needle localization of a deep-sited left-sided breast lesion. Migration of the localization wire in the chest wall occurred during the procedure documented by imaging. Computed tomography (CT) examination showed no evidence of the wire in the left lower lung field, no peritoneal free fluid, active bleeding, or abnormalities of abdominal organ, but a metallic-density representing the localization wire was seen for a length of 13 cm from the right diaphragmatic crus to the right psoas muscle, close to the inferior vena cava. A following CT examination showed the wire partially outside the inferior vena cava and partially inside the right iliac vein. The wire was successfully taken out by an angiographic interventional procedure.

Abdomen↗
PubMed2000

Interstitial laser photocoagulation under ultrasound guidance of liver tumors: results in 104 treated patients.

OBJECTIVE: To evaluate the efficacy and complications of interstitial laser photocoagulation (ILP) under ultrasound (US) guidance as a technique for focal ablation of liver tumors in patients with normal and impaired hepatic function. PATIENTS AND METHODS: A total of 104 patients, 77 with 85 nodules of hepatocellular carcinoma on cirrhosis (29 in Child-Pugh A class, 43 in B e 5 in C class) and 27 patients with hepatic metastases (25 from colon, two from lung carcinoma) underwent ILP under US guidance. Depending on tumor size up to four needles were inserted in the tumor and multiple laser illuminations were performed in one or multiple sessions. Necrosis of the nodules was evaluated with triphasic contrast-enhanced CT. RESULTS: Ninety-four patients underwent a single ILP session and nine patients two sessions. CT showed complete necrosis in 70 out of 85 HCC nodules in 65 treated patients and in 24 out of 31 patients with metastases. Three Child C class patients dropped out the control of efficacy by CT because of severe liver failure associated in one case with transient paralytic ileum. One of these patients died 2 months after treatment. Two patients with metastasis dropped the completion of the treatment because of complication occurred after the ILP session (one paralytic ileum, one gastric haemorrage). CONCLUSIONS: ILP under US guidance is effective in inducing complete necrosis in small and large liver tumors. Nevertheless, ILP can cause severe derangement of liver function in patients with advanced cirrhosis.

Aged↗
PubMed2000

[The echo-guided interstitial laser photocoagulation of malignant liver tumors. The authors' personal technic, immediate results and short-term complications in patients with normal and altered liver function].

PURPOSE: The literature studies about interstitial laser photocoagulation of liver tumors mainly deal with the treatment of liver metastasis in patients with normal liver function. We report our personal experience with interstitial laser photocoagulation in patients with liver tumors (mostly cirrhotics with hepatocellular carcinoma). Our aim was to evaluate the short term efficacy of percutaneous interstitial laser photocoagulation in inducing focal ablation of liver tumors and the possible complications in patients with normal and impaired liver function. MATERIAL AND METHODS: Sixty-six patients (52-80 years; 42 men), 47 with 51 hepatocellular carcinoma nodules (diameter = 1.6-6.6 cm; mean 3.1 cm) on cirrhosis (18 in Child-Pugh A class, 24 in B e 5 in C class) and 19 patients with single liver metastasis (17 from colon, 2 from lung carcinoma; diameter = 3.9 cm; mean: 4.5 cm) underwent interstitial laser photocoagulation under ultrasound guidance. Depending on tumor size up to four needles were inserted in the tumor and multiple laser illuminations were performed: in nodules < or = 2 cm a single optical fiber and a single needle insertion were used, in nodules > 2 < 3 cm, 2-3 fibers were used with a single laser illumination, in nodules > 3 < 4 cm, 4 fibers were inserted and two laser illuminations were performed in the same session after 1.5 cm withdrawal of all fibers in the tumor, in nodules > 4 cm 2 sessions with 2 laser illuminations per session were performed. Necrosis of the nodules was evaluated with triphasic Helical CT 7 days after treatment. Patients with incomplete necrosis at CT were treated with additional interstitial laser photocoagulation sessions to attain complete necrosis. RESULTS: Fifty-eight patients underwent a single interstitial laser photocoagulation session, 7 patients 2 session and 1 patient 3 sessions. The range of administered energy per patient was 1200-32,000 Joules (mean: 6700 J). CT showed complete necrosis of 47 nodules in 43 patients with hepatocellular carcinoma and in 15/18 patients with metastasis. Three Child C class patients with mild ascites and hyperbilirubinemia before procedure (nodules O: 1.9, 3.5 and 5.8 cm) dropped out of CT follow-up because of severe liver function impairment with increased ascites and hyperbilirubinemia, associated with transient ileum paraliticus in 1 case. One of these patients died two months after treatment. Two patients with metastasis dropped out of treatment because of complications occurred after the interstitial laser photocoagulation session (1 ileum paraliticus, 1 gastric hemorrhage) and another one refused to continue the treatment.

Aged↗
PubMed1999

[Diagnostic imaging and interventional radiology of amebic liver abscesses. Personal experience].

PURPOSE: The diagnostic imaging findings in hepatic amebiasis and the capabilities of percutaneous drainage have already been described but some debate is open on both diagnosis and treatment. We report our experience with ultrasound (US) and Computed Tomography (CT) studies of the hepatic amebic abscess and its management. MATERIAL AND METHODS: During the last 4 years we examined 14 patients with liver abscess: 11 men and 2 women; 13 were Italian and 1 African (25-61 years old, mean 36). All subjects underwent US and contrast-enhanced CT (with a conventional scanner in 12 and a helical unit in 2). The first 4 cases were also submitted to US-guided diagnostic aspiration. Six patients were treated with percutaneous drainage under US guidance using an 8-10 F pig-tail catheter which was removed 4-18 days later (mean 6). RESULTS: The abscesses were always single and uniloculated, in most cases located peripherally in the right lobe. They were large (2-11 cm, mean 7) and had round, oval, or irregular shape in 9, 3, and 2 cases respectively. US generally showed the abscess as an inhomogeneously hypoechoic mass with ill-defined walls. CT demonstrated a homogeneously hypodense collection with a thick peripheral hypodense halo; after contrast agent administration wall attenuation was increased between the edematous halo and the cavity, and an incomplete idosense ring appeared. Biphasic helical acquisitions allowed demonstration of some difference between the two vascular phases and yielded other interesting findings. Drug treatment provided complete abscess resolution in 8 patients, though in 2 it was badly tolerated. In one case no improvement was found and the patient was submitted to percutaneous drainage, which was the treatment of choice in the remaining 5 patients. The treatment was successful in all cases, but 1 patient who discontinued the combined medical therapy developed a heterotopic lesion. CONCLUSION: US and CT findings, though variable and partially different from those previously reported, may be considered sufficient for diagnostic assessment, especially if in the proper clinical and biohumoral setting. Both drug treatment and percutaneous drainage (to be considered for selected cases) are effective in the treatment of this type of abscess.

Adult↗
PubMed1999

[The angiogram sign in pulmonary atelectases studied by spiral computed tomography. Its incidence and semeiologic value].

PURPOSE: We investigated the yield of Helical CT in the study of lung vessels, the incidence of the angiogram sign and its actual value. MATERIAL AND METHODS: July 1997 to December 1998, we studied 30 cases of pulmonary collapse of different origin. We found 15 cases of passive collapse (10 from pleural effusion, 2 from diaphragmatic compression, 2 from traumatic pneumothorax, and 1 from isthmic aortic aneurysm), 12 cases of obstructive collapse (9 from bronchogenic carcinoma, 1 from mucoid obstruction, 1 from hilar lymphadenopathy, and 1 from mediastinal cancer), 2 cases of adhesive collapse and 1 case of round atelectasis. All the examinations were performed with the Helical technique during nonionic iodinated contrast agent injection (bolus, 300-350 mg/mL); we used an automatic injector set at 2-3 mL/s. We studied the images for the angiogram sign, that is hyperdense bands, usually longer than 2 cm, through the collapsed lung, which correspond to normal pulmonary vascular branches. RESULTS: The angiogram sign was found in 95% of passive (14/15) and in 80% of obstructive (10/12) collapses. However in 2 of those we also found some hyperdense spots referable to vessels seen on transverse slices. The angiogram sign was missing in 1 of 2 adhesive collapses because of vascular distortion from irradiation-related fibrosis. The "comet-tail" vascular pattern was seen in round atelectasis. We had no cases of cicatricial collapse. CONCLUSIONS: Thanks to its fast acquisition capabilities, Helical CT well depicts peak vascular enhancement, which permitted identification of the angiogram sign in several pulmonary collapse cases. Thus, this sign becomes even less specific, and just one of the signs of pulmonary consolidation.

Angiography↗
PubMed1999

[Multiphasic spiral computed tomography in hepatocarcinoma. An evaluation following different percutaneous ablative procedures].

PURPOSE: To report our personal experience with helical CT evaluation of hepatocellular carcinoma treated with various percutaneous interventional procedures. We assessed both nodular response and the spectrum of changes within normal parenchyma. MATERIAL AND METHODS: December 1996 to September 1998 we examined with helical CT 41 patients (73 nodules in all) with hepatocellular carcinoma treated with percutaneous ablation therapies: conventional ethanol injection in 18 subjects (31 nodules), one-shot ethanol injection in 3 (8 nodules), radiofrequency thermal ablation in 16 (25 nodules), and combined chemoembolization and ethanol injection in 4 (9 nodules). CT performed was 4-27 days after the last session, acquiring biphasic volumetric images in 14 patients and triphasic volumetric images in 27. A second treatment with subsequent CT study was performed for 28 lesions; 15 underwent 3 serial studies and 6 underwent 4 studies. RESULTS: Compared with pretreatment findings, the diameter was unchanged in 62% of the nodules and increased in 38%. Morphology was unchanged in 63% of the lesions while in 37% a mild deformation toward the needle path or a more regular and round shape was evident. Borders were unchanged in 37% of the cases and modified in 63%, appearing well-defined in 73% and ill-defined in 27%. The necrotic portion had a low attenuation with a nodule-to-parenchyma gradient more evident on delayed than on venous and finally arterial acquisitions; 8% of the lesions were not recognizable on unenhanced scans. Residual viable tissue was identified in 44% of the nodules and quantified as 100% in 1% of all lesions, > 75% in 3%, > 50% in 4%, > 25% in 12%, < 25% in 23%. It was located centrally in 6% of the cases, peripherally in 12%, and eccentrically in 81%, and the shape was crescent in 66% of the cases, oval in 19%, and different in 16%. During the arterial phase the residual tumor appeared hyperdense in 97% of the nodules and isodense in 3%, while during the portal phase it was hyperdense in 22%, isodense in 28% and hypodense in 50%, and during the delayed phase hypodense in 100%. For what concerns the uninvolved parenchyma, lobar atrophy was present in 4% of the nodules, segmental atrophy in 8%, and subsegmental in 16%; caval thrombosis was found in 1 patient, portal thrombosis in 4. Arterioportal fistulas were identified in 5% of the nodules and areas of transient inhomogeneous attenuation in several cases. Subsegmental biliary dilation was detected in 4% of the lesions. CONCLUSION: Multiple-phase helical CT allows optimal depiction of primitive liver nodules treated with percutaneous interventional procedures and has a central role in the assessment of tumor response. Accurate is also the evaluation of changes or complications involving the surrounding parenchyma. Regarding the ablation effect, two typical features can be identified: after total necrosis nodular volume is unchanged or increased, borders are well-defined, and density is low and homogeneous (especially in delayed phases), while after partial necrosis the diameter is not modified, margins are ill-defined, attenuation is less decreased, and peripheral tumor maintains high density in arterial phase and low density in delayed phases. As for the treatment procedure, we found that thermal ablation with radiofrequency and single-session ethanol injection cause more evident alterations within both nodule and hepatic parenchyma, while after multi-session ethanol injection changes are less dramatic and consequently more difficult to assess.

Adult↗
PubMed1998

[Computerized tomography assessment of replacement of the cruciate ligaments of the knee].

January, 1993, to December, 1995, we examined with CT 44 patients submitted to surgical replacement of knee cruciate ligaments, namely 18 anterior cruciate ligaments (ACL) and 6 posterior cruciate ligaments (PCL). ACL was replaced with a patellar tendon graft (Eriksson technique) in 23 cases and with a semitendinous graft (Lindemann-Bousquet technique) in 7 cases. The autologous new ligament appeared as a laminar structure of intermediate density. The tendon had been covered with a synthetic lining (Leeds-Kejo) in 10 of the above cases, while the new ACL graft was completely synthetic in 8 cases, which synthetic allografts appeared hyperdense relative to autologous new ligaments. PCL replacement had been performed with Augustine technique (patellar tendon graft in a tibial tunnel) in 3 cases, with Hughston technique (medial gastrocnemius graft in a medial condylar tunnel) in 2 cases and with a synthetic graft (Gore-tex) in 1 case. Twelve of 38 new ACLs were injured (7 Eriksson, 3 Lindemann-Bousquet and 2 synthetic grafts): the injured new ligament was enlarged and hypodense, or involved in atrophic absorption. The new ligament was partially calcified in one of the 3 patients with PCL replacement with a patellar tendon graft (Augustine technique). The bone bract was dislocated in the intercondylar notch in a patient submitted to Hughston surgery because of proximal disinsertion of the new ligament. The Gore-tex new PCL was sinuous in the proximal tract, with intra-articular calcified loose bodies. CT adequately depicted surgical results and diagnosed the new ligament injuries and other articular abnormalities. MRI is currently the gold standard in the multiplanar studies of the postoperative knee, but CT can be confidently used to identify ligament injuries and intra-articular calcified loose bodies.

Anterior Cruciate Ligament↗
PubMed1998

[The correlation between Doppler echography with a contrast medium and CT in the study of a hepatocarcinoma submitted to chemoembolization].

PURPOSE: We report our preliminary experience concerning Doppler studies with the intravenous injection of a galactose-based echo contrast agent (SHU 508 A) in hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization. We correlated US findings with those of iodized-oil helical CT. MATERIAL AND METHODS: In 1997 we examined 18 patients with cirrhosis and HCC (31 nodules in all) submitted to hepatic oily chemoembolization 15-30 days earlier. The lesions were studied with color and power Doppler US before and after echo contrast agent infusion (300 mg/mL, injection/nodule, constant rate in 60-90 s) and with Lipiodol CT (0-7 days after US). In the retrospective analysis, special care was paid to Doppler signals from pulsatile intra- and perinodular flow and to the detection of new small vessels on enhanced images. The signal was graded as absent (0), weak (1), medium (2) and strong (3). The oily agent uptake on CT images was graded as absent (0), grade I (< 10%), II (< 50%), III (> 50%) and homogeneous (IV). All scores were given on a blind basis. RESULTS: Liver enhancement was found in all cases and always lasted long enough to allow the accurate depiction of parenchymal lesions (at least 8 minutes). Signal intensity could be evaluated in 27 of 31 HCCs (2 were too deeply seated and two were too affected by cardiac activity). We had the following scores: basal color Doppler: grade 0 = 15 lesions, grade 1 = 8 lesions, grade 2 = 4 lesions; contrast-enhanced color Doppler: grade 0 = 11 lesions, grade 1 = 7 lesions, grade 2 = 8 lesions, grade 3 = 1 lesion; basal power Doppler: grade 0 = 12 lesions, grade 1 = 8 lesions, grade 2 = 6 lesions, grade 3 = 1 lesion; contrast-enhanced power Doppler: grade 0 = 10 lesions, grade 1 = 7 lesions, grade 2 = 8 lesions, grade 3 = 2 lesions; Lipiodol-CT: grade 0 = 1 lesion, grade I = 1 lesion, grade II = 7 lesions, grade III = 8 lesions, grade IV = 10 lesions. The difference between color and power Doppler scores, both compared to each other and between basal and enhanced images, never exceeded one. CONCLUSIONS: Contrast-enhanced Doppler US is a simple and fast technique allowing strong, constant and long-lasting enhancement. Doppler US techniques permit the effective and realistic study of HCC nodules treated with chemoembolization and show a better correlation with Lipiodol CT than basal studies. Power Doppler is slightly more sensitive and accurate than color Doppler and shows a better correlation with Lipiodol CT.

Adult↗
PubMed1998

[Echo-guided radiofrequency percutaneous ablation of hepatocellular carcinoma in cirrhosis using a cooled needle].

INTRODUCTION: Radiofrequency hyperthermia using the newly-developed "cooled-tip" needle is one of the latest US-guided percutaneous treatments of hepatocellular carcinoma arising in cirrhosis. The continuous cooling of the needle tip allows tissue heating and necrosis far from the electrode without tissue charring, which was the major drawback of the old monopolar technique. Herein we report our preliminary results on feasibility and effectiveness of the thermoablation of mono- or paucifocal hepatocellular carcinoma with the cooled-tip needle. MATERIAL AND METHODS: November, 1996, to January, 1998, we treated thirteen cirrhotic patients (mean age 69.5 yrs, 10 men, 12 HCV-positive; 11 in Child's Class A and 2 in Class B) with 19 hepatocellular carcinoma nodules (mean diameter: 27 mm; range: 10-41 mm; 6 with diameter > 3 cm). None of the patients had portal thrombosis and/or extrahepatic spread. We used a radiofrequency generator (100 W power) connected to an 18 G perfusion electrode needle with an exposed tip of 2-3 cm. The circuit is closed through a dispersive electrode positioned under the patient's thighs. A peristaltic pump infuses a chilled (2-5 degrees C) saline solution to guarantee the continuous cooling of the needle tip. The needle was placed into target lesions under US guidance. The interventional procedure was carried out under general anesthesia using Propofol without intubation. Dynamic CT (more recently with the helical technique) was carried out 15-20 days after thermoablation to assess treatment efficacy. RESULTS: In all, 31 thermal injuries (at 1000-1200 mA for 10-15 minutes) were caused in 21 sessions in the 19 hepatocellular carcinoma nodules (mean: 1.5 lesions per nodule and 1.6 sessions per patient). Complete necrosis as assessed at dynamic CT (no enhancement during the arteriographic phase) was achieved in 16 of 19 nodules (84%). No side-effects occurred. During the follow-up (median: 11 months) no death occurred and five patients had recurrent hepatocellular carcinoma appearing either as single nodule or as multinodular liver involvement. CONCLUSIONS: In our experience radiofrequency hyperthermia with the cooled-tip needle permits effective and safe percutaneous ablation of HCC in cirrhosis. In addition, treatment time is short and lesions > 3 cm can be treated. Further experience is needed to better define the role of percutaneous thermoablation in the treatment strategy of hepatocellular carcinoma.

Aged↗
PubMed1998

[The role of imaging diagnosis in the study of intestinal infarct].

Acute mesenteric insufficiency is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn, this is due to the lack of specificity, specially in the early-middle phase, of the clinical presentation, laboratory data, and plain abdominal radiographic findings. In front of this uncertainty, some authors advocated an "aggressive" approach with early use of angiography (nevertheless at risk of a high rate of negative examinations), other remained on more wait-and-see or fatalist positions, and other evaluated the possible diagnostic impact of noninvasive methods alternative to angiography. With the purpose of a correct employment from the surgeon of the various diagnostic tools actually available, we illustrated in this review the possibilities and limitations of the methods proposed in the evaluation of bowel infarction: plain abdominal radiography, gastrointestinal tract contrast studies, angiography, sonography, computed tomography (CT), magnetic resonance imaging (MRI).

Angiography↗
PubMed1997

[Assessment with magnetic resonance of cartilage injuries of the knee with tridimensional techniques with fat suppression].

MR studies of chondral injuries of the knee are performed to obtain a high C/N ratio between the articular cartilage and such other structures as subchondral bone, intraarticular fat pad and synovial fluid. This goal has been achieved with the 3D SPGR fat-suppressed technique. This kind of sequence yields high spatial contrast resolution because of its contiguous thin (1.5 mm) slices and high contrast resolution between the hyaline cartilage, which is strongly hyperintense, and the surrounding structures (fat, synovial fluid, subchondral bone) which appear hypointense. From September, 1994, to February, 1995, we submitted to MRI 34 patients, adding the 3D fat-suppressed technique after the routine sequences. These volumetric sections were obtained to image the tibiofemoral joint cartilage in 15 patients and to study the patellofemoral compartment in 19 patients. Chondral injuries were graded according to Beguin and Locker classification and MR results were compared with arthroscopic findings. 3D SPGR fat-suppressed sequences permitted accurate chondral thickness evaluation and the depiction of cartilage injuries, especially in advanced injuries (stages 3 and 4). However, in earlier stages, this MR technique tends to overestimate globular hypointense areas in normal thickness cartilage. This MR pattern needs a close correlation with clinical findings and should be interpreted according to the presence/absence of other associated intraarticular injuries.

Adolescent↗
PubMed1997

[The crescent and the periluminal halo: two computer tomography signs of aortic aneurysm with risk of rupture?].

PURPOSE: To assess the prevalence, significance, and practical value of two recently described CT signs of instable aneurysm: the crescent sign (a curvilinear high-attenuating density within the thrombus) and the periluminal halo (a low-attenuating internal layer of the thrombus around the patent lumen). MATERIAL AND METHODS: Among the CT examination performed in the last 5 years, we retrospectively selected the nonruptured aneurysms with a diameter exceeding 4 cm (no. = 93, average diameter 5.1 cm, unenhanced images in 28 cases and enhanced in 84) and the ruptured aneurysms (no. = 16, average diameter 6.7 cm, unenhanced images in 9 cases and enhanced in 9). We studied the prevalence of the crescent and halo sign, their relationship with the aneurysm diameter, and the effect of contrast enhancement. RESULTS: The crescent sign was identified with a statistically significant prevalence in ruptured (37.5% of cases) over asymptomatic aneurysms (5.5%); the halo, instead, had the same frequency in the 2 groups (12.5% and 9.5%, respectively). Both signs were more frequent in bigger aneurysms and were recognizable without differences in unenhanced and enhanced images. CONCLUSIONS: The crescent sign, though not exclusive of aneurysmal rupture, indicates instability and its detection should lead to careful follow-up or surgical repair. The halo seems to have no real value as risk factor.

Adult↗
PubMed1997

[Echography in the study of an intramural hematoma of the intestines].

PURPOSE: To report our experience concerning the integrated diagnostic imaging of intestinal intramural hematoma, with special reference to the different patterns and to the accuracy of US examinations. MATERIAL AND METHODS: In the last 4 years we examined 7 patients with intraparietal hematoma, due to anticoagulant therapy, using real-time US. All the subjects presented with abdominal pain, sometimes associated with distention, tenderness, bleeding, hematocrit reduction, palpable mass or obstruction. The hematomas involved the duodenum in 2 cases, the jejunum in 4, and the descending colon in 1. US was performed in all patients, plain abdominal radiographs in 6, oral barium studies in 1, large bowel enema in 1, and computed tomography (CT) in 3. All patients were managed conservatively except the one with colonic location who was treated surgically. RESULTS: In all subjects, the US findings were characteristic and included clean and defined double- or multilayered thickening of the bowel wall (usually with a thick and hyperechoic inner layer and a thin and hypoechoic outer layer), undulated mucous membrane, narrowed lumen with corpuscolated fluid content and gas spots, decreased peristalsis with fixity of the images, fluid between the loops. Plain abdominal radiographs were relevant in 3 cases, showing focal intestinal distention, thickening of the intestinal wall and of the valvulae conniventes, bowel lumen narrowing and fixity of the findings. The findings were nonspecific/negative in the 2 subjects with duodenal involvement and demonstrated an intestinal obstruction in that with colonic location. Oral barium study did not provide, in the single patient examined with this tool, specific results, only causing time consumption and diagnosis delay. Barium enema was valuable in demonstrating the presence and level of the colonic obstruction due to the hematoma. Similarly to US, CT always demonstrated the intestinal changes, with a better panoramic detailing, but did not provide relevant additional information. CONCLUSION: US shows a rather characteristic spectrum of findings in the intramural intestinal hemorrhage. The US data, possibly confirming plain abdominal radiographic findings, are in most cases relevant for the correct diagnosis of intraparietal hematoma and conclusive for the diagnostic course.

Acute Disease↗