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C Bartolozzi

Publications and source records attributed to C Bartolozzi.

At least 73 records · Page 4Linked to original sources
PubMed1997

Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience.

The objective of our work was to evaluate the long-term results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in patients with liver cirrhosis. A total of 184 cirrhotic patients with HCC underwent PEI as the only anticancer treatment over an 8-year period. Patients were followed after therapy by means of clinical examinations, laboratory tests, and US and CT studies performed at regular time intervals. Survival rates were determined according to the Kaplan-Meier method. The overall survival was 67% at 3 years, 41% at 5 years, and 19% at 7 years. The 3-, 5-, and 7-year survival rates of patients with single HCC < or = 3 cm (78, 54, and 28%, respectively) were significantly higher (p < 0.01) than those of patients with single HCC of 3.1-5 cm (61, 32, and 16, respectively) or multiple HCCs (51, 21, and 0%, respectively). Survival of Child-Pugh A patients (79% at 3 years, 53% at 5 years, and 32% at 7 years) was significantly longer (p < 0.01) than that of Child-Pugh B patients (50% at 3 years, 28% at 5 years, and 8% at 7 years). A selected group of 70 patients with Child-Pugh A cirrhosis and single HCC < or = 3 cm had a 7-year survival of 42%. Long-term survival of cirrhotic patients with HCC treated with PEI is comparable to that reported in published series of matched patients submitted to surgical resection.

Adult↗
PubMed1997

Comparison of the diagnostic performance of high-frequency ultrasound as a first- or second-line diagnostic tool in non-palpable lesions of the breast.

To compare the diagnostic performance of high-frequency ultrasound (HFU) as a first- or second-line diagnostic tool in non-palpable lesions (NPL) of the breast and to define the place of HFU in the diagnostic process, 89 women with this kind of lesion, previously detected by mammography, underwent HFU with 7.5-13 MHz transducers. The examinations were performed by two equally experienced operators of which only one (operator I) was aware of the mammographic findings. The mammographic examinations revealed the following non-palpable lesions: asymmetry-hyperdensity (17 cases), nodule (44 cases), stellate lesion (5 cases), microcalcifications (23 cases). Total sensitivity of HFU in the examinations performed by operator I was 83 %, while in the examinations performed by operator II (unaware of the mammographic findings) it was only 35 %. In all cases HFU allowed the operators to determine the basic features of the lesions. Our experience confirms that ultrasonography, even if performed with high frequency, cannot be proposed as a screening examination but may profitably be employed as a second-step technique to characterize NPL previously identified by mammography. This 'second-step' role can do the following: rule out true pathology (cases of false-positive mammography findings); furnish some basic features in the case of focal lesions; show other findings in the case of microcalcifications, such as microcysts, 'filled duct' appearance, parenchymal inhomogeneities and nodules; guide interventional procedures; and localize lesions preoperatively.

Breast Neoplasms↗
PubMed1997

Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography.

The aim of our study was to compare the diagnostic efficacy of power Doppler imaging and conventional color Doppler sonography for differentiating between hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) of the liver. Thirty-one focal liver lesions (in 29 patients) with histologic proof of HCA (n = 9) or FNH (n = 22) were studied with power and color Doppler sonography according to a standardized examination protocol. The size of the lesions ranged between 1.5 and 14.5 cm (HCA, 3.5-14.5 cm, mean +/- SD 7.3 +/- 3.3 cm; FNH, 1.5-9.1 cm, mean +/- SD 5.1 +/- 2.1 cm). Intratumoral vessels with a venous Doppler spectrum, associated with either pulsatile or continuous peripheral flow, were detected in HCA (eight of nine lesions by power Doppler imaging and six of nine by color Doppler imaging) but not in FNH. In contrast, color signals with an arterial Doppler spectrum, radiating from the center to the periphery of the lesion, were depicted in FNH (20 of 22 cases by power Doppler imaging and 15 of 22 by color Doppler sonography) but not in HCA. Differentiation of HCA and FNH was achieved in 28 of 31 cases (90 %) by power Doppler imaging and in 21 of 31 (68 %) by color Doppler sonography (p < 0.01). Power Doppler imaging is superior to conventional color Doppler sonography in the depiction of the intratumoral flow characteristics of HCA and FNH, and enables a more accurate differential diagnosis than color Doppler sonography.

Adenoma, Liver Cell↗
PubMed1997

Ex-vivo MR imaging of liver intracellular contrast agents.

The objective is to evaluate whether an ex-vivo model can be used to test intracellular contrast agents for MR imaging of the liver. T1 weighted inversion recovery, proton density spin echo and T2* weighted gradient echo images of the liver were acquired at 0.5 T in 10 rats before and 30 min after intravenous injection of 0.075 mmol/kg Gadolinium benzyloxypropionictetraacetate (Gd-BOPTA, n = 5) or 0.015 mmol/kg dextran magnetite (DM, n = 5), Four additional animals served as controls. After exsanguination and perfusion with saline and formalin, specimens of the liver and brain were embedded in an agar gel and examined with MR imaging one to three weeks later using the same protocol. In-vivo, the mean liver signal enhancement caused by Gd-BOPTA in T1, proton density and T2* weighted images was +23%, +28% and -70%, respectively. The mean liver signal enhancement caused by DM was -71%, -76% and -94%. In-vitro, no signal change was seen in the brain of animals injected with Gd-BOPTA and DM as compared to controls. Liver signal was increased by Gd-BOPTA and decreased by DM. Mean liver enhancement rate induced by Gd-BOPTA was +22%, +5% and +27% for T1, proton density and T2* weighted images, respectively. Mean liver enhancement rate induced by DM was -27%, -19% and -31%. MR imaging signal changes induced by liver intracellular contrast agents are still appreciable in an ex-vivo model. The latter might be useful for for preliminary investigation of intracellular contrast agents for MR imaging of the liver.

Animals↗
PubMed1997

Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis.

Amiodarone-induced thyrotoxicosis (AIT) occurs both in abnormal thyroid glands (nodular goiter, latent Graves' disease) (type I AIT) or in apparently normal thyroid glands (type II AIT). Differentiation of the two forms is crucial, because type I AIT responds well to methimazole and potassium perchlorate combined treatment, whereas type II AIT is effectively managed by glucocorticoids. Differential diagnosis is often difficult, although thyroid radioactive iodine uptake is usually low-to-normal in type I and low-suppressed in type II, and serum interleukin-6 levels are normal/slightly elevated in type I, markedly elevated in type II. Color flow Doppler sonography (CFDS) is a technique that shows intrathyroidal blood flow and provides real-time information on thyroid morphology and hyperfunction. To investigate the usefulness of CFDS in differentiating the two types of AIT, 27 consecutive AIT patients, 11 type I and 16 type II, were evaluated by CFDS before starting antithyroid treatment. Gender, age, severity of thyrotoxicosis, and cumulative amiodarone dose were similar in the two groups. All type II AIT patients had a CFDS pattern 0 (ie, absent vascularity), in agreement with the pathogenesis of the disease, due to thyroid damage. Likewise, nine patients with subacute thyroiditis, another destructive process of the thyroid gland, also had a CFDS pattern 0. Eleven patients with type I AIT had a CFDS pattern ranging from pattern I (presence of parenchymal blood flow with patchy uneven distribution) (7 patients, 64%) to pattern II (ie, mild increase of color flow Doppler signal with patchy distribution) (1 patient, 9%) and pattern III (markedly increased color flow Doppler signal with diffuse homogeneous distribution)(3 patients, 27%), similar to that found in patients with untreated Graves' disease patients, thus indicating a hyper-functioning gland. Control subjects and euthyroid patients under long-term amiodarone treatment had absent thyroid hypervascularity and a CFDS pattern 0. These findings demonstrate that CFDS distinguishes type I and II AIT. Because of its rapidity and noninvasive features, CFDS represents a valuable tool for a quick differentiation between the two types of AIT. This can avoid any delay in initiating the appropriate treatment for a rapid control of thyrotoxicosis in patients whose tachyarrhythmias or other cardiac disorders make thyroid hormone excess extremely deleterious.

Adult↗
PubMed1997

Identification of the feeding arteries of spinal vascular lesions via phase-contrast MR angiography with three-dimensional acquisition and phase display.

PURPOSE: To determine whether identification of the feeding arteries of spinal vascular lesions with phase-contrast MR angiography benefits from the higher spatial resolution of three-dimensional (volume) acquisitions and flow-direction information provided by the phase reconstruction of two-dimensional acquisitions. METHODS: Fifteen patients with high- or low-flow spinal vascular lesions proved by spinal arteriography underwent MR angiography with phase-contrast techniques. Arteriographic and MR angiographic studies were reviewed to identify the arterial feeders of spinal vascular lesions. RESULTS: On modulus reconstructions of coronal 2-D or 3-D acquisitions, three of four arteries feeding high-flow lesions and three of 14 arteries feeding low-flow lesions were identified as hypertrophic vessels joining the parent intercostal or cervical arteries. Of 11 intradural veins draining dural arteriovenous fistulas, three were identified on coronal 2-D acquisitions and six on coronal 3-D acquisitions as vessels that coursed from a neural foramen to a midline tangle of vessels. Phase reconstruction showed ascending and descending flow patterns in two patients with intramedullary arteriovenous malformations, and diverging flow in perimedullary veins draining a hemangioblastoma. In nine patients with dural arteriovenous fistulas, phase reconstruction provided information as to the level of the arterial feeders. Phase reconstruction in coronal plane acquisitions also provided evidence of centripetal flow. CONCLUSION: Three-dimensional acquisitions and phase display of 2-D acquisitions improved the visibility of arterial pedicles of spinal vascular lesions at phase-contrast MR angiography.

Adult↗
PubMed1997

[The correct mammographic exam: the usefulness of additional views].

INTRODUCTION: Till 20 years ago, physical examination of the breast was the fundamental procedure for the diagnosis of breast conditions, but mammography has now become the only examination to diagnose infraclinical carcinoma. High quality mammographic images enhance the radiologist's skill. MATERIAL AND METHODS: We performed 2713 mammograms in a year's work and then selected 456 patients with questionable or poor mammographic findings (craniocaudal or midlateral oblique views) for further studies. The additional examinations were performed either to show the whole gland or to clarify the following findings: hyperdensity/asymmetry, ill defined nodule/pseudonodule, stellate lesions, microcalcifications, superficial or cutaneous lesions, inflexed nipples. As additional studies, we acquired spot compression images with/without magnification, exaggerated craniocaudal and cleavage images, images with a skin marker, rolled and tangential images. Based on radiologic findings, 155 patients were submitted to US, 104 to FNAB (under US or stereotaxic guidance) and 67 to surgery. RESULTS: The additional views proved useful in 83.2% of patients showing the whole parenchyma in 35.4%, ruling out suspected abnormalities in 28.8%, depicting and characterizing nodules and microcalcifications in 19% of patients. CONCLUSIONS: In our study, additional views played an important role in the correct execution of mammographic studies because they: showed the whole gland; permitted to rule out suspected pathologic conditions; confirmed and defined previous questionable lesions, thus allowing the radiologist to plan the proper diagnostic route.

Adult↗
PubMed1997

[Doppler color US in the diagnosis and treatment of iatrogenic pseudoaneurysms].

Pulsatile masses occur increasingly as a complication of transfemoral or transaxillary percutaneous catheterization, as the number of catheterization procedures and their complexity has increased. These iatrogenic injuries may be represented by a pseudoaneurysm or by a periarterial hematoma with transmitted arterial pulsation: the 2 vascular injuries require prompt differentiation because pseudoaneurysms need treatment by means of US-guided compression or surgical repair. Nineteen patients (10 men and 9 women, aged 40-85 years, mean: 62 years) with a groin (no. = 17) or axillary (no. = 2) pulsatile mass following angiographic catheterization were prospectively examined with color Doppler sonography (US). A pseudoaneurysm was detected in 13 patients (12 femoral and one axillary injury), whereas the other 6 pulsatile masses were consistent with periarterial hematomas. US-guided compression was attempted in 13 pseudoaneurysms and the pulsatile mass was repaired in 11/13 cases (84.6%), including 10/12 femoral and 1/1 axillary lesions. All the vascular injuries successfully treated with US-guided therapy were repaired 1-4 days after the angiographic complication. On the other hand, two pseudoaneurysms unsuccessfully treated with US-guided compression were studied after 8 and 24 days, respectively, after the angiographic complication and subsequently submitted to surgical repair. The pseudoaneurysms size did not seem to affect the favorable outcome of the US-guided treatment. With the exception of the 2 surgical cases, the other 17 patients underwent clinical examination and color Doppler US one and 7 days after the US-guided compression of the pulsatile mass. Moreover, a 6-25 weeks clinical follow-up showed no late complications or recurrences in all the cases. In conclusion, color Doppler US is now the technique of choice to assess potential complications related to femoral or brachial artery catheterization.

Adult↗
PubMed1997

[Osteochondral lesions of the humeral head: the usefulness of echographic study].

PURPOSE: In the cranial humeral end, osteochondral injuries localize in a circular crown including part of the humeral head and part of the major and minor tuberosities. Since this region is easy to depict with US, we investigated the potentials of this technique in detecting osteochondral injuries. MATERIALS AND METHODS: Seventy-five osteochondral injuries found at 492 US examinations performed in 12 months with a 7.5 MHz linear probe were retrospectively reviewed. Clinical history taking was focused on the following: a) previous trauma or b) luxation-instability and c) if the patient was a sportsman devoted to activities requiring forced abduction-external rotation or adduction-internal rotation. Since the site of the head's humeral injury is an important clue for diagnosis, we subdivided the humeral circle into four ideal quadrants by two perpendicular lines with the main line passing through the bicipital groove. Then, each injury was ascribed to a quadrant. All patients were also submitted to radiography (at least two films) and to MRI; CT was performed in 12 patients. Ten patients underwent surgery. RESULTS: We found 34 Hill-Sachs lesions, 15 traumas, 9 arthrotic lesions, 7 cases of anterointernal and 4 of posterosuperior impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. In our experience, US was an accurate tool in the identification of humeral head conditions, which were confirmed at CT and/or MRI in all patients (no false positives). As for the injury nature, US diagnosis was confirmed in all Hill-Sachs lesions (34/34 cases), traumas (15/15 cases) and 50% of the cases of posterosuperior impingement (2/4 cases). These conditions made up about 2/3 of the whole cases (51/75 cases). US failed to establish the injury nature in the 9 arthrotic lesions, 7 cases of anterointernal impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. CONCLUSIONS: US can be suggested as the method of choice in the study of the osteochondral lining of the humeral head.

Calcinosis↗
PubMed1996

Local staging of prostate carcinoma with endorectal coil MRI: correlation with whole-mount radical prostatectomy specimens.

The purpose of this study was to investigate the accuracy of endorectal coil MRI in the local staging of prostate carcinoma. A total of 73 patients with biopsy-proven prostate carcinoma were examined at 0.5 T prior being submitted to radical prostatectomy. The gold standard was provided in all patients by findings at whole-mount sectioning of the surgical specimens. At pathology 28 patients had stage T2, 30 had stage T3a/b, and 15 had stage T3c lesions. Overall accuracy of endorectal coil MRI in defining local tumor stage was 82% (60 of 73 patients). Of 73 patients, 5 (7%) were underestimated and 8 (11%) overestimated. The sensitivity and the specificity of endorectal coil MRI in diagnosing capsular penetration were 95% and 82%, respectively. Seminal vesicle invasion was detected with 80% sensitivity and 93% specificity. Our data indicate that endorectal coil MRI is an accurate method for local staging of prostate cancer.

Humans↗
PubMed1996

Ethanol injection for the treatment of hepatic tumours.

Percutaneous ethanol injection (PEI) is a relatively new therapeutic technique for the treatment of liver tumours. PEI is now considered a reliable alternative to surgical resection for cirrhotic patients with a single, small hepatocellular carcinoma (HCC). Intratumoral injection of absolute ethanol, in fact, achieves complete ablation of HCC nodules 3 cm or less in diameter with a high probability. Moreover, PEI is not associated with significant morbidity or mortality and does not damage non-cancerous liver parenchyma. Long-term survival rates of PEI-treated patients were similar to those obtained in matched patients submitted to partial hepatectomy. In large HCC lesions, the anticancer effect of PEI can be significantly enhanced by pretreatment of the tumour with transcatheter arterial chemoembolisation. PEI may also be effectively used to destroy adenomatous hyperplastic nodules in liver cirrhosis, which represent precancerous lesions. The results of PEI in the treatment of liver metastases, in contrast, have been far less encouraging than in the case of HCC, so that PEI is not recommended when other interventional procedures such as radiofrequency electrocautery or interstitial laser photocoagulation are available. Imaging procedures plays a key role in PEI, as they provide a reliable assessment of the therapeutic effect of the procedure.

Angiography↗
PubMed1996

Assessment of tumor vascularity in hepatocellular carcinoma: comparison of power Doppler US and color Doppler US.

PURPOSE: To compare power Doppler ultrasound (US) with conventional color Doppler US for the assessment of tumor vascularity in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty-one patients with 88 histologically proved HCCs were examined with power and color Doppler US according to a standardized examination protocol. Findings at Doppler studies of each lesion were correlated with findings at digital subtraction angiography. RESULTS: Angiography revealed neovascularization or staining in 75 (85%) of 88 lesions. Intratumoral color signals with an arterial Doppler spectrum were detected in 69 (92%) of 75 angiographically hypervascular tumors at power Doppler US and in 55 (73%) of 75 at color Doppler US (P < .01). Blood flow signals with an arterial Doppler spectrum were not detected at power or color Doppler US in any of the 13 angiographically hypovascular tumors. The small size and the deep location of the lesion significantly reduced (P < .05) the detection rate of blood flow signals at color Doppler US but did not affect the results of power Doppler US. CONCLUSION: Power Doppler US is superior to conventional color Doppler imaging in the depiction of tumor vascularity in HCC.

Aged↗
PubMed1996

Small hepatocellular carcinoma. Detection with US, CT, MR imaging, DSA, and Lipiodol-CT.

Twenty-two patients with 37 small (3 cm or less) nodular lesions of hepatocellular carcinoma (HCC) were examined with ultrasonography (US), CT, MR imaging, digital subtraction angiography (DSA), and CT following intraarterial injection of Lipiodol (Lipiodol-CT). All patients subsequently underwent surgery, and the gold standard was provided by intraoperative US. The detection rate was 70% for US, 65% for CT, 62% for MR imaging, 73% for DSA, and 86% for Lipiodol-CT. A significant difference (p < 0.05) was observed between the detection rate of Lipiodol-CT and the detection rates of all the other imaging modalities. The difference was even more manifest (p < 0.02) when only lesions smaller than or equal to 1 cm were considered. It is concluded that Lipiodol-CT is the single most sensitive examination to detect small nodules of HCC. It should therefore be considered a mandatory step in the preoperative evaluation of patients with HCC considered to be surgical candidates after noninvasive imaging studies.

Aged↗
PubMed1996

Usefulness of MR signal intensity in distinguishing benign from malignant pleural disease.

OBJECTIVE: The aim of this study was to analyze the potential usefulness of MR signal intensity in differentiating malignant from benign pleural disease. SUBJECTS AND METHODS: Forty-five patients with pleural lesions identified on CT scans were subsequently examined by MR imaging at 0.5 T. T1-weighted, proton density-weighted, T2-weighted, and enhanced T1-weighted spin-echo images were obtained. For 34 patients, a diagnosis of malignant (n = 18) or benign (n = 16) disease was established. The morphologic features of the pleural lesions and MR signal intensity on T1-weighted, proton density-weighted, T2-weighted, and enhanced T1-weighted images were evaluated, and the ratio of lesion to muscle signal intensity was computed. RESULTS: Assessment of morphologic features by MR imaging and CT was not significantly different. High signal intensity on proton density-weighted and T2-weighted images was observed in all malignant lesions and in two benign lesions (sensitivity, 100%; specificity, 87%; negative predictive value, 100%). The ratio of lesion to muscle signal intensity on T1-weighted, proton density-weighted, T2-weighted, and enhanced T1-weighted images discriminated between malignant and benign lesions (p < .0001). For the subgroup of lesions misinterpreted by CT (n = 6), the evaluation of MR signal intensity on long-TR images made it possible to differentiate malignant from benign conditions. CONCLUSION: MR signal intensity is a valuable additional feature for differentiating malignant from benign pleural disease. Signal hypointensity with long-TR sequences is a reliable predictive sign of benign pleural disease.

Adult↗
PubMed1996

Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions.

OBJECTIVE: This study prospectively evaluated the sensitivity of high-resolution sonography compared with double-tracer 201Tl-99mTc scintigraphy (Tl-Tc) subtractive scintigraphy and double-phase 99mTc-sestamibi (Tc-MIBI) scintigraphy prior to surgery in the assessment of patients with primary hyperparathyroidism in a geographic region where areas of endemic thyroid goiter are present. SUBJECTS AND METHODS: Sonography and scintigraphy were used as first-step imaging procedures in 73 patients with primary hyperparathyroidism. In 30 (41%) of 73 cases, we found an association with a thyroid abnormality. We compared sonography with double-tracer Tl-Tc scintigraphy in 41 cases, with Tc-MIBI scintigraphy in 22 other cases, and with both scintigraphic studies in 10 other cases. RESULTS: Surgery demonstrated 68 solitary parathyroid lesions (66 adenomas, one hyperplasia, and one carcinoma), two adenomas in two patients, and multiple hyperplastic glands in two patients for a total of seven lesions. In one case no abnormal parathyroid gland was found. Overall sensitivity of sonography, Tl-Tc, and Tc-MIBI scintigraphy was 85%, 62%, and 82%, respectively. In patients with concomitant thyroid disease, the sensitivity of sonography, dual-tracer Tl-Tc, and Tc-MIBI was 77%, 67%, and 80%, respectively. CONCLUSION: Our study proves that sonography and scintigraphy are equally able to detect parathyroid lesions before surgery in patients with concomitant thyroid diseases. In patients without thyroid abnormalities, detection rates of sonography and Tc-MIBI do not show any statistical difference, and the detection rate of Tl-Tc is significantly inferior to that of sonography. Sonography alone should be used as the first step for localization of abnormal parathyroid glands prior to surgery, and Tc-MIBI scintigraphy should be used as the second step when sonography is negative.

Adolescent↗