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Biomedical subjects

C Bartolozzi

Publications and source records attributed to C Bartolozzi.

At least 91 records · Page 5Linked to original sources
PubMed1996

Peripheral ischemic occlusive arterial disease: comparison of color Doppler sonography and angiography.

We examined 334 legs in 167 consecutive patients with advanced peripheral ischemic disease using color Doppler sonography and angiography. Angiography revealed 714 lesions (369 nonsignificant stenoses, 297 significant stenoses, and 48 occlusions) in the 334 legs examined. Overall, color Doppler sonography revealed diagnostic agreement with angiography in 668 of 714 lesions (93.5%), including 343 of 369 (92.9%) nonsignificant stenoses, 279 of 297 (93.9%) significant stenoses, and 46 of 48 (95.8%) occlusions. Overestimation occurred in 26 of 369 (7%) nonsignificant stenoses and 3 of 297 (1%) significant stenoses. Underestimation was observed in 15 of 297 (5%) significant stenoses and in 2 of 48 (4.2%) occlusions. Peak systolic velocity ratio correlated better (P < 0.01) than peak systolic velocity with diameter reduction percentage as assessed at angiography. Color Doppler sonography is an accurate noninvasive method for evaluating patients with peripheral ischemic disease.

Adult↗
PubMed1996

[Calcaneal fractures: guidelines for the diagnosis with computerized tomography].

We report on 31 cases of calcaneal fractures studied with CT according to the latest classification by the Italian Surgical Society of the Foot. Of the utmost importance is the radiologic assessment of the posterior facet and of the underlying bone, which make up the so-called talamus which bears most of the body weight. In our series, talamus fractures were the most frequent ones (26/31 cases): they are characterized by a main sagittal line, running obliquely and dividing the posterior surface and the bone into an anteromedial, or substentacular, fragment and a posterolateral, or tuberosity, fragment. According to fracture severity, the first differential criterion is the presence/absence of displacement and depression (type I fractures the latter, 6 cases in our series, and (types II and III the former, 20/26 cases in our series). Based on the degree of displacement and depression, fractures as classified as type II (10/26 cases) when only the lateral portion of the talamus is displaced and depressed, or as type III (10/26 cases) when the whole talamus is fragmented, displaced and depressed. Moreover, other worsening factors must be considered and B subgroups differentiated in types II and III fractures; these factors are: calcaneus-cuboid facet involvement, lateral wall fragmentation, posterior facet comminution, a small sustentacular fragment and a secondary frontal fracture interrupting the plantar cortex. Extra-talamic fractures, defined as such when isolated, rarely occur. Relative to the anterior apophysis, radiologic attention must be focused on fractures of the dorsal prominence, or beak, which are very often misdiagnosed. As regards the posterior tuberosity, its lateral dislocation must be studied because it may account for calcaneofibular impingement. CT exhibits excellent potentials, provided that slices are thin, acquired on the axial and coronal planes and that, as far as possible, sagittal reconstructions are used, the latter being very useful to depict talamic surface.

Adolescent↗
PubMed1996

[Implementation of a server World Wide Web of radiology accessible by Internet].

Internet is an international computer network that uses standard communication protocols for the exchange of information. This facilitates the retrieval of multimedia data through a "web" of servers distributed in the whole world. Among Internet users, Radiologists are a potentially important segment, due to the inherent multimedia characteristics of the discipline, which requires a continuous international update of information. The Department of Radiology of the University of Pisa has an Internet access through the metropolitan area network which was installed in the framework of the CNR Telecomunicazioni Project. The Internet access allowed the implementation of a World Wide Web server made public on Internet in March, 1994, being the first European server specifically oriented to radiology. This server can be accessed at the following address: http:@www.rad.unipi.it:7080/IRMosaicHome.html . On the server, 3 hypermedia papers are present, a list of international servers containing radiological information, a questionnaire, and statistics concerning the number of users who accessed the server. In the first 18 months of public access through Internet (April 1, 1994-September 30, 1995) 16,166 users accessed the server, retrieving 127,349 documents, corresponding to 1,279.7 MByte of information. The mean amount of information retrieved in each access to the server in the considered quarters ranges from 72 to 85.8 kByte. The geographic distribution of the users who accessed the server is the following: United States, 7,158, Italy, 2,466; other European countries, 3,813; other extra-European countries, 2,729. The increasingly diffuse knowledge of Internet services had a substantial impact on the rise in number of the servers and of the users who can access them. It is likely that in the future this technology will be used with increasing interest by Radiologists, since it provides easier "navigation" through multimedia information, consisting of text and several images, without the inherent limitations of the printed paper.

Computer Communication Networks↗
PubMed1996

[Comparison of computerized tomography and magnetic resonance in the assessment of benign and malignant pleural diseases].

To compare the diagnostic capabilities of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in differentiating benign from malignant pleural disease, we examined with MRI at 0.5 T forty-five patients with pleural lesions identified on CT scans. For 34 patients, a final diagnosis of malignant (n = 18) or benign (n = 16) disease was made. T1, proton density/T2 and enhanced T1-weighted spin-echo images were acquired. CT and MR images were independently studied by two observers, who were unaware of the final diagnosis. Various morphological features suggesting benign or malignant pleural disease were evaluated. On the basis of the morphological CT features, a final diagnosis of benignity of malignancy was expressed in terms of two different levels of confidence-probable or definitive. The MR signal intensity of pleural lesions was compared with that of intercostal muscles (isohypointense or hyperintense). No significant differences were observed between CT and MR morphological findings. High signal intensity on proton density/T2-weighted images was observed in all malignant lesions and in 2 benign lesions (100% sensitivity, 87% specificity). In the absence of this sign (i.e., isointense or hypointense signal), the lesions were always benign (100% negative predictive value). All the definitive CT diagnoses were correct, while 6 of 17 probable CT diagnoses were incorrect. In the subgroup of lesions misinterpreted with CT, MR signal intensity on long-TR images always allowed the correct differentiation of benign from malignant conditions. To conclude, MR signal intensity is a valuable additional feature to differentiate benign from malignant pleural disease. We suggest the use of MRI in the pleural lesions where the level of confidence of CT diagnosis is low.

Adult↗
PubMed1995

Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients.

BACKGROUND: Percutaneous ethanol injection (PEI) has been used in the Far East for treating small, unresectable hepatocellular carcinoma (HCC). To clarify when treatment with PEI may be best indicated for Western patients with HCC, the authors performed a retrospective analysis of the clinicopathologic factors influencing prognosis. METHODS: From December 1987 to August 1994, 105 patients with cirrhosis with HCC received PEI as the sole anticancer treatment. Eighty-two patients had uninodular tumors smaller than 5 cm, and 23 patients had multiple lesions (2-4) smaller than or equal to 3 cm each. All patients were in Child-Pugh class A (n = 64) or B (n = 41). Survival was analyzed according to patient- and tumor-related factors by means of the Kaplan-Meier method. RESULTS: The estimated survival rates of all 105 patients were 96% at 1 year, 86% at 2 years, 68% at 3 years, 51% at 4 years, 32% at 5 years, and 24% at 6 years. Survival was not affected by sex, age, etiology of cirrhosis, or hepatitis B surface antigen or anti-hepatitis C virus positivity, but depended on Child-Pugh class (P = 0.006) and presence of ascites (P = 0.009). Patients with a pretreatment alpha-fetoprotein level of 200 ng/ml or less had a better prognosis than patients with an alpha-fetoprotein level higher than 200 ng/ml (P = 0.007). Patients with unmodular HCC of 3 cm or less had significantly better long term survival (P = 0.04) than patients with uninodular HCC of 3.1-5 cm or with multinodular tumors. Tumor grade according to Edmondson and Steiner and tumor volume, in contrast, did not significantly influence prognosis (P > 0.1). CONCLUSIONS: For Western patients with HCC treated with PEI, the prognosis was highly dependent on the severity of the underlying cirrhosis. Treatment with PEI is best indicated for patients with uninodular tumors of 3 cm or less in greatest dimension and an alpha-fetoprotein level lower than 200 ng/ml.

Administration, Cutaneous↗
PubMed1995

Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves' disease from Hashimoto's thyroiditis.

Thyroid hypoechogenicity at ultrasound is a characteristic of autoimmune thyroid diseases, with an overlap of this echographic pattern in patients affected by Graves' disease or Hashimoto's thyroiditis. Aim of the present paper was to study the thyroid blood flow (TBF) by color-flow doppler (CFD) and peak systolic velocity (PSV) at the inferior thyroid artery in 37 Graves' and 45 goitrous Hashimoto's thyroiditis patients. CFD pattern was defined as normal (or type 0): TBF limited to peripheral thyroid arteries (PSV = 17.7 +/- 3 cm/sec, mean +/- SD); type I: TBF mildly increased; type II: TBF clearly increased; type III: TBF markedly increased. The CFD was in direct relationship to the PSV. Out of 18 patients with Graves' disease and untreated active hyperthyroidism CFD pattern was type III in 17 and type II in 1. The PSV was 42.1 +/- 15 cm/sec. In 17 patients euthyroid under methimazole, the CFD pattern was type 0 in 3 (17%) type I in 5 (30%), type II in 5 (30%), type III in 4 (23%). In this group of Graves' patients the PSV was 36 +/- 14 cm/sec. In two patients, hypothyroid after radioiodine treatment, the CFD pattern was type 0 in 1 and type I in 1. In the group of Hashimoto's patients TBF was in no relationship with thyroid status or treatment and was type 0 in 22 (49%), type I in 20 (44%), type II in 3 (7%), while none had type III CFD pattern. Thyroid hypoechogenicity at ultrasound was present in 32/37 (86%) Graves' and 41/45 (91%) Hashimoto's patients. All the four patients with Hashimoto's thyroiditis and normal thyroid ultrasound pattern had also a normal CFD pattern, while 4/5 patients with Graves' disease and normal echographic pattern had an increased TBF. In conclusion, a diffusely increased thyroid blood flow is pathognomonic of untreated Graves' disease and an abnormal CFD pattern identifies the majority of Graves' patients with a normal thyroid ultrasound pattern. Thus, CFD sonography may be useful in distinguishing patients with Graves' disease and Hashimoto's thyroiditis having a similar thyroid echographic pattern at ultrasound.

Diagnosis, Differential↗
PubMed1995

Chest radiography and high resolution computed tomography in the evaluation of workers exposed to silica dust: relation with functional findings.

OBJECTIVES: To compare the usefulness of high resolution computed tomography (HRCT) with chest radiography (CR) in the diagnosis and assessment of severity of silicosis. METHODS: 27 workers exposed to silica underwent CR, HRCT, and pulmonary function tests. Two experienced readers independently evaluated CR by International Labour Office classification, and grouped the results into four categories. HRCT categories of nodule profusion and the extent of emphysema were graded on a four point scale; in 20 subjects the percentage distribution of lung densities were measured by HRCT. RESULTS: Concordance between readers was higher for HRCT than for CR (K statistic = 0.49 and 0.29 respectively). There was poor concordance between CR and HRCT in the early stage of silicosis. No significant difference in pulmonary function tests was found among different CR categories, but forced expiratory volume in one second (FEV1), maximal expiratory flow at 50% and 75% of FVC (MEF50, MEF75), and diffusion capacity significantly decreased with increasing HRCT categories. Subjects with simple silicosis detected by HRCT had a lower FEV1 than subjects without silicosis, whereas subjects with conglomerated silicosis showed higher residual volume and functional residual capacity than subjects with simple silicosis. These relations were not affected by smoking or symptoms of chronic bronchitis. Different grades of emphysema detected by HRCT were significantly different in diffusion capacity. Only the HRCTs of the lowest and the highest categories of profusion of parenchymal opacities were significantly different in their distribution of density classes. CONCLUSION: HRCT is more reproducible and accurate than CR, as suggested by the higher agreement between readers and the better correlation with pulmonary function tests, irrespective of smoking and chronic bronchitis; however, these data do not support the hypothesis that HRCT is more sensitive than CR in the early detection of silicosis.

Adult↗
PubMed1995

Hepatocellular carcinoma: use of color Doppler US to evaluate response to treatment with percutaneous ethanol injection.

PURPOSE: To determine the usefulness of color Doppler ultrasound (US) in the evaluation of the response of hepatocellular carcinoma (HCC) to percutaneous ethanol injection (PEI). MATERIALS AND METHODS: Forty-one patients with 48 lesions 2-5 cm in diameter underwent color Doppler US before and after PEI. Computed tomography (CT), magnetic resonance (MR) imaging, and percutaneous biopsy were also performed to help establish the outcome of therapy. RESULTS: Before treatment, color signals with an arterial Doppler spectrum were seen in 44 of 48 lesions with a frequency shift of 0.51-4.11 kHz (mean, 1.65 kHz). After PEI, 37 of these lesions showed no color signal and were found to be necrotic at CT, MR imaging, and biopsy. In six of seven lesions containing residual tumor, pulsatile flow was still identified, although the frequency shift was significantly decreased (P = .01). CONCLUSION: Color Doppler US proved useful in the assessment of the therapeutic effect of PEI on HCC.

Aged↗
PubMed1995

Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization.

PURPOSE: To compare the efficacy of transcatheter arterial chemoembolization (TACE) combined with percutaneous ethanol injection (PEI) versus repeated TACE in the treatment of large hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty-three patients with cirrhosis and a large HCC (main tumor, 3.1-8.0 cm in diameter with no more than two daughter nodules) were enrolled in a prospective, randomized study. Twenty-six patients underwent a single TACE session followed by PEI (TACE-PEI group), whereas 27 patients underwent two to five TACE sessions (TACE group). Both groups of patients were similar with regard to liver function. Follow-up ranged from 8 to 39 months. RESULTS: Complete therapeutic responses were higher (P < .05) and tumor recurrences during follow-up were lower (P < .05) in the TACE-PEI group than in the TACE group. Patients in the TACE-PEI group survived longer than those in the TACE group, although the difference was not significant (P > .1). The rates of survival without recurrence were better in the TACE-PEI group than in the TACE group (P < .05). CONCLUSION: Use of a single TACE session combined with PEI is more effective than repeated TACE in the treatment of large HCC.

Aged↗
PubMed1995

Portal vein thrombosis after percutaneous ethanol injection for hepatocellular carcinoma: value of color Doppler sonography in distinguishing chemical and tumor thrombi.

OBJECTIVE: The distinction between benign (chemical) and tumor thromboses of the portal vein after treat,ent with percutaneous injection of ethanol for hepatocellular carcinoma is crucial for the proper management of the patient. The purpose of this study was to determine whether color Doppler sonography can be used to differentiate between the two types of thrombi. SUBJECTS AND METHODS: Between October 1991 and April 1994, portal vein thrombosis was detected by color Doppler sonography in 19 patients (13 men and six women 59-77 years old; mean age, 67 years) who had hepatocellular carcinomas and who had received percutaneous ethanol injection (n = 11) or percutaneous ethanol injection after transcatheter arterial embolization (n = 8). The criterion for diagnosing tumor thrombosis by color Doppler sonography was the detection of pulsatile arterial flow in the thrombus. The benign or malignant nature of the thrombosis was subsequently established by percutaneous fine-needle biopsy of the thrombus; malignant thrombosis was seen in 13 patients, and chemical thrombosis was seen in six patients. RESULTS: Pulsatile arterial flow in the thrombus was observed by color Doppler sonography in 12 of the 13 malignant thrombi and in none of the bland thrombi. The flow was hepatopetal in seven cases and hepatofugal in five cases. The peak systolic frequency shift ranged from 0.59 to 2.65 kHz (mean, 1.35 kHz), and the resistive index ranged from 0.37 to 0.69 (mean, 0.55). The sensitivity and the specificity of color Doppler sonography for the detection of tumor thrombosis were 92% and 100%, respectively. CONCLUSION: Our study shows that color Doppler sonography is a reliable way to differentiate between chemical and tumor thromboses of the portal vein in patients with hepatocellular carcinomas treated by ethanol injection. When the sonogram shows pulsatile arterial flow within the thrombus, percutaneous biopsy of the thrombus is unnecessary. The finding is always indicative of malignant thrombosis.

Aged↗
PubMed1995

[The radiological assessment of the knee in the meniscectomy patient].

The increasing number of radiologic examinations performed on patients previously submitted to arthroscopic meniscectomy led us to analyze the types of lesion most frequently found in these patients and the prognostic factors related to meniscectomy. Thus, the radiographs, CT and MR examinations were reviewed of 34 symptomatic patients submitted to arthroscopy at least 1 year earlier and in whom symptoms had appeared no more than 3 months earlier, thus ruling out the symptoms related to surgical complications. Lesions were found in the menisci, in the meniscal stumps and in the articular ends. The lesions involving the menisci not submitted to previous arthroscopy were not studied in detail. As to meniscal stumps, CT and MRI exhibited the same diagnostic accuracy, in detecting lesion recurrence, in 50% of cases. In the remaining cases their results were similar, with some false negatives (CT) and some false positives (MRI). As to osteoarthritis, MRI proved superior in detecting the microscopic evidence of cartilage-bone erosions even though 20% of patients exhibited findings of such entity as to be visible at CT. As regards the macroscopic evidence of articular ends deformity, CT and MRI yielded the same results. To define the prognostic factors of meniscectomy, all patient was asked to define their activity level after meniscectomy, that is before the onset or recurrence of symptoms. A detailed questionnaire was used to this purpose, using the Tapper-Hoover rating scale, expressly developed to derive a functional knee score after meniscectomy. The results indicate that the functional knee score (related to prognosis) was lower in patients older than 40, in meniscectomy performed in older age, in long intervals between trauma and meniscectomy, after complex and horizontal-cleavage lesions and, finally, in sedentary activity.

Adult↗
PubMed1995

[High-resolution computed tomography compared with the thoracic radiogram and respiratory function tests in assessing workers exposed to silica].

To compare the usefulness of high-resolution computed tomography (HRCT) and chest radiography in the functional evaluation of silica-exposed workers, 27 workers were submitted to posteroanterior and lateral chest radiographs, apex to base HRCT scans and pulmonary function tests. Two experienced readers studied plain films independently to assess small opacities profusion (ILO-UC, Geneva 1980): from 0/- to 3/+. HRCT grading and extent of silicotic nodules and associated emphysema were scored on a four-point scale. Inter-reader analysis showed better agreement for HRCT (K = 0.49) than chest radiography (K = 0.29). Poor agreement was observed between chest radiography and HRCT classes, particularly in the early stages of silicosis. No correlation was observed between chest radiography score and pulmonary function tests, while a significant correlation was observed between HRCT classes (grade and extent of the nodules) and FEV1, MEF50, MEF75, RV and FRC. In conclusion, HRCT exhibited better reproducibility and higher accuracy than chest radiography in identifying the absence of silicotic nodules and in depicting functionally important lesions. To this purpose, HRCT can be considered a useful support to conventional chest radiography.

Aged↗
PubMed1995

Corticospinal tract degeneration in motor neuron disease.

Long-repetition-time spin-echo MR images showed symmetric hyperintensity of the intracerebral corticospinal tracts in two patients with clinical and neurophysiologic diagnosis of primary lateral sclerosis and amyotrophic lateral sclerosis. In both, axial low-flip-angle gradient-echo images of the cervical spine showed hyperintensity of the lateral columns of the cord consistent with antegrade degeneration of the crossed corticospinal tracts.

Adult↗
PubMed1995

MR angiography of spinal vascular malformations.

PURPOSE: To determine the potential and limitations of MR angiography in the evaluation of spinal vascular malformations. METHODS: Eleven consecutive patients with spinal vascular malformations proved with spinal selective arteriography underwent two-dimensional phase-contrast MR angiography. RESULTS: Abnormal vessels within the spinal canal were identified with MR angiography in 10 patients. In 1 patient with a dural arteriovenous fistula no definite vascular abnormality was seen with MR angiography. Correlation of MR angiography with spinal selective arteriography showed that the former allowed identification of the arterial feeder in 3 patients with intramedullary arteriovenous malformations and 2 with perimedullary arteriovenous fistula, whereas the source of intradural draining vein was seen in only 2 of 6 patients with dural arteriovenous fistula. CONCLUSION: MR angiography is a promising complementary tool to MR imaging for detection and characterization of spinal vascular malformations.

Adolescent↗
PubMed1995

[Comparative evaluation of ultrasonography, computerized tomography, angiography and lipiodol CT in defining extent of hepatocarcinoma. A multicenter study].

The authors report the results of a multicentric trial on hepatocellular carcinoma (HCC) patients, whose lesions were confirmed with biopsy or by high (> 400 ng/ml) alpha-fetoprotein levels. The series consisted of 149 patients examined in 8 different centers and submitted to ultrasonography (US), Computed Tomography (CT) before and after contrast agent administration, angiography and Lipiodol CT. According to lesion size and number, the patients were divided with each imaging modality into three groups: a) group 1: unifocal HCC < 5 cm diameter; b) group 2: multifocal HCC with 2-3 nodules and/or tumor mass < 80 ml; c) multifocal HCC with more than 3 nodules (with total tumor mass not exceeding 40% of liver volume) or with total tumor mass > 80 ml. In 77 patients all the examinations were available for comparison. US and CT diagnosed more patients as belonging to group 1 than angiography and Lipiodol CT, while more patients were classified as groups 2 and 3 with angiography and Lipiodol CT, meaning that US and CT may understage some HCC cases (about 15%) because they show a lower number of nodules. This observation was confirmed by the direct comparison between US and Lipiodol CT (in 114 patients), CT and Lipiodol CT (in 103 patients) and angiography and Lipiodol CT (in 116 patients). US and Lipiodol CT were in disagreement in 18 cases, CT and Lipiodol CT in 16 cases and angiography and Lipiodol CT in 13 cases. In most of these cases, Lipiodol CT showed more lesions than the other techniques. The size of the undetected lesions was small, ranging few mm to 2 cm in nearly all cases. To conclude, the results of this multicentric trial show that Lipiodol CT is a fundamental tool to evaluate HCC extent. In contrast, conventional CT appeared not to add any significant piece of information and can therefore be excluded from the diagnostic protocol of HCC.

Angiography↗
PubMed1994

MRI of pleomorphic xanthoastrocytoma: case report.

MRI showed a cortically-based partially cystic and markedly enhancing mass in the uncus of the right temporal lobe in a patient with long standing refractory partial complex seizures. Histopathological examination revealed a pleomorphic xanthoastrocytoma, a rare, usually benign tumour thought to originate from subpial astrocytes.

Adult↗