Biomedical subjects

Carlo Catalano

Publications and source records attributed to Carlo Catalano.

43 records · Page 3Linked to original sources

PubMed2002

Virtual gastroduodenoscopy: a new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: After open or laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity, the bypassed stomach and duodenum are not readily available for radiological and endoscopic evaluation. Furthermore, little is known about the long-term physiologic and histologic changes that occur in the bypassed GI segments following these procedures. Many alternative radiological and endoscopic techniques have been described to access the distal gastric pouch and the duodenum after RYGBP. Apart from percutaneous gastrografin studies, all these techniques require the insertion of a gastrostomy tube in the distal stomach. METHODS: A new diagnostic method to access the bypassed segments by virtual CT gastroscopy (VG) was used in 5 morbidly obese patients who underwent laparoscopic RYGBP (LRYGBP). RESULTS: All patients tolerated the procedure well, which appears safe and suitable for an outpatient setting. The virtual images offered an excellent intraluminal view of the stomach and duodenum. CONCLUSIONS: VG holds promise as the method of choice in the follow-up of LRYGB patients, having the potential to detect inflammatory changes and cancer in the excluded segments early.

Adult↗

PubMedDate not supplied

Computed tomography angiography: state-of-the-art imaging using multidetector-row technology.

Multidetector-row computed tomography (MDCT) is an essential diagnostic modality for many clinical algorithms. This is particularly true with regard to the evaluation of cardiovascular disease. As a result of increased image acquisition speed, improved spatial resolution, and greater scan volume, MDCT angiography (computed tomography angiography [CTA]) has become an excellent noninvasive imaging technique, replacing intra-arterial digital subtraction angiography for most vascular territories. The clinical success of CTA depends on precise synchronization of image acquisition with optimal vascular enhancement. As technology continuously evolves, however, this task can be challenging. It remains important to have a fundamental knowledge of the principles behind technical parameters and contrast medium administration. This article reviews these essential principles, followed by an overview of current clinical applications.

Angiography↗

PubMedDate not supplied

Radial scars of the breast: contrast-enhanced magnetic resonance mammography appearance.

The purpose of this study was to evaluate the appearance of contrast-enhanced magnetic resonance mammography (CE-MRM) in patients with suspected radial scar on mammography. Thirty women with radial opacities or black star findings at mammography, preoperatively underwent CE-MRM. Examinations were performed with a 1.5 T magnet with a bilateral surface coil using a FS T2-weighted turbo spin echo (TSE) and three-dimensional (3D) dynamic T1-weighted fast low-angle shot (FLASH) sequences. Criteria for lesion evaluation included morphologic patterns and signal intensity curves. Mammography and CE-MRM findings were compared with pathologic findings. CE-MRM suggested the presence of radial scar in 18 of 30 cases and the presence of malignancy in 11 of 30 cases; 1 lesion was classified as borderline. At surgery 22 radial scars (including 4 with associated ductal carcinoma in situ) and 8 carcinomas were detected. CE-MRM provided a specificity of 89%, sensitivity of 83%, and accuracy of 87%. Differently from breast cancer, radial scars are nonenhancing at CE-MRM. Nevertheless, the possibility of nonenhancing carcinomatous foci existing within radial scars implies that surgical excision should be performed in all cases.

Aged↗

PubMedDate not supplied

Multislice computed tomography in the preoperative assessment of adult-to-adult living donor liver transplantation: personal results.

PURPOSE: To evaluate the possible role of multislice spiral computed tomography (MSCT) as the sole imaging examination in the preoperative assessment of potential donors undergoing adult-to-adult living donor liver transplantation (LDLT). MATERIALS AND METHODS: Fifteen patients underwent MSCT with 0.5-second gantry rotation time. Pre- (4 X 2.5 mm collimation) and post-contrast (4 X 1 mm collimation) acquisitions during arterial and portal venous phases were performed after intravenous administration of 140 ml of non ionic contrast agent at 4-5 ml/s, with a delay time of 25 and 60 seconds, respectively. Pre-contrast scans with 80 and 140 kVp were acquired at the same level used to assess liver density. Real-time interaction with the post-contrast 3D data set was performed on a dedicated workstation to determine total and lobar liver volume, and to assess arterial and venous vascular anatomy. RESULTS: Steatosis was found in three patients, who as a consequence were excluded as possible candidates. MSCT correctly identified five cases of arterial anatomical variations: two cases of the right hepatic artery arising from the superior mesenteric artery, two cases of the common hepatic artery arising from the superior mesenteric artery and one case of the left hepatic artery arising from left gastric artery. In two cases portal trifurcation was considered a criterion for exclusion. A 4% error in the liver volume calculation was found at surgery, in no case considered significant. Two patients underwent surgery and three have been short-listed. CONCLUSIONS: MSCT enables complete preoperative evaluation of potential donors undergoing LDLT. Total and lobar volume determination provided accurate and reproducible information. MSCT enabled correct surgical planning without intra-operative complications. One of the limits of the technique was the poor visualization of the biliary anatomy with the need to perform an intraoperative cholangiography in all the patients.

Adult↗

PubMedDate not supplied

Gadobenate dimeglumine (Gd-DTPA) vs gadopentetate dimeglumine (Gd-BOPTA) for contrast-enhanced magnetic resonance angiography (MRA): improvement in intravascular signal intensity and contrast to noise ratio.

PURPOSE: The purpose of this study was to compare contrast enhanced MR angiography (MRA) with gadopentetate dimeglumine (Gd-DTPA) to MRA with gadobenate dimeglumine (Gd-BOPTA), a high relaxivity paramagnetic contrast agent. MATERIALS AND METHODS: Twelve patients referred for carotid artery stenosis were examined with MR angiography using a fast spoiled gradient echo sequence. Gd-DTPA and Gd-BOPTA enhanced MR angiography were performed within 48-72 hours using a dose of 0.1 mmol/kg for Gd-BOPTA and 0.2 mmol/kg for Gd-DTPA, at a flow rate of 2 ml/s. Images were evaluated by two blinded radiologists. Qualitative and quantitative evaluations were performed comparing the sets of images from the two examinations. RESULTS: Qualitative evaluation demonstrated superior arterial contrast enhancement and vessel conspicuity with Gd-BOPTA compared with Gd-DTPA. Quantita-tive evaluation showed an improvement in both signal intensity and contrast to noise ratio with Gd-BOPTA. CONCLUSION: The greater relaxivity of Gd-BOPTA, at lower doses, compared with Gd-DTPA, provides higher intravascular signal and signal to noise ratio. Gd-BOPTA appears to be an optimal contrast agent for contrast enhanced MRA.

Carotid Stenosis↗

PubMedDate not supplied

Evaluation of aortic arch calcification in hemodialysis patients.

BACKGROUND: In the general population, aortic arch calcification (AAC) is related to cardiovascular (CV) disease. Vascular calcifications are common findings in dialysis patients; therefore, we carried out a retrospective study evaluating which risk factors are associated to AAC in stable hemodialysis (HD) patients. METHODS: Standard posterior-anterior chest radiographs, performed the day after the midweek HD session in 132 patients (mean age 65 +/- 12 yrs) who had been on renal replacement therapy (RRT) for 33 months (range 1-471), were analyzed. Cardiothoracic ratio (CTR) was also calculated. RESULTS: AAC was detected in 51% of patients. They were older (68 +/- 8 vs. 62 +/- 14 yrs; p = 0.003), were on RRT for longer (51 (range 2-471) vs. 22 (range 1-195) months; p = 0.0001), had greater CTR (54 (32-71) vs. 50% (40-65); p = 0.034) and higher prevalence of peripheral vascular disease (PVD) (40 vs. 17%; p = 0.049), whilst body weight was lower (62 +/- 14 vs. 68 +/- 14 kg; p = 0.04) than those without AAC. On the contrary, sex, diabetes frequency, smoking habit, history of hypertension and hyperphosphatemia, cerebrovascular and ischemic heart disease (IHD), blood pressure (BP) and antihypertensive therapy, lipids, albumin, degree of anemia, calcium, phosphate and their product were no different between the two groups. Logistic regression analysis showed that age (odds ratio (OR) 1.069 95% confidence interval (95% CI) 1.02-1.11; p = 0.003), length of time on RRT (OR 1.02 95% CI 1.01-1.03; p = 0.0002), calcium-phosphate product (OR 1.03 95% CI 1.007-1.07; p = 0.016), systolic BP (OR 1.03 95% CI 1.005-1.06; p = 0.02) and PVD (OR 3.08 95% CI 1.17-8.06; p = 0.02) were independently associated to AAC. CONCLUSIONS: We conclude that AAC is related to atherosclerosis and to renal failure-related CV risk factors. A careful evaluation of a frequently performed investigation is useful in CV disease risk stratification in HD patients.

Aged↗

PubMedDate not supplied

CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer.

PURPOSE: To evaluate the role of contrast-enhanced Magnetic Resonance Mammography (MRM) in the evaluation of the contralateral breast in patients with recently diagnosed breast cancer. MATERIALS AND METHODS: Fifty patients with proved unilateral breast cancer, with a negative contralateral breast at physical examination, ultrasound and mammography, were studied with a 1.5 T magnet (Siemens, Vision Plus, Germany). A bilateral breast surface coil was used. Dynamic 3D Flash T1-weighted sequences were acquired in the axial plane before and 0, 2, 4, 6 and 8 minutes after the administration of 0.1 mmol/kg of Gd-BOPTA at a flow rate of 2 ml/s followed by 10 ml of saline. The level of suspicion was reported on a scale from 0 to 5 following the BI-RADS classification, based on lesion morphology and kinetic features. The results were compared with the histological findings after biopsy or surgery. RESULTS: Fourteen out of 50 patients (28%) had contralateral lesions identified on MRM. Biopsy was performed in four of them for suspicious lesions (BI-RADS 4) while 10 patients underwent surgery because of highly suggestive malignant lesions (BI-RADS 5). Histology diagnosed three fibroadenomas, 5 ductal carcinomas in situ, 2 lobular carcinomas in situ, 3 invasive ductal carcinomas and 1 invasive lobular carcinoma. Contrast-enhanced MRM yielded no false negative and three false positives. CONCLUSIONS: Our results demonstrate a very good accuracy of Magnetic Resonance Mammography in the detection of synchronous contralateral cancer in patients with newly diagnosed breast cancer. Therefore, contrast-enhanced MRM could be introduced to screen patients with proven breast cancer before they undergo surgery.

Adult↗