Biomedical subjects

Ernesto Tomei

Publications and source records attributed to Ernesto Tomei.

7 recordsLinked to original sources

PubMed2006

Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy.

The aim of this paper was to assess the diagnostic value of magnetic resonance (MR) fluoroscopy in the study of oesophageal motility disorders and to compare MR fluoroscopy results with those of manometry and barium contrast radiography. Twenty-five subjects referred for dysphagia and three patients in follow-up after pneumatic dilatation of the lower oesophageal sphincter to treat severe achalasia underwent esophageal manometry, barium contrast radiography and MR fluoroscopy. Examinations were performed on a 1.5 T scanner. Dynamic turbo- fast low angle shot (turbo-FLASH) sequences acquired during oral contrast agent administration were used to perform MR fluoroscopy. MR fluoroscopy correctly diagnosed achalasia in nine patients, uncoordination of esophageal body motility in ten and scleroderma oesophagus in one. Diagnostic performance was satisfactory, with a sensitivity of 87.5% and a specificity of 100% in the general depiction of motility alterations. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. Studies on larger populations are necessary to obtain statistically significant results.

Adult↗

PubMed2006

Adult celiac disease: what is the role of MRI?

PURPOSE: To evaluate the ability of MRI to identify intra- and extraintestinal findings of celiac disease in an adult population. MATERIALS AND METHODS: Forty-one subjects (18 men and 23 women; mean age = 41.3 years; 31 with biopsy-proven celiac disease, and 10 healthy volunteers) underwent MRI of the small bowel. MR studies were performed on a 1.5-T magnet using T2-weighted half-Fourier single-shot turbo spin-echo (HASTE) and true fast imaging in steady-state precession (True-FISP) sequences. The MR features and sensitivity, and the specificity and accuracy of some of these features are described. RESULTS: In the 31 celiac patients, MRI showed bowel dilatation in 61.3% (N = 19), increased number of ileal folds in 48.4% (N = 15), reversed fold pattern abnormality in 38.7% (N = 12), increased wall thickness in 16.1% (N = 5), duodenal stenosis in 6.5% (N = 2), intussusception in 12.9% (N = 4), mesenteric lymphadenopathy in 41.9% (N = 13), mesenteric vascular changes in 22.6% (N = 7), ascites in 6.5% (N = 2), and no abnormalities in 12.9% (N = 4). The volunteers had unremarkable exams. The overall specificity and accuracy were 100%, and sensitivity was 79% and 75% for increased number of ileal folders and reversed fold pattern abnormality, respectively. CONCLUSION: MRI is able to demonstrate intra- and extraintestinal features that may lead to the diagnosis of celiac disease in adults.

Adult↗

PubMed2005

Small intestine contrast ultrasonography: an alternative to radiology in the assessment of small bowel disease.

BACKGROUND: Radiology and transabdominal ultrasonography (TUS) are used in the evaluation of the small bowel; however, the former technique is limited by radiation exposure, and the latter by its inability to visualize the entire small bowel. AIM: To evaluate the diagnostic accuracy of small intestine contrast ultrasonography (SICUS) to assess the presence, number, site, and extension of small bowel lesions. SUBJECTS AND METHODS: TUS, SICUS, and small bowel follow-through (SBFT) were performed in 148 consecutive patients (78 women; age range, 12 to 89 yr), 91 with undiagnosed conditions, and 57 with previously diagnosed Crohn's disease (CD). RESULTS: In the undiagnosed patients, the sensitivity and specificity of TUS and SICUS were 57% and 100%, and 94.3% and 98%, respectively. In the CD patients, the sensitivity of TUS and SICUS was 87.3% and 98%, respectively. In comparison with SBFT, the extension of lesions was correctly assessed with SICUS and greatly underestimated with TUS. The concordance index between SBFT and SICUS for the number and site of lesions was 1 and 1 (P < 0.001), respectively, in undiagnosed patients, and 0.81 and 0.83 (P < 0.001), respectively, in CD patients. Between SBFT and TUS, the concordance index was 0.28 and 0.27 (not significant), respectively, in undiagnosed patients, and 0.28 and 0.31 (not significant), respectively, in CD patients. CONCLUSIONS: The diagnostic accuracy of SICUS is comparable to that of a radiologic examination, and is superior to that of TUS in detecting the presence, number, extension, and sites of small bowel lesions. These findings support the use of noninvasive SICUS for an initial investigation when small bowel disease is suspected and in the follow-up of CD patients.

Abdomen↗

PubMed2003

MR imaging of the small bowel using polyethylene glycol solution as an oral contrast agent in adults and children with celiac disease: preliminary observations.

OBJECTIVE: The purpose of our report is to describe morphologic abnormalities of the small bowel in a population of patients with known celiac disease using MR imaging with polyethylene glycol solution as an oral contrast agent. CONCLUSION: Polyethylene glycol-enhanced MR imaging is a noninvasive (no ionizing radiation is used), feasible, and reproducible imaging technique in both adult and pediatric populations. Findings on polyethylene glycol-enhanced MR imaging, similar to those of conventional barium studies, may suggest a diagnosis of celiac disease because the technique can not only reveal intestinal involvement but also show extraintestinal findings.

Administration, Oral↗

PubMed2002

GI distension in severe ulcerative colitis.

OBJECTIVES: In previous retrospective studies in patients with severe ulcerative colitis (UC), small bowel distension was found to characterize a subgroup of patients at higher risk for both toxic megacolon (TMC) and multiple organ dysfunction syndrome (MODS). In this study we prospectively evaluated the prevalence of GI distension and its relationship to clinical outcome in patients with severe UC. METHODS: Of 109 consecutive inpatients with acute UC (admitted to the GI Unit of the University of Rome during the period 1995-2000), 45 had severe colitis. Routine blood tests and acid-base balance and plain abdominal film evaluations were performed upon admission and repeated every 1-3 days. The gas content of the stomach and small and large intestines was evaluated on plain abdominal films. All patients were submitted to the standard Oxford intensive medical regimen; clinical improvement, occurrence of major complications, need for surgery, and mortality were evaluated. Statistical analysis was carried out using Student's t, chi2, Fisher's exact, Mann-Whitney, and Wilcoxon rank sum tests, when appropriate. RESULTS: Of 45 patients with severe UC, 24 (53%) had GI distension. Three of these 24 patients had TMC on admission (all underwent surgery and survived), 21 showed increased GI gas content (four developed TMC 1-4 days after the detection of GI distension and were operated on, two developed MODS and died, and eight did not improve but were submitted to surgery and survived). None of the 21 patients with normal GI gas content had complications; all survived (five did not improve and required surgery). CONCLUSIONS: In severe UC, persistent GI distension characterized a subgroup of patients with poor response to medical therapy and at higher risk for TMC and of need for surgery. The development of MODS was the most important predicting factor for fatal outcome.

Adult↗

PubMedDate not supplied

Adult celiac disease: MRI findings.

The purpose of our report is to describe a spectrum of findings of celiac disease at MR enterography. MR enterography is a non-invasive, feasible, and reproducible imaging technique for the evaluation of small bowel. Findings on MR enterography, similar to those of conventional barium studies, may suggest a diagnosis of celiac disease.

Administration, Oral↗

PubMedDate not supplied

MR of the small bowel with a biphasic oral contrast agent (polyethylene glycol): technical aspects and findings in patients affected by Crohn's disease.

PURPOSE: To report our experience using MR of the small bowel with polyethylene glycol (PEG) solution as an oral contrast agent in a population of adults and children with known Crohn's disease. MATERIALS AND METHODS: 40 patients (29 males; 11 females), 15 adults (age range 24-52 years) and 25 children (age range 5-17 years), with known Crohn's disease, underwent MR of the small bowel using a supeconductive 1.5 T magnet, and polyethylene glycol solution as an oral contrast agent. The fixed amount of contrast agent was 750-1000 ml for adults and 10 ml/kg of body weight for children. The Crohn's Disease Activity Index (CDAI) was available in all patients. Our study protocol included the acquisition of T2-weighted half-Fourier single-shot turbo spin-echo (HASTE) sequences and true fast imaging in the steady-state precession (true-FISP) sequences, followed by the acquisition of "spoiled" 2D gradient echo T1-weighted sequences with fat suppression (FLASH, fast low-angle shot) or alternatively "spoiled" 3D (VIBE, volume interpolated breath-hold examination), acquired 70 seconds after intravenous administration of gadopentetate dimeglumine (Gd-DTPA) (0,1 mmol/kg). A specific MR score was created and calculated for each patient and was compared by means of the Spearman rank with CDAI. RESULTS: In all patients no significant side effects were observed and the MR examination was well tolerated even by paediatric patients. In all cases MR showed a small bowel wall thickening (> 4 mm) in the terminal ileum, with lumen stenosis in 26 patients. In 3 cases pathological segments proximal to the terminal ileum were observed and in another 3 cases caecal involvement was visible. The MR examination was able to show abnormalities of perivisceral fat tissue in 15 patients, mesenteric lymphadenopathy in 1 patient and abdominal abscess in 1 case. The Spearman rank showed a statistically significant correlation between CDAI and the MR score (r = 0.91, P = 0,0001). DISCUSSION: MR using PEG as an oral contrast agent could be considered a test of great interest in the evaluation of the small bowel in patients suspected of having Crohn's disease in that it is easily reproducible, well tolerated even by paediatric patients and it provides useful information about the localisation, extension and activity of inflammatory disease without the use of ionising radiation.

Administration, Oral↗