Biomedical subjects

Gabriele Masselli

Publications and source records attributed to Gabriele Masselli.

9 recordsLinked to original sources

PubMed2006

Assessment of Crohn's disease in the small bowel: Prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis.

Our objective was to assess the diagnostic value of magnetic resonance enteroclysis (MRE) compared with conventional enteroclysis (CE) in patients with Crohn's disease. A secondary objective was to evaluate the diagnostic accuracy of each different MR sequence. Sixty-six consecutive patients with known Crohn's disease underwent MRE and CE. Fast imaging employing steady-state acquisition (FIESTA), single-shot fast spin-echo (ssFSE), and contrast-enhanced T1-weighted sequences were assessed by two radiologists who reached a consensus about the following findings: visualization of wall ulcers, pseudopolyps, fistulae, mural stenosis, and mesenteric abnormalities. Standard descriptive statistics and the McNemar test were used. The sensitivity, specificity and accuracy of MRE were 90-87% and 83% for the depiction of parietal ulcers, 84%-88% and 86% for pseudopolyps, 100-94% and 96% for mural stenosis, 93-100% and 94% for fistulae. The number of detected extraluminal findings was significantly higher with MRE (P < 0.01). The accuracy of FIESTA sequence was statistically higher in the depiction of wall ulcers and fistulae than that of three-dimensional fast spoiled gradient echo (3D-FSPGR) (P < 0.01) and ssFSE (P < 0.05) sequences. Contrast-enhanced 3D-FSPGR was superior for mural stenosis visualization compared to ssFSE (P < 0.05) and FIESTA (P < 0.05). MRE correlates accurately with CE in the detection of superficial and transmural abnormalities and has the advantage of assessing the mesenteric manifestations.

Adolescent↗

PubMed2005

Magnetic Resonance Enteroclysis imaging of Crohn's.

AIM: The aim of our prospective study was to evaluate the diagnostic accuracy of MR Enteroclysis (MRE) to assess the extension and complications of Crohn's Disease (CD) in comparison with conventional enteroclysis (CE). MATERIALS AND METHODS: The study comprised 30 consecutive patients affected by Crohn's disease (18 women and 12 men; age range 16-76, mean age 40.6 years), who underwent conventional and MR enteroclysis. The MR enteroclysis protocol includes three sequences: coronal and axial FIESTA and ssFSE sequences and T1-3D-FSPGR sequences before and after intravenous injection of gadolinium, acquired after administration of 1.6-2 l of iso-osmolar polyethylene glycol solution via a nasojejunal catheter. Two radiologists blindly scored each sequence for opacification of the lumen, small bowel distension and image quality and evaluated the following parameters: presence of wall ulcers, pseudopolyps, stenoses and fistulae. RESULTS: The accuracy of the FIESTA sequence was significantly higher (p<0.01) than the ssFSE and 3D FSPGR sequences in the evaluation of lumen opacification and bowel distension, and for the overall quality of the images (p<0.01). The sensitivity and specificity of MRE were 82% and 100% for the visualisation of parietal ulcers, 87% and 100% for pseudopolyps, 100% and 88% for stenoses, 75% and 100% for parietal fistulae. High-grade stenoses with prestenotic dilation (n=6) and low-grade stenoses (n=9) were visualised both by MRE and CE. MRE also showed abscesses in two patients, not seen at CE. The FIESTA and ssFSE sequences had higher accuracy in the detection of wall ulcers and fistulae, whereas the 3D FSPGR sequences showed higher accuracy in the evaluation of wall thickening. CONCLUSIONS: MRE is able to demonstrate the spectrum of superficial, intramural and exoenteric alterations in Crohn's disease and closely correlates with CE in demonstrating alterations of the bowel lumen and wall.

Adolescent↗

PubMed2004

Magnetic resonance imaging of cholangiocarcinoma.

Cholangiocarcinoma arises from the bile ducts and is the most common primary malignancy of the biliary tree. Cholangiocarcinoma is classified according to its growth pattern: mass-forming, periductal-infiltrating, or intraductal-growing type. The majority of cholangiocarcinomas occur at the common hepatic duct (CHD) and its bifurcation, also referred to as Klatskin's tumor, but they also can occur in more peripheral branches within the hepatic parenchyma. Microscopically, cholangiocarcinoma represents an adenocarcinoma with a glandular appearance arising from the epithelium of the bile ducts. On magnetic resonance (MR) images, cholangiocarcinomas appear hypointense on T1-weighted images, and hyperintense on T2-weighted images. Central hypointensity can be seen on T2-weighted images and correspond to fibrosis. On dynamic MR images, cholangiocarcinomas show moderate peripheral enhancement followed by progressive and concentric filling in the tumor with contrast material. Pooling of contrast within the tumor on delayed MR images is suggestive of peripheral cholangiocarcinoma. The role of MR imaging in hilar cholangiocarcinoma is to confirm/reach a diagnosis and to assess resectability. Hilar cholangiocarcinoma shows the same signal intensity pattern of peripheral tumors both on T1- and T2-weighted images. On magnetic resonance cholangiopancreatography (MRCP) images, hilar cholangiocarcinoma appears as a moderately irregular thickening of the bile duct wall (>/=5 mm) with symmetric upstream dilation of the intrahepatic bile ducts. The aim of preoperative investigation in Klatskin tumors typically requires the evaluation of the level of biliary obstruction, the intrahepatic tumor spread, and the vascular involvement; it also needs to show any atrophy-hypertrophy complex. Because of its intrinsic high tissue contrast and multiplanar capability, MR imaging and MRCP are able to detect and preoperatively assess patients with cholangiocarcinoma, investigating all involved structures such as bile ducts, vessels and hepatic parenchyma. The main reason for surgical/imaging discrepancy is represented by the microscopic diffusion along the mucosa and in the perineural space.

Bile Duct Neoplasms↗

PubMedDate not supplied

Pancreas divisum and santorinicele: assessment by dynamic magnetic resonance cholangiopancreatography during secretin stimulation.

PURPOSE: To evaluate the usefulness of MRCP, before and after secretin administration, in diagnosing Santoriniceles in patients with pancreas divisum. MATERIAL AND METHODS: One hundred and eight patients with suspected pancreatic disease, underwent dynamic magnetic resonance cholangiopancreatography (MRCP) before and after secretin administration (S-MRCP). S-MRCP images were evaluated for presence/absence of pancreas divisum, Santorinicele; size of the main pancreatic duct and of the Santorinicele. The onset of duodenal filling was calculated on dynamic S-MRCP images. S-MRCP findings were compared to endoscopic retrograde cholangiopancreatography (ERCP) ones (39/108). RESULTS: Pancreas divisum (PD) was detected in 6/108 patients (6%) at MRCP, and in 16/108 patients (14%) at S-MRCP. ERCP confirmed the diagnosis in 12/16 patients, with 1 false positive. 3 patients did not undergo ERCP. Santorinicele was detected in 4/108 (3%) patients at MRCP and in additional 4/108 (3%) patients at S-RMCP, only in patients with PD. Santoriniceles were confirmed in 7/8 patients at ERCP; in 1/8 patient CPRE was unsuccessful. The duct of Santorini was significantly larger (p< 0.05), in the pancreatic head, in patients with PD and Santorinicele (3.6 mm) compared to those with PD only (2.2 mm). A significant reduction in size of the pancreatic duct (26%) and of the Santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was significantly delayed in patients with Santorinicele (2.1 vs 1.3 minutes)(p<0.05). CONCLUSIONS: S-MRCP helps to identify patients with pancreas divisum and Santorinicele, a known cause of impeded pancreatic outflow which benefits from endoscopic treatment.

Adolescent↗

PubMedDate not supplied

Combined diagnostic imaging of Crohn's disease: an outlook.

Crohn's disease is an inflammatory disease of the mucosa and bowel wall layers involving peritoneal, mesenteric structures and lymph nodes. The combination of the various imaging procedures plays a major role in the evaluation of Crohn's disease patients, based on which an optimal definition of the disease stage is achieved. This is required for a correct therapeutic strategy that can be exclusively medical, surgical or elective in complications. In the combined approach, the follow-through study of the small bowel and enteroclysis in particular, represents the examination of choice to document the early disease, early signs of recurrence with the demonstration of all mucosal alterations, including fistulous tracts. Sonography, CT and MRI allow the evaluation of Crohn's location in the wall and adjacent region. Preliminary results of CT-enteroclysis and MR-enteroclysis seem able to document mucosal alterations and morphofunctional characteristics In the near future these new examinations could become a real one-stop-shop coupled with wireless endoscopy in the study of Crohn's disease.

Crohn Disease↗

PubMedDate not supplied

The state of the art of small bowel imaging: combine the old with the new.

Barium contrast examinations are the reference methods for the detection of morphological intraluminal alterations of the small bowel. Oral small bowel examination in many Centers has been replaced by small bowel enteroclysis. It allows optimal filling of intestinal loops, through a nasojejunal tube and the diagnostic sensitivity and specificity are higher as compared to the conventional examination. US, CT and MRI are useful diagnostic procedures in the evaluation of parietal and extraparietal alterations and in the study of complications of small bowel disease. In recent years, CT-enteroclysis and MR-enteroclysis have been developed, both enable the evaluation of luminal, extraluminal and mural alterations of the small bowel. Diagnostic imaging plays a major role in the study of the small bowel. The most appropriate diagnostic method should be selected, based on the clinical observations and on the availability of the technique.

Diagnostic Imaging↗

PubMedDate not supplied

Intestinal lymphangiectasia.

The case of a 26-year-old female patient with abdominal pain, nausea, hypoproteinemia, enteric loss of plasma proteins, lymphedema, severe steatorrhea and malabsorption, is presented. Enteroclysis and sonography were performed. Based on the case history and the characteristics of focal lesion and intestinal folds provided by the two radiologic examinations, a specific diagnosis of intestinal lymphangiectasia, confirmed at biopsy, could be established. Intestinal lymphagiectasia is a very uncommon condition characterized by dilated submucosal lymphatic channels.

Adult↗

PubMedDate not supplied

Intralobar pulmonary sequestration in an elderly adult.

The case of a patient admitted to the hospital for symptoms characterized by chest pain, productive cough, fever, dyspnea resistant to antibiotic therapy is discussed. Previous plain chest X-ray performed elsewhere was suggestive of inflammotory lung consolidation. An admission chest X-ray revealed a left lower lobe density. On chest CT-angiography a lobulated mass in the posterior basal segment of the left lower lobe was visualized: the diagnosis of intralobar pulmonary sequestration (ILPS) was hypothesized.

Aged↗

PubMedDate not supplied

Diagnostic approach to a case of a complex cystic mass of the pelvis.

The diagnostic approach to a patient with a complex pelvic cyst incidentally found on CT and come to the Emergency Department for lumbar pain, is discussed. To better define the location and nature of the cyst MRI was performed. It supported the diagnostic hypothesis of cystic endosalpingiosis, confirmed at the histological examination of the surgical specimen.

Cysts↗