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Biomedical subjects

L Broglia

Publications and source records attributed to L Broglia.

At least 19 recordsLinked to original sources
PubMed1999

Local invasion of gastric cancer: CT findings and pathologic correlation using 5-mm incremental scanning, hypotonia, and water filling.

OBJECTIVE: Our purpose was to assess the accuracy of CT with drug-induced hypotonia and water filling in revealing the depth of tumor invasion of the gastric wall, according to the T factor of TNM classification, and to verify the capability of this technique in differentiating diffuse from intestinal gastric cancer. SUBJECTS AND METHODS: Forty patients (age range, 35-78 years) with histologically proven gastric tumors underwent CT, in the prone position, with drug-induced hypotonia and water filling. The images were prospectively reviewed by two radiologists who were asked to assess the depth of tumor invasion in the gastric wall. The thickening of the hypodense layer and the contrast enhancement of lesion were measured. RESULTS: CT correctly assessed gastric wall invasion in 77% and 82% of cases for observers A and B, respectively; overstaging was 20% and 15%, respectively; and understaging occurred in 3% of cases for both observers. Diagnostic sensitivity for serosal invasion was 100% for both observers; specificity was 80% and 87%, respectively. Substantial agreement between the observers was obtained (kappa = .6). Diffuse and intestinal cancers could be differentiated by CT in 92% of cases, considering the thickening of the hypoattenuating layer of the gastric wall (diffuse cancer: 7 +/- 1.2 mm; intestinal cancer: 1.4 +/- 0.4 mm) and contrast enhancement (diffuse cancer: 85 +/- 8.2 H; intestinal cancer: 51 +/- 3 H). CONCLUSION: CT with patients in a drug-induced hypotonia and in a prone position, and using water filling, is a promising technique for evaluating the depth of tumor invasion and for differentiating intestinal from diffuse gastric cancer.

Adult↗
PubMed1999

[Optimization of dosage and exam technique in the use of oral contrast media in magnetic resonance].

PURPOSE: Aim of our study was to optimize the dose, scan delay and sequences for use in MR studies with an oral contrast agent (FerriSeltz, Bracco, Milan, Italy) to obtain positive or negative contrast enhancement in the bowel lumen. MATERIAL AND METHODS: In vitro: 10 mL vials with increasing concentrations (10-100 mg/mL) of the agent, containing 200 mg ferric ammonium citrate/g, were studied with a 1.5 T magnet (Philips NT, The Netherlands), by acquiring T2-weighted STIR and TSE and T1-weighted TFE sequences. Signal intensity was compared by using a ROI. In vivo: 16 volunteers were examined with the same sequences at 20 minutes and 2 hours after the oral administration of 6-27 g of the product diluted in 600 mL water. Images were analyzed by two radiologists and scored on a 4-point scale based on signal intensity; results were compared with Student's "t"-test. RESULTS: In vitro: MR signal was always hyperintense on T1-weighted images, as well as on T2-weighted TSE and SPIR images at concentrations lower than 45 mg/mL. Hypointense signal was seen on T2-weighted TSE and SPIR images at higher concentrations and on STIR sequences at 10-20 mg/mL concentrations. In vivo: the bowel exhibited positive enhancement on T1-weighted TFE and T2-weighted TSE and SPIR images 20 minutes after contrast agent administration at concentrations lower than 45 mg/mL. At 2 hours, bowel loops were hypointense on T2-weighted TSE and SPIR images at 15-20 mg/mL concentrations. STIR images showed hypointense bowel loops at both 20 minutes and 2 hours after 10-20 mg/mL contrast agent administration. Quantitative analysis showed a statistically significant superiority (p < .05) of T2-weighted STIR images in providing negative opacification of the bowel lumen. CONCLUSIONS: Ferric ammonium citrate, being a positive or negative contrast agent according to its dilution, permits to tailor the dose to optimize bowel lumen opacification.

Administration, Oral↗
PubMed1998

[Computerized tomography, magnetic resonance, and nuclear medicine in the non-invasive diagnosis of focal nodular hyperplasia of the liver].

INTRODUCTION: Focal nodular hyperplasia (FNH) is a benign liver lesion requiring a prompt diagnosis and a conservative management. Aim of our study was to prospectively integrate enhanced CT, MRI, nuclear medicine in the noninvasive diagnosis of FNH. MATERIAL AND METHODS: 20 FNH lesions (diameter ranging 1.5-13 cm) in 18 asymptomatic patients were investigated with MRI and nuclear medicine. MRI examinations were performed with a 1.5 T superconducting system (Philiphs NT) by acquiring T1-weighted, T2-weighted, T2-weighted fat-suppressed Turbo Spin-Echo and dynamic MRI sequences, with breath-hold T1-weighted Turbo Field Echo and Gd-DTPA. Nuclear medicine included in all cases 99mTc sulfur colloid or 99mTc iminodiacetic acid studies. Diagnostic sensitivity of MRI was compared with that of nuclear medicine, and the sensitivity of the two modalities combined. The definitive diagnosis was made by percutaneous core-needle biopsy (12 lesions), surgery (2 lesions) and longterm follow-up (6 lesions). RESULTS: In 13 lesions larger than 3.5 cm typical findings, such as the central scar and homogeneous pattern, were observed in 9 cases (75%) with enhanced CT, in 10 cases (83%) with unenhanced MRI and in 11 cases (91%) after gadolinium injection. Hepatobiliary scintigraphy showed increased tracer uptake in delayed scans in 10/12 cases (83%) while sulfur colloid studies were diagnostic in 2/12 cases only (16%), showing the same tracer uptake than the surrounding liver parenchyma. In 7 lesions smaller than 3.5 cm, only 1 case showed typical findings; dynamic MRI showed typical early hypervascularity in 5 of the 6 remaining lesions (71%) which persisted on late images. In lesions smaller than 3.5 cm, sulfur colloid studies were diagnostic in 1/7 lesions (14%) and hepatobiliary scintigraphy in 3/7 lesions (42%). Considering all 20 lesions, MRI-nuclear medicine integration performed better than MRI alone. CONCLUSIONS: Enhanced MRI and biliary scintigraphy are important tools to make the final diagnosis of FNH. In small lesions both examinations should performed, but in large lesions MRI may be sufficient to make an unquestionable diagnosis, limiting hepatobiliary scintigraphy to questionable cases.

Contrast Media↗
PubMed1997

Hydro-CT in patients with gastric cancer: preoperative radiologic staging.

A total of 35 patients (age range 35-78 years) with gastric tumors on the lesser curve, or in the antro-pyloric region, underwent angio-CT in the prone position after filling the stomach with 500 ml of water and intravenous administration of glucagon. The films were reviewed by three radiologists independently, staging each tumor according to the TNM classification preoperatively. The overall accuracy of tumor staging ranged between 66-77 %, overstaging between 17-25 %, and understaging between 3-8.5 %. The diagnostic sensitivity, specificity, and accuracy for serosal invasion ranged between 90 and 100, 76 and 84, and 80-88 %, respectively, and the overall accuracy for N staging was 46, 48, and 51 % for the three observers. If, however, N1 and N2 tumors were considered as a single group, N-stage accuracy increased, ranging between 63 and 77 %. The "K test" for analyzing the interobserver agreement was 60 %, i. e., the diagnostic results are reproducible. Water filling of the stomach optimizes visualization of the gastric wall on contrast-enhanced CT. The prone position and drug-induced hypotony allows for good distension without any disturbing artifact reduction obscuring the lower gastric body.

Adult↗
PubMed1997

US and CT findings of small bowel neoplasms.

Small bowel (SB) neoplasms are very rare tumours, but are still associated with high mortality rates, since the tumour-related symptoms occur late and are non-specific. In addition, endoscopy is not feasible in most cases, and radiological contrast studies do not reach the high accuracy obtained in the evaluation of upper and lower gastrointestinal tract. Cross-sectional imaging, and particularly CT, is becoming increasingly relevant in the diagnosis of these tumours. Both US and CT allow tumour detection, even when performed on an emergency basis, and are capable of showing the lesion as well as possible complications. Moreover, CT offers the possibility of a preoperative staging by evaluating tumour extension through the bowel wall, lymph node involvement and possible metastases. Finally, in most cases a direct correlation between cross-sectional findings and histology can be found, thus permitting tumour characterisation.

Contrast Media↗
PubMed1997

Pathologic features and clinical outcome after anatomic radical prostatectomy by transcoccygeal approach.

OBJECTIVES: A nonrandomized prospective study was conducted aimed at verifying the clinical outcome and pathologic features of a group of patients submitted to transcoccygeal radical prostatectomy. METHODS: Radical transcoccygeal prostatectomy was performed at our institution in 26 patients after laparoscopic (24 cases) or open surgical (2 cases) pelvic lymphadenectomy. Eighteen patients were selected because they were considered to be at risk for nodal metastases on the basis of preoperative staging (prostate-specific antigen level of 20 ng/mL or greater and/or Gleason score greater than 5); the remaining 8 manifested incidental prostate carcinoma. RESULTS: Intraoperative complications included rectal injury in 1 patient (3.8%) and massive blood loss in another. Transitory leakage at the site of the urethrovesical anastomosis and urethrorectal fistula occurred postoperatively in 2 patients. The rate of positive surgical margins was 26.9%. The mean follow-up time is 27 months (range 3 to 39 months). Total urinary continence was obtained in 21 patients (80.8%); 5 patients (19.2%) still require urinary pads. Four patients (15.4%) have experienced tumor recurrence evidenced only by increased serum prostate-specific antigen levels. Local tumor recurrence with positive biopsy of the urethrovesical junction was diagnosed in 3 patients (11.5%), and 1 (3.8%) experienced systemic tumor recurrence. CONCLUSIONS: Radical transcoccygeal prostatectomy is a safe procedure for the surgical treatment of prostate cancer, both from a clinical and a pathologic point of view. Operative complication as well as pathologic features and clinical outcome reported in this series of patients must be related to selection criteria used in most cases. The exact role of radical transcoccygeal prostatectomy in the clinical setting has yet to be defined. According to these preliminary results, radical transcoccygeal prostatectomy should be further investigated in the treatment of incidental carcinoma after transurethral resection of the prostate or suprapubic prostatectomy and could become an elective indication in such cases.

Aged↗
PubMed1997

MR cholangiography in the examination of patients with biliary-enteric anastomoses.

OBJECTIVE: The aim of our study was to determine the role of MR cholangiography in the noninvasive examination of patients with biliary-enteric anastomoses. SUBJECTS AND METHODS: Twenty-four patients (nine men and 15 women; mean age, 68.9 years old) with biliary-enteric anastomoses underwent MR cholangiography. We used a fat-suppressed three-dimensional turbo spin-echo sequence (3000/700 [TR/TE]; echo train length, 128) with no breath-hold, optimized with a 0.5-T magnet. Imaging studies were performed because of scheduled follow-up (five patients), persistent jaundice (six patients), cholangitis and abnormal liver function (eight patients), and a combination of transient jaundice, epigastric pain, and abnormal liver function (five patients). RESULTS: Image quality was graded from optimal to good in 21 (88%) of 24 cases and poor in three (13%) of 24 cases. The degree of bile duct dilatation was correctly assessed, with complete agreement between the two observers in all cases. MR cholangiography correctly showed bile duct irregularities in six of the eight patients with cholangitis (kappa = .59), anastomotic strictures in all 19 patients with strictures (kappa = .86), and 3- to 15-mm stones in nine of 10 patients (kappa = .95). A slight overestimation of the strictures occurred in four of the 19 cases with strictures. CONCLUSION: MR cholangiography is a reliable imaging technique for the examination of patients with biliary-enteric anastomoses.

Aged↗
PubMed1997

[Comparison of computerized tomography and magnetic resonance with fast sequences with and without paramagnetic contrast media in the assessment of liver metastasis: qualitative and quantitative analysis].

We compared unenhanced and contrast-enhanced fast MRI and CT in the detection of liver metastases. Eleven patients with single or multiple hepatic lesions (42 in all) were submitted to CT and MR studies; T1- and T2-weighted TSE, T2-weighted TSE with fat suppression, unenhanced breath-hold TFE and early or delayed enhanced breath-hold TFE images were acquired with a 1.5 T super-conductive magnet (Philips NT). The quantitative analysis of all MR images was performed for contrast/noise ratio (CNR) and number of detected lesions; MR and CT images were also compared qualitatively for lesion conspicuity, anatomical structure identification and artifacts. The results were compared with Student's t test. Early enhanced breath-hold TFE was statistically superior to T1-weighted TSE (p = .0009), T2-weighted TSE (p = .01) and CT (p = .0004) for lesion conspicuity and to T1-weighted TSE, T2-weighted TSE, unenhanced TFE (p = .0001) and CT (p = .01) for anatomical structure identification. CT was superior to T1- and T2-weighted TSE (p = .0001) and unenhanced TFE (p = .004) for the lack of artifacts. Fat-suppressed T2-weighted TSE images had a statistically higher CNR than T2-weighted TSE (p = .02), T1-weighted TSE (p = .0006) and unenhanced and delayed TFE sequences (p = .007; p = .0001, respectively). To conclude, MRI appears superior to CT in the detection of liver metastases; the examination should include early enhanced breath-hold T1-weighted TFE and T2-weighted fat-suppressed TSE images.

Adult↗
PubMed1997

[The diagnostic accuracy and reproducibility of computed tomography with water distention and induced hypotonia in the preoperative staging of gastric tumors].

Thirty-five patients with gastric cancer were preoperatively examined with CT performed in the prone position. Patient preparation consisted in filling the stomach with tap water and i.v. glucagon administration. The CT images were independently reviewed by two radiologists, who staged each tumor according to the TNM classification. The results were compared with surgical and histological findings. The overall accuracy for T staging ranged 74-77%, overstaging 17-23%; understaging was 3%. Diagnostic sensitivity, specificity and accuracy for serosal invasion were 100%, 80%, 85% and 100%, 84% e 88%, respectively, for the two radiologists. The overall accuracy for N staging was 48% and 51% for the two observers, respectively. Considering N1 and N2 as a single group, accuracy ranged 68-77%. The interobserver agreement analyzed by the "K tests" was 80%, with a K index of 60%. CT performed with the patient in the prone position, after preparation with gastric wall hypotony and distension with water, is a valid technique permitting excellent depiction of the gastric wall and providing useful preoperative information to the surgeon.

Adult↗
PubMed1996

MR cholangiopancreatography (MRCP) at 0.5 T: technique optimisation and preliminary results.

The aim of our study was to evaluate the feasibility of MR cholangiopancreatography (MRCP) at 0.5 T. To our knowledge no previous studies of MRCP have been performed at mid-field strength. Thirty-one patients with dilated biliary systems were examined with three-dimensional MRCP. All patients were studied with a 0.5 T superconducting magnet. A three-dimensional turbo spin-echo (TSE) sequence was acquired (TR = 5000 ms, TE = 244 ms, echo train length = 45; acquisition time = 14 min 10 s). Coronal images were post-processed with the MIP algorithm. Recently, the parameters have been optimised (TR = 3000 ms, TE = 700 ms, echo train length = 128), reducing the acquisition time to 3 min. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 26 cases; 5 patients underwent percutaneous transhepatic cholangiography PTC. MRCP and ERCP images were evaluated by an experienced radiologist and an endoscopist. MRCP of diagnostic quality was acquired in all patients. Choledocholithiasis was correctly evaluated by MRCP in 12 of 12 patients, compared with 11 correct diagnoses by ERCP. The presence and the level of the stricture were accurately shown in 16 of 16 patients with MRCP and in 13 of 16 patients with ERCP. The peripheral biliary tree above the obstruction and pancreatic duct were better evaluated by MRCP in all cases. In 3 of 3 patients who had undergone bilio-enteric surgery, a correct evaluation of the site of the anastomosis was possible with MRCP. It is concluded that MRCP performed at mid-field strength allows good visualisation of the dilated biliary system. Excellent results have been obtained on comparison with ERCP. MRCP performed at mid-field strength could have the same clinical value as high field strength MRCP.

Adult↗
PubMed1996

An integrated approach to senology education: combination of a hypermedia program with a multimedia archive.

The aim of this work was to demonstrate the computerized system on senology, which combines a hypermedia application to a multimedia didactical archive, integrated with a radiological information system. These applications have been developed on Macintosh computers using the softwares Supercard and 4th Dimension. The hypermedia application deals with basic principles of anatomy as well as the radiologic semeiology and pathology through different imaging techniques in order to illustrate basic principles. Thus, students can modify their learning pathways and the timing as they wish. Limitations are related to time consumption in preparing the programs and technical difficulties in expanding them. Multimedia archive allows to classify a large number of difficult and uncommon clinical cases, creating an easily updatable teaching file in digital format which considerably improves access to stored image data, also reducing loss of films and film degradation. From initial experiences we conclude that these systems are valid devices in information and up to date for physicians dedicated to the study of breast pathology.

Breast↗
PubMed1996

Self-expanding stents in transjugular intrahepatic portosystemic shunt: experience with nitinol Strecker stents.

The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1-6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6-24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related.

Adult↗
PubMed1996

[Magnetic resonance pyelography: optimization of the technic and the preliminary results].

Magnetic resonance pyelography (MRP) is a new noninvasive method which demonstrates dilated urinary tracts with no need of contrast agent injection. This study was aimed at technique optimization, using new fast sequences with high intrinsic contrast, to demonstrate the urinary tract in obstructive uropathy patients. Twelve consecutive patients and 4 healthy volunteers were included in this prospective study; all the exams were performed with a high gradient power 0.5-T unit using T2- weighted turbo SE sequences, acquired three-dimensionally on the coronal plane. Obstructive uropathy was caused in 9 patients by neoplastic lesions, in 2 by postoperative strictures and in 1 by inflammatory tissue. In all patients MRP depicted the dilated urinary tract optimally, with good morphological detailing and the accurate assessment of both level and cause of obstruction. In the healthy volunteers, the absence of dilatation did not permit the complete visualization of the urinary tract. To conclude, MRP is a new technique which permits high-quality imaging of the urinary tract. Further studies are needed to assess its actual potentials and clinical role.

Adult↗
PubMed1996

[Lithiasis of the common bile duct: the role of cholangiography and magnetic resonance].

The aim of our study was to evaluate the sensitivity, specificity and diagnostic accuracy of Magnetic Resonance Cholangiography (MR-CP) in patients with suspected choledocholithiasis. Sixty-two patients (mean age: 56.3 years) previously submitted to US, were examined with MRCP. MR exams were performed with an 0.5 T superconductive magnet (Gyroscan T5-II; Philips, Medical System, Best, NL) and a body coil. 3D-TSE sequences (TR/TE/ETL = 5.000/244/45 ms) were acquired, with 14 min 10 sec acquisition time. In the last 21 patients, acquisition time was reduced down to 3 min, by optimizing the parameters as follows: TR/TE/ETL = 3.000/700/128 ms. The images, obtained on the coronal plane, were then reconstructed with the MIP algorithm. MRCP images were studied both as MIP reconstructions and as single slices. The diagnosis was always compared with endoscopic or percutaneous findings. MRCP images were of diagnostic quality in all cases, with 91.7% sensitivity, 100% specificity and 96.8% diagnostic accuracy. MRCP had 100% positive predictive value and 95% negative predictive value. In conclusion, this technique is extremely useful to examine the patients with obstructive jaundice secondary to lithiasis.

Adult↗
PubMed1996

[Breast scintigraphy with technetium 99m sestamibi, as support to radiologic methods in the study of breast lesions].

Our study was aimed at investigating the efficacy of scintigraphy with 99mTc-Sestamibi (MIBI) as a support to mammography and US in the diagnosis and staging of breast cancer. Twenty-seven women with breast lesions were examined: the masses, detected at mammography and US, ranged in diameter 0.7 to 2.5 cm; mass features suggested a benign lesion in 5 patients, a malignant lesion in 9 patients and a questionable diagnosis in 13 patients. 99mTc-MIBI scintigraphic images were analyzed blind by two observers and the pattern was considered positive when tracer uptake was demonstrated at the lesion. In neoplastic lesions, tracer uptake was looked for also in the axilla. All the patients were submitted to surgery and, in case of malignancy, lymphadenectomy was also performed. MIBI scintigraphy was negative in 14/16 benign lesions and positive in 9/11 malignant lesions. Tracer uptake in the axilla was observed in 3 of 5 patients with nodal involvement. Scintigraphy had 82% sensitivity, 87% specificity and 85% accuracy in the diagnosis of breast cancers.

Adult↗
PubMed1996

[Biliary-enteric anastomosis: role of cholangiography with magnetic resonance].

Our study was aimed at investigating the role of MR-cholangiography (MRC) in the examination of patients treated with biliary-enteric anastomosis. MRC was performed in 15 patients (8 men and 7 women, mean age: 64.7 years) operated on for biliary-enteric anastomoses (13 hepaticojejunostomies and 2 choledochoduodenostomies) whose symptoms were as follows: persistent jaundice in 4 patients; cholangitis and abnormal liver function tests in 2 patients; associated transient jaundice, epigastric pain, abnormal liver function tests in 2 patients. The remaining 7 patients were asymptomatic and examined during their follow-up. MRC was performed with a non-breath-hold, fat-suppressed 3D turbo spin echo sequence (TR = 3000 msec, TE = 700 msec, ETL = 128) with an acquisition time ranging 4 min 24 sec to 5 min 48 sec. Six patients were subsequently submitted to Percutaneous Transhepatic Cholangiography (PTC) to confirm the diagnosis and to perform a therapeutical procedure. Two patients, submitted to choledochoduodenostomy were examined with ERCP. The remaining seven patients, examined during their surgical follow-up and who presented no major symptoms or dilation of the bile ducts, were not submitted to any invasive procedure. Image quality was graded as good to fair in 12/15 cases (80%) and poor in 3/15 cases (20%). The degree of bile ducts dilation was correctly assessed with complete inter observer agreement in 8/8 patients. MRCP correctly showed: bile ducts irregularities in 2 of 4 patients with cholangitis (k = 0.59), anastomosis stenosis in 8 of 8 patients (k = 0.86), and 5-15 mm stones in 5 of 5 patients (k = 0.95). In conclusion, MRCP is a safe, noninvasive technique in the study of biliary-enteric anastomoses with high accuracy in assessing the cause of jaundice. MRCP images can be used as a guide for subsequent interventional procedures. Its main disadvantages are the lack of functional information and the high cost which limits its its use to the screening of symptomatic patients.

Aged↗