PubMed Health⌕ Search

Biomedical subjects

M A Cova

Publications and source records attributed to M A Cova.

13 recordsLinked to original sources
PubMed2006

MR angiography versus intra-arterial digital subtraction angiography of the lower extremities: activity-based cost analysis.

PURPOSE: The aim of this study was to analyse the costs pertaining to the radiology department of magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) in the evaluation of arterial disease of the lower limbs. MATERIALS AND METHODS: The differential cost of the two procedures, i.e. the sum of equipment costs (amortisation and service contract), variable costs (supplies and related services) and personnel costs (radiologist, radiographer and nurse) was determined. The common cost (auxiliary personnel and indirect internal costs) was also calculated. Finally, the full cost of the two procedures was obtained (sum of differential and common costs). RESULTS: The differential cost of MRA was 186.14 euro (equipment costs: 50.80 euro, variable costs: 75.04 euro, personnel costs: 60.30 euro) while the differential cost of intra-arterial DSA was 238.18 euro (equipment costs: 57.60 euro, variable costs: 90.13 euro, staff costs: 90.45 euro). The estimated common cost was 5.62 euro. Therefore, the full cost of MRA was 191.76 euro and the full cost of intra-arterial DSA was 243.80 euro (27.1% higher). DISCUSSION AND CONCLUSIONS: Intra-arterial DSA costs more than MRA, mainly because of the higher costs of supplies used during the procedure and higher personnel costs (as a result of the longer duration of intra-arterial DSA). It should be noted that our evaluation considers costs pertaining to the radiology department only. It is evident that an economic analysis considering hospital costs as well would result in much higher costs for DSA if post-procedure hospitalisation is required. Our results cannot be simply exported to other radiology departments since they refer to the technology and organisation adopted in our department. However, our cost analysis model can be easily applied to other environments. MRA provides good diagnostic accuracy in the evaluation of arteries of the lower extremities, and its biological cost is far lower than that of intra-arterial DSA (MRA is noninvasive, it does not use ionising radiation, and the contrast medium is safe). Its lower cost is another argument in favour of the use of MRA instead of intra-arterial DSA in the evaluation of lower-extremity arterial disease.

Angiography, Digital Subtraction↗
PubMed2006

Functional MRI in the assessment of cortical activation in subjects with Parkinson's disease.

PURPOSE: The purpose of this study was to evaluate cortical activation patterns in patients with Parkinson's disease during a relatively complex motor task. MATERIALS AND METHODS: Seven patients (six men and one woman) with lateralised akinetic-rigid Parkinson's disease underwent functional magnetic resonance imaging (MRI) of the brain with a 1.5-T magnet. Finger tapping was chosen as a motor task. The control group included 11 volunteers (six men and five women) with no neurological disease. RESULTS: Patients showed hyperactivity of the ipsilateral and contralateral motor cortex associated with bilateral over-activation of the parietal cortex during movement of the affected hand. In some cases, there was a lack of activation of the pre-motor and supplementary motor areas whereas, when present, activation in these areas was greater during movement of the healthy hand. Finally, activation of the occipital cortex was found in all patients as a result of their tendency to control movement visually. CONCLUSIONS: Results of this study confirm a re-organisation of cortical circuits due to subcortical damage in patient's with Parkinson's disease.

Adult↗
PubMed2006

Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws.

OBJECTIVES: It is important to recognize osteonecrosis of the jaws in patients treated with bisphosphonates because an early diagnosis can make a significant difference to the outcome of the disease. The aim of this study is to describe the radiological features of bisphosphonate osteonecrosis (BON) in order to aid its prompt recognition. METHODS: A conventional radiograph, a computed tomograph (CT), a magnetic resonance image (MRI) and a 99Tc(m)-MDP 3-phase bone scan were carried out for 11 patients with BON. The main imaging findings of osteonecrosis are described. RESULTS: Conventional radiography and CT displayed osteolytic lesions with the involvement of cortical bone. MRI demonstrated the characteristic features of osteonecrosis and the oedema of soft tissues. Both CT and MRI were very useful in defining the extent of the lesions. 99Tc(m)-MDP three-phase bone scan was the most sensitive tool to detect the osteonecrosis at an early stage. CONCLUSIONS: 99Tc(m)-MDP three-phase bone scans who could be used as a screening test to detect subclinical osteonecrosis in patients who have received bisphosphonates. CT scans and MRI are useful in defining the features and extent of osteolytic lesions.

Aged↗
PubMed1997

[Turbo STIR sequence: optimization and comparison with conventional STIR sequence in bone diseases].

INTRODUCTION: The most common fat-suppressed sequence used to study skeletal conditions is the STIR sequence which has shown high sensitivity in the detection of skeletal lesions and whose main drawback is its long acquisition time. Currently, Turbo-STIR (T-STIR) sequences can shorten the acquisition time. The purpose of this study was therefore to compare the conventional STIR sequence with the new T-STIR sequence in the study of skeletal conditions to compare their diagnostic yield. MATERIAL AND METHODS: Twenty patients with different types of skeletal lesions were examined. MR examinations were performed with a Philips Gyroscan S15/ACS II unit (1.5 T). All the patients underwent a STIR sequence (TR/TE = 1500/20, TI = 180 ms, matrix = 204 x 256, NEX = 2, slice thickness = 5 mm, acquisition time = 9 min 24 s) and a T-STIR sequence (TR/TE = 1500/20, TI = 180 ms, matrix = 204 x 256, NEX = 2, slice thickness = 5 mm, TFL = 3, acquisition time = 3 min 33 s). The images were evaluated by measuring both quantitative parameters--percent contrast (%C), contrast to noise ratio (C/N), signal to noise ratio (S/N)--and qualitative parameters--lesion conspicuity, margins and extension, motion artifacts, image quality. RESULTS: The only statistically significant difference between the two sequences was image quality, which was superior in the conventional STIR sequence (p < .05). No statistically significant difference was demonstrated with the quantitative evaluation. DISCUSSION: In this study, T-STIR sequences were performed with low-high acquisition profile to acquire an actual echo time of 20 ms which permits to obtain optimal S/N with good spatial resolution. Therefore, T-STIR sequences with low-high acquisition profile provides better results than T-STIR sequences with linear acquisition profile which permits to obtain an actual echo time of 40 ms. CONCLUSION: This work shows that T-STIR sequences can replace conventional STIR sequences in the study of skeletal conditions reducing the acquisition time by 60%. This result can be obtained only by an accurate optimization of acquisition parameters.

Adolescent↗
PubMed1992

[Magnetic resonance in trigeminal neuralgia].

One of the possible causes of the so-called "essential" trigeminal neuralgia is a neurovascular compression of the fifth cranial nerve root at the pons. The demonstration of this hypothesis could orientate the surgical treatment to microvascular decompression. In order to evaluate the role of MRI in the diagnosis of trigeminal neuralgia due to neurovascular compression, the authors present the results of a prospective evaluation of the cranial MR studies of 18 neuralgic patients in comparison with a retrospective evaluation of the cranial MR studies of 50 healthy control subjects. The results show that neurovascular compression can be demonstrated in 83.3% of the neurological patients. In all cases a good correlation between the clinical symptoms, the side of positive MR findings and the surgical findings, when available, was demonstrated. On the other hand, neurovascular compression was demonstrated in 28% of the healthy control subjects. The authors conclude that neurovascular compression can be demonstrated in a high percentage of patients with the so-called "essential" trigeminal neuralgia. Compared with the other imaging modalities (angiography, Computed Tomography) MRI is the best technique in the diagnosis of this disease. In fact, MRI is not only able to differentiate the symptomatic from the essential type of neuralgia, but is also very sensitive in the identification of trigeminal neuralgia due to neurovascular compression. This diagnosis could direct the surgical treatment to microvascular decompression.

Adolescent↗
PubMed1990

[The definition and realization of a computerized archive for radiological data of scientific interest].

The general requirements are analyzed of a system designed to acquire and manage radiological data of scientific interest. These requirements consist in: easy implementation, to develop the system in the same environment where it is going to be used; easy use, to avoid excessive needs and resources for the system to be managed in practice; reduced implementation cost, in terms of resources required for its implementation; user-oriented approach, in the sense of meeting the radiologists' requirements, and flexibility, for the system to be an effective tool for the widest range of possible applications. Two actual applications of this general approach are then discussed, one relative to breast investigations data, and the other to digital procedures (US, CT, DSA, MR) data. For each application the software tools employed are analyzed, together with the archive structures and the used codes, the collecting data procedures and the programs. For the breast investigations archive the possibility of obtaining standard periodic reports is pointed out. These reports summarize the global department activity in this area during selected periods (six months-one year). They allow interesting clinical conclusions to be drawn. As for the digital procedures archive, the possibility is stressed of searching different combinations of scientific data out of tens of thousands of cases in just a few minutes.

Computer Systems↗
PubMed1989

[CT study of the cervical spine with intravenous administration of the contrast medium].

Computed tomography (CT) without contrast medium is largely applied to the study of intervertebral disk pathology in the lumbar spine, but has not been widely accepted in the cervical spine, due to technical and anatomical limitations. For these reasons many neuroradiologists still prefer myelography or myelo-CT. CT may yield better results if combined with iv contrast medium injection, which allows a better visualization of disk herniation. This technique is aimed at enhancing the density of the venous plexus which is located close to the intervertebral disk, the vertebral bodies and the neural foramina. A better contrast enhancement is thus obtained between the disk and the spinal cord. The authors' experience is based on 61 patients who underwent contrast enhanced CT; in 22 cases myelography and myelo-CT were also performed. The authors describe their technique and the most frequent CT findings of disk herniation: the typical finding includes a focal hypodensity surrounded by a linear blush, due to a posteriorly dislocated epidural vein. The posterior linear blush alone may be present in few cases. Contrast-enhanced CT is very useful in the study of disk pathology of the cervical spine, even when compared with myelography and myelo-CT, due the increase in the density of epidural plexus it allows. However, the technique must be very accurate if the same results as those of myelo-CT are to be obtained.

Adult↗
PubMed1988

[Evaluation of mineral bone content using quantitative computerized tomography].

The authors have evaluated bone mineral content in the vertebral spongiosa by means of Computed Tomography. The method proposed by Genant and Cann has been applied to examine 164 healthy volunteers and 108 patients. Both healthy males and females showed a progressive bone mineral loss increasing with age; the bone mineral loss was most severe in females during the 4th and 5th decade of life. Pathology included patients with osteoporotic fractures (vertebral and femoral neck), patients with partial gastrectomy, renal failure, primary hyperparathyroidism, Cushing syndrome, corticosteroid therapy. Bone mineral values were significantly lower in most pathologic groups. Computed Tomography proves thus to be a valuable method to assess bone mineral content and to identify patients at risk for fractures.

Adolescent↗
PubMed1988

[The role of computerized tomography in the diagnosis of postoperative intervertebral diskitis].

Six patients with diskitis following lumbar disk surgery were investigated by Computed Tomography (CT). Four patients underwent CT in a rather early phase of the disease (5-37 days after the onset of the symptoms): a posterior paravertebral fluid collection was always recognized, while the plain film was normal. Later on (2-4 months), the classical signs of diskitis were evident, with both CT and the plain film. The collection was always present at CT. A reintervention, performed on 3 patients, revealed the purulent content of the collections. It seems reasonable to suggest a relationship between the collection and the subsequent diskitis; the collection is probably an early sign of the disease. Its detection is of great value, because it could allow an immediate and adequate therapy. The authors stress the usefulness of performing CT in an early phase on this kind of symptomatic patients.

Adult↗
PubMed1987

[Instrumental diagnosis of non-glandular superficial inflammation].

The study of soft tissues has greatly improved since the introduction of ultrasonography (US) and computed tomography (CT). In order to define the role of instrumental investigations, 51 patients affected by non glandular superficial soft tissue masses underwent US and 9 were also examined with CT. US proved to be accurate to define the size, the structure of the mass (93%), the benign or malignant nature (91%). US was also useful for percutaneous biopsy. However, US cannot be considered the only investigation because it does not give enough data about bony and articular structures: a conventional X-ray film must be performed in order to define the relation of the mass with the adjacent bone and to clarify the possible presence of fatty tissue in a solid mass shown at US. CT has a role in case of large masses, surrounding a bone diaphysis, when the malignant nature is suspected and to define the relationship with vessels and muscles.

Abscess↗
PubMedDate not supplied

[An information system for the management support of a radiology institute. Critical analysis and experience].

The Radiology Information System (RIS) for the management of the Radiology Department at the Trieste University Hospital is here presented. It consists of 3 subsystems: the first one is devoted to the management of the patients archive and to the examination scheduling function, the second deals with the statistical and administrative reporting task, and the third manages the archives of scientific data. Each subsystem is analysed in details, in terms of functions, hardware, software, archives, and personnel. The actual implementations of such systems are considered, with respect to the main functions of the Radiology Department, on the basis of the authors' actual experience. An attempt is made to set aside features related to the local situation, thus providing useful data for different realities. Specific quantitative measures are presented, whenever appropriate, to provide a solid ground to explain and motivate the most relevant aspects relative to the management of the Radiology Department in general and of the RIS in particular. Workloads and/or execution times of the main functions were collected and the RIS has turned out to yield significant benefits (e.g., easier and more confident access to the information). On the other hand, the costs are not negligible and must be carefully planned during the projecting phase. Some expected future developments of the RIS are outlined: in the short run the network conversion is devised, and a functional integration among the subsystems; in the medium run an autonomous system is planned, and in the long run a connection is considered with a Picture Archiving and Communication System (PACS) and with the Hospital Information System (HIS).

Diagnosis, Computer-Assisted↗