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M L Storto

Publications and source records attributed to M L Storto.

At least 19 recordsLinked to original sources
PubMed2006

Endovascular abdominal aortic aneurysm repair: how many patients are eligible for endovascular repair?

PURPOSE: The purpose of this study was to determine how many patients with abdominal aortic aneurysm (AAA) are eligible for endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) angiograms obtained between January 2002 and June 2003 in 182 patients with suspected AAA. Indication for surgical or endovascular treatment was based on clinical and radiological criteria. The percentage of patients eligible for EVAR was evaluated. RESULTS: Out of a total of 182 patients with suspected AAA studied by CT angiography, after combined radiological-surgical assessment, 130 were considered eligible for surgical or endovascular treatment (71.4%). EVAR was indicated in 51 patients (39.3%, group A) and surgical repair was indicated in 79 patients (60.7%, group B). The reasons for ineligibility for EVAR were the following: unfavourable anatomy of the proximal neck in 41 patients (51.9%), diameter of the aneurysm sac >7 cm in 13 patients (16.4%), markedly tortuous/dilated iliac axis in six patients (7.6%), age <65 years in 17 patients (21.5%) and patient refusal in two cases (2.5%). There were no statistically significant differences in aneurysm diameter (52.7+/-0.8 versus 49.8+/-1.2 mm, p=ns), patients' age (73.2+/-1.2 versus 70.6+/-2.02 years, p=ns) or proximal neck length (2.95+/-1 versus 3.03+/-1.2 cm, p=ns) between groups A and B. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms through the placement of aortic stent-grafts has now become a viable alternative to open surgery. In recent years, the number of patients treated with EVAR has steadily risen as a result of increased physician experience, availability of new and more versatile devices and improvements in noninvasive imaging techniques. Unfavourable neck anatomy is the primary factor for exclusion from endovascular repair.

Aged↗
PubMed2000

Malignant pleural disease.

The vast majority of pleural neoplasms invade the pleura secondarily and can be seen in patients with bronchogenic carcinoma, breast cancer, lymphoma, and ovarian or gastric carcinoma. Primary pleural neoplasms are less common, although they have developed notoriety since the up-surge of malignant mesothelioma and the knowledge of its connection to asbestos exposure. Other malignant primary tumors include localized fibrous tumor and pleural liposarcoma. In most patients with diffuse malignant pleural disease the chest radiograph shows pleural effusion with or without pleural thickening. Computed tomography (CT) usually provides precise localization and extent of the disease and may be of value in assessing chest wall and mediastinal involvement. In specific situations, magnetic resonance (MR) may be useful as a problem-solving tool when CT findings of chest wall or diaphragmatic invasion are equivocal or in patients with contraindication to intravenous administration of ionic contrast material.

Asbestos↗
PubMed2000

Incidental detection of thoracic sarcoidosis on whole-body 18fluorine-2- fluoro-2-deoxy-D-glucose positron emission tomography.

18 Fluorine-2- Fluoro-2-Deoxy-D-Glucose positron emission tomography (18FDG PET) allows imaging of sites with increased metabolic activity. Increased metabolic activity in mediastinal nodes in sarcoidosis has been described. We report the prospective diagnosis of thoracic sarcoidosis on 18FDG PET based on extensive, peripheral, upper lobe parenchymal, and mediastinal nodal tracer uptake.

Female↗
PubMed1999

[Possibility of false negative results in the diagnosis of lung neoplasms with computerized tomography].

PURPOSE: To describe the radiological appearance of overlooked malignant pulmonary lesions at CT and to analyze the reasons of misdiagnosis. MATERIAL AND METHODS: Ten patients with pulmonary malignant lesions (PML) overlooked at first CT examination were selected among patients with lung cancer who were referred to our institution between 1994 and 1997. CT scans were evaluated by consensus of two chest radiologists with different experience in chest radiology, who were blinded to the final diagnosis. RESULTS: The overlooked pulmonary lesions were 5 endobronchial cancers and 5 central solitary nodules. The mean diameter of the lesions ranged 1 to 2 cm. Furthermore, 7 patients had associated pleural and/or parenchymal abnormalities. The technical quality of CT examinations was considered good in 2 cases, acceptable in 6 cases, poor in 2 cases. PML were correctly identified in 6/10 cases by the first (more experienced) radiologist and in 4/10 by the second radiologist. Four cases were considered suspect for the presence of PML by the first radiologist, 2 by the second. CONCLUSIONS: Endobronchial location of the tumors and their small size were the most frequent causes of misdiagnosis of PML at chest CT in our series. However, a systematic evaluation of CT scans can reduce the percentage of missed lesions.

Aged↗
PubMed1998

Bronchioloalveolar carcinoma of the lung.

Bronchioloalveolar carcinoma is a histologically distinct form of pulmonary adenocarcinoma representing an estimated 2-10 % of all primary lung cancers. Its varied appearances include focal masses, nodular patterns, and pneumonic and diffuse forms so that bronchioloalveolar carcinoma should be considered in the differential diagnosis of solitary or multiple pulmonary nodules and acute or chronic alveolar diseases. In this article we describe the different radiographic manifestations of bronchioloalveolar carcinoma with particular emphasis on CT findings and those signs that may help in identifying the lesion as bronchioloalveolar carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1998

Assessment of air trapping using postexpiratory high-resolution computed tomography.

The authors assess the utility of postexpiratory high-resolution computed tomography (HRCT) scans in the evaluation of air trapping in patients with obstructive lung disease. Thirteen healthy volunteers and 14 patients with obstructive lung disease (OLD) were examined using inspiratory and postexpiratory HRCT scans. All had pulmonary function tests. Lung attenuation was measured on both inspiration and expiration, and the extent of air trapping on postexpiratory scans was visually assessed. The results of the healthy volunteers were compared with those of patients with OLD, and HRCT findings were correlated with pulmonary function tests. Lung attenuation on expiration, its change from inspiration to expiration, and air-trapping scores of patients with OLD were significantly different from those of the healthy volunteers. When the healthy participants and patients with OLD were combined and analyzed as one group, the lung attenuation change and air-trapping score both significantly correlated with pulmonary function tests (p < 0.001) and correlation values were similar (r = 0.61-0.89). Air trapping was found in 61% of healthy participants and all the patients with OLD, although the extent was significantly greater in the patients with OLD. Inspiratory and postexpiratory HRCT can be used to evaluate air trapping in patients with OLD. Measurements of lung attenuation and estimates of air-trapping extent are both valuable methods of analysis.

Adult↗
PubMed1998

Neoplastic extension across pulmonary fissures: value of spiral computed tomography and multiplanar reformations.

To assess the value of spiral computed tomography (CT) with multiplanar reformations for detection of neoplastic extension across pulmonary fissures, 51 patients with a lung neoplasm near a fissure underwent spiral CT, followed by multiplanar reformations, and spaced thin-section CT scans through the area of contact between tumor and fissure. The CT studies were evaluated for visibility of fissures and their relationship to the tumor. Imaging findings were compared with surgical results in 31 patients who underwent thoracotomy. Visibility of fissures on multiplanar reformations was either good or acceptable in 47 (92.2%) patients, and poor in four. Surgical findings of neoplastic extension across the major or the minor fissure were present in seven and eight patients, respectively. Thin-section CT scans were 83.3% sensitive in assessing neoplastic involvement of the major fissure, axial CT scans were 57.1% sensitive, and spiral CT multiplanar images were 100% sensitive. In the evaluation of the minor fissure, thin-section CT and axial spiral CT scans were considered inconclusive in six patients whereas multiplanar reformations enabled correct assessment of the fissure/neoplasm relationship in all but one patient. Spiral CT multiplanar images are accurate for detection of transfissural neoplastic extension, and are superior to axial CT scans for evaluation of tumors near the minor fissure.

Aged↗
PubMed1997

Staging of thoracic lymphoma by radiological imaging.

Thoracic lymphomas, which are very common especially in Hodgkin's disease patients, are characterised by enlargement of mediastinal lymph nodes, parenchymal abnormalities, and pleural, pericardial and chest wall involvement. The use of several imaging techniques has been proposed in order to assess the extent of the disease correctly and to plan therapy. The most relevant results in this field, especially those using computed tomography (CT), magnetic resonance imaging (MRI) and gallium scanning, are summarised in this review. Presently CT is widely and successfully used in staging patients, whereas MRI seems to be preferable, as a second-step technique, if pericardial, pleural and chest wall involvement are suspected. The role of gallium scanning is limited in the staging, although it could be relevant in the follow-up of treated patients.

Adult↗
PubMed1997

Pulmonary alveolar proteinosis: high-resolution CT, chest radiographic, and functional correlations.

STUDY OBJECTIVE: To determine whether a correlation exists between pulmonary function and both frontal chest radiographs and high-resolution chest CT findings in patients with pulmonary alveolar proteinosis (PAP). DESIGN: Retrospective review of radiographic and clinical data. SETTING: Tertiary referral hospital. PATIENTS: Seven patients with PAP were studied on 25 occasions using high-resolution chest CT (n=21), frontal chest radiographs (n=19), and pulmonary function tests (PFTs) (n=25). MEASUREMENTS AND RESULTS: Visual estimates of the extent, degree, and overall severity of parenchymal abnormalities were determined for plain radiographs and high-resolution chest CT, and were correlated with PFTs. With high-resolution CT, the extent and severity of ground-glass opacity correlated significantly with the presence of a restrictive ventilatory defect, reduced diffusing capacity, and hypoxemia. Chest radiographic findings also correlated significantly with restrictive ventilatory defect, diffusing capacity, and hypoxemia. CONCLUSION: In patients with PAP, although high-resolution CT correlates more closely with pulmonary function, plain radiographs should be sufficient for follow-up.

Adult↗
PubMed1997

High-resolution CT of the lung: determination of the usefulness of CT scans obtained with the patient prone based on plain radiographic findings.

OBJECTIVE: We assessed the usefulness of chest radiographs for predicting whether high-resolution CT scans obtained with the patient prone would be valuable in assessing suspected diffuse lung disease. MATERIALS AND METHODS: In 100 consecutive patients undergoing high-resolution CT, findings on plain chest radiographs were classified as normal, possibly abnormal, or abnormal. CT scans obtained with the patient supine were assessed for the presence and distribution of lung abnormalities without knowledge of the plain radiographic classification. A second review of the CT scans was done with equal numbers of scans obtained with the patient prone and with the patient supine. The usefulness of the CT scans obtained with the patient prone for detecting lung disease was determined and related to the plain radiographic classifications. RESULTS: High-resolution CT scans obtained with patients prone were helpful in excluding or confirming posterior lung abnormalities in 10 (28%) of 36 patients who had normal findings on chest radiographs, five (28%) of 18 patients who had possibly abnormal findings on chest radiographs, and only two (4%) of 46 patients who had abnormal findings on chest radiographs. The proportion of patients who benefited from high-resolution CT scans obtained with the patient prone was significantly lower among the patients with abnormal findings on chest radiographs than among the patients with normal (p = .008) or possibly abnormal (p = .02) findings on chest radiographs. The two patients with abnormal findings on radiographs in whom CT scans obtained with the patient prone were helpful had minimal radiographic abnormalities. CONCLUSION: In patients with suspected diffuse lung disease, obtaining high-resolution CT scans with the patient prone may be useful when chest radiographs show normal findings, possibly abnormal findings, or minimal abnormalities indicative of diffuse lung disease. However, such scans are of little value in patients whose radiographs show abnormalities indicative of diffuse lung disease.

Adolescent↗
PubMed1996

Lung cancer staging: the role of computed tomography and magnetic resonance imaging.

Because complete resection remains the only reliable method of cure of lung cancer, one important aim of preoperative staging is to select patients with localised disease who may benefit from surgery, while avoiding unnecessary thoracotomies in patients with unresectable neoplasm. Computed tomography (CT) of the chest is a valuable method for staging local and regional spread of lung neoplasms, although limitations in its accuracy are well-known. While gross invasion of the mediastinum and major structures as well as the presence of metastatic disease can be easily demonstrated with CT, differentiation between tumour contiguity and subtle invasion of mediastinum or chest wall often remains a problem. Although magnetic resonance imaging (MRI) may have the same limitations as CT, in specific situations it may be superior in diagnosing minimal chest wall or mediastinal invasion. Moreover, MRI is useful in the assessment of patients with superior sulcus tumours as well as in patients with contraindication to intravenous administration of ionic contrast material. Since nodal size is the only useful criterion for evaluating lymph node metastases, CT and MRI show similar, poor accuracies in lymph node staging resulting from both low sensitivity (normal-sized nodes may contain microscopic metastases) and low specificity (enlarged lymph nodes may be reactive). For this reason, if enlarged lymph nodes are detected, further evaluation is recommended before excluding the patient from a potentially curative resection. Advantages and limitations of CT and MRI in the preoperative staging of non-small-cell carcinoma are reviewed in this article. The imaging of small-cell carcinoma is not included because most patients with this cell type do not benefit from surgical resection. Similarly we do not discuss imaging of distant metastases.

Humans↗
PubMed1996

Artifacts in chest radiographs with a third-generation computed radiography system.

Photostimulable phosphor computed radiography (CR) is a developing and increasingly widespread technology. The purpose of this pictorial essay is to familiarize readers with the appearance and cause of image artifacts that can occur in a third-generation computed radiographic system. Artifacts are described that relate to imaging plates, image readers, image processing, and film processing.

Adult↗
PubMed1996

[Spiral computerized tomography and videothoracoscopy in the assessment of contralateral nodular lesions in patients with bronchogenic carcinoma].

Recent improvements in endoscopic technology and surgical techniques have widened the application field of video-assisted thoracoscopy (VAT). We report our personal experience in 14 male patients (mean age: 67 years, range: 55-73 years) in whom one or multiple indeterminate contralateral lung nodules were found during bronchogenic carcinoma staging and then surgically resected with VAT. All patients underwent volumetric CT of the chest. Sixteen lung nodules were detected contralateral to the neoplasm; their mean diameter was 5 mm (range: 2-10 mm). The mean distance between pleural surface and lung nodule was 8 mm. All patients had primary lung cancer (3 central and 11 peripheral lesions), histologically confirmed by bronchoscopic or percutaneous CT-guided biopsy. None of them had any contraindication to surgery because of extrathoracic pathologic conditions. VAT was performed as normal, under general anesthesia, with assisted ventilation with a double-lumen endotracheal tube and using a percutaneous mechanical stapler. The nodules were easier to identify using a skin reference point corresponding to the parietal projection of the nodule, positioned with CT before surgery. Surgery lasted 58 minutes on the average (range: 30-120 minutes). In all patients VAT was successful in resecting the nodule. In 9 patients a metastasis from a contralateral lung cancer was found: 4 adenocarcinomas, 4 epidermoid carcinomas and 1 small cell carcinoma. In the remaining 5 patients, VAT-resected lung nodules were of chronic inflammatory nature. The latter patients underwent definitive surgery of the primary tumor (2 adenocarcinomas, 2 epidermoid and 1 large cell carcinomas) ten days later (range: 9-30 days). There were no major complications but a prolonged air leak in one patient, which needed drainage to be maintained for 5 days. Presently, VAT permits an atypical resection, avoiding the morbility of thoracoscopy and thus represents a mandatory technique in selected patients amenable to definitive surgery.

Aged↗
PubMed1995

Hydrostatic pulmonary edema: high-resolution CT findings.

Hydrostatic pulmonary edema can be defined as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, as in congestive heart failure or intravascular volume overload. The diagnosis of hydrostatic pulmonary edema is usually based on clinical information, conventional chest radiograph findings, and response to treatment and does not require high-resolution CT. However, recognizing the appearance of hydrostatic pulmonary edema on high-resolution CT can be important, as the edema can mimic other diseases or can occur as an unsuspected finding in patients having high-resolution CT for other indications, and a misdiagnosis may lead to unnecessary lung biopsy. Although the CT appearances of pulmonary edema have been described in several studies [1-3], to date, the high-resolution CT appearances of hydrostatic pulmonary edema have been described only in isolated cases [4-6] or in experimental studies of phantom or animal models [7, 8]. This essay illustrates the spectrum of high-resolution CT findings seen in adult patients with hydrostatic pulmonary edema secondary to cardiac disease.

Aged↗
PubMed1995

[Spiral computed tomography of the trachea. Study technique and possible clinical applications].

This work was aimed at optimizing the spiral CT technique in studying the trachea to obtain multiplanar reconstructions with high diagnostic yield. The authors tried to identify an image reconstruction technique, on both the coronal and the sagittal planes, to visualize the whole trachea on a single image in each patient. Twenty patients, 15 with pathologic tracheal involvement and 5 with pulmonary lesions with no tracheal involvement, were examined with a Somatom Plus CT unit (spiral technique: 120 kV, 210 mA, 5-mm slices, 5-mm/s table feed and 24-s scanning time). Multiplanar reconstructions were obtained on the oblique plane, identified by three axial reference scans at different levels. The whole trachea was reconstructed on a single image in 100% of cases on the coronal plane and in 95% of cases on the sagittal plane. Image quality was good in 16 patients and acceptable in 4. The authors stress the value of spiral CT multiplanar images when the reconstruction plane lies in the tracheal lumen on both the coronal and the sagittal planes.

Cysts↗