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M Zompatori

Publications and source records attributed to M Zompatori.

108 records · Page 6Linked to original sources
PubMedDate not supplied

[Automatic evaluation of total lung capacity and of emphysema involvement with spiral computerized tomography (CT) in obstructive pneumonia].

OBJECTIVE: To evaluate, in patients with chronic obstructive lung disease or chronic bronchitis, inspiratory helical CT with 3D postprocessing, to measure lung volumes and the amount of emphysema and to compare these measurements with lung function tests. MATERIAL AND METHODS: Seventeen patients with chronic obstructive lung disease disease or chronic bronchitis underwent pulmonary function tests and helical CT after a full inspiration with 3D postprocessing (lower threshold -1024 HU, upper thresholds -200, -300 and -400 HU). Lung inspiratory volumes (TLC-CT) were determined for each model; the amount of emphysema was evaluated by means of an automatic score and a visual score with HRCT. RESULTS: There is a good correlation between automatic and visual scores (p < 0.001); the automatic score had a good correlation with lung function tests, above all with total lung capacity (r = -0.56; p = 0.01) but the visual score had a much closer correlation with DLCO (r = -0.70; p < 0.001). TLC-CT had a significant correlation with pletismographic TLC (TLC-P); the upper threshold -200 HU was more correct (TLC-P = 8011 cc.; TLC-CT 200 = 7138 cc.; r = 0.83; p < 0.001). The volume change of 3D model was about 230 cc. per 100 HU (p < 0.001) modifying upper thresholds, but no change was observed in the volume occupied by emphysema and the percentage of emphysema presented minimal, clinically non significant modifications. DISCUSSION AND CONCLUSIONS: In emphysematous patients, the helical CT with 3D model construction is a good technique to evaluate lung volumes and to quantify emphysema with automatic score; this one, however, probably underscores the extent of pathology; therefore, the addition of a visual score with HRCT is probably worthwhile.

Aged↗
PubMedDate not supplied

Multidetector CT-urography in the study of urological complications in renal transplant.

PURPOSE: To evaluate the value of CT-urography in the diagnosis and follow-up of the urological complications of renal transplantation. MATERIALS AND METHODS: We performed 19 CT-urography examinations (3 of which were follow-up) on 15 patients by using a spiral multislice CT scanner and multiplanar reconstructions. The examinations were carried out directly after administration of 100 ml of iodinated contrast medium by slow iv infusion, with acquisitions starting 5 minutes after the end of the infusion. Surgery was regarded as the gold standard for the diagnosis of urological complications in the operated patients, whereas in patients who had undergone medical therapy or stent placement the gold standard was 1 month ultrasound and clinical follow-up with evaluation of diuresis and renal function. RESULTS: Between January 1999 and December 2001 a total of 210 kidney transplantations were performed at our hospital. There were 34 urological complications in 28 patients with a 16.1% prevalence, consistent with the major international studies. The complications detected were 14 urine leaks and 19 ureteral obstructions secondary to stones, oedema, blood clots and stricture. We observed one case of reflux in the allograft ureter. Fourteen out of 16 CT-urography examinations yielded important clues for the diagnosis of urological complications in kidney allografts, completely replacing standard urography. In particular, CT-urography correctly detected 5 urinary fistulas by demonstrating iodinated contrast material leaks along the ureteral tract, and 8 cases of obstructive uropathy due to different causes (1 submucosal tunnel edema, 1 blood clot, 1 stone and 5 cases of ureteral stricture). One case of urinary fistula and one of obstructive uropathy were not detected. DISCUSSION AND CONCLUSIONS: CT-urography proved to be an important diagnostic tool in the evaluation of urological complications of kidney allografts, showing a diagnostic accuracy over 90%; it is useful for confirming the type and site of urological lesions, and therefore to provide guidance for a targeted surgical approach. Compared with excretory urography, which is no longer used in this diagnostic field, CT-urography is more complete and precise as it provides information not only about the urinary tract, but also about the kidney parenchyma and pararenal fluid collections. The only disadvantage, which limits its use to selected cases, is the risk associated with the use of iodinated contrast agents in patients with impaired renal function.

Contrast Media↗
PubMedDate not supplied

Spiral CT evaluation of pulmonary emphysema using a low-dose technique.

PURPOSE: To evaluate the diagnostic accuracy and clinical acceptability of low-dose spiral CT for determining pulmonary volumes and emphysema extension in patients with pulmonary emphysema, in comparison with studies based on spiral CT at conventional dose. MATERIALS AND METHODS: We prospectively evaluated eighteen patients, current or former smokers, with a clinical diagnosis of chronic obstructive pulmonary disease. All the patients underwent: HRCT with three scans at predetermined levels; quantitative spiral CT, with two inspiratory scans, one conventional scan at 240 mA, and the second one a low-dose scan at 80 mA. We used the following parameters: 120 kV, rotation time 0.8", scan time less than 20" (single inspiratory breath-hold), layer thickness 7.5 mm, pitch 6 (high speed), interpolation algorithm at 180 degrees. A 3D reconstruction was performed, with segmentation of the lungs and automatic quantification of pulmonary volumes. We compared the volumes of absolute and percent emphysema and the ratings of the dose delivered to the patient (CTDIw and DLP) obtained with the two spiral CT scans with each other and with the respiratory function tests. RESULTS: The average total lung capacity (TLC) obtained by conventional-dose spiral CT (CTs1) was 6889.4 cc (SD +/-1813.2), and the capacity with low-dose spiral CT (CTs2) was 6929.4 cc (SD +/-1811.6). The percentage of emphysema was 39.7% (range: 2.2-63.5%; SD: +/-19.9) for the CTs1 and 41.1% (range: 2.1-66.4%; SD: +/-20). The CTDIw corresponding to CTs1 was 12.2 mGy (range: 11.9-16.4; SD: +/-1), the one corresponding to CTs2, 3.6 mGy (range: 3.6-4.9; SD: +/-0.3). The DLP corresponding to CTs1 was 391.7 mGy x cm (range: 333.3-518.9; SD: +/-46.7), the one corresponding to CTs2 was 117.8 mGy x cm (range: 100.3-156; SD: +/-14). As for the respiratory function tests, the total lung capacity (TLC) obtained by body plethysmography was 7061 cc (SD: +/-2029.7); the percent TLC was 115.9 (range: 66-165; SD: +/-27.6), the forced expiratory volume at one second (FEV1%, percentage of predicted value) was 46.7% (range: 17-123; SD: +/-27.3), residual volume (RV%) as a percentage of predicted value was 186.3 (range: 84-359; SD: +/-80.7), the Tiffeneau index (TI) was 46% (range: 25-71; SD: +/-15.7). We observed a very significant correlation between radiological and functional TLC for both CT methods. The percentage scores for emphysema obtained with the two methods correlated significantly with the functional indexes. The pixel index of CTs1 correlated with TLC% (r=0.87; p<0.0001), FEV1% (r=-0.53; p<0.02), RV% (r=0.76; p=0.004), TI (r=-0.79; p=0.0001). The pixel index of CTs2 correlated with TLC% (r=0.87; p<0.0001), FEV1% (r=-0.56; p=0.01), RV% (r=0.78; p=0.003), TI (r=-0.8; p=0.0001). The adoption of the method with low tube current entailed a highly significant reduction in the estimated dose delivered to patients (CTDIw and DLP) with r=0.9 and p < 0.0001. DISCUSSION AND CONCLUSIONS: Quantitative low-dose spiral CT is a very good method to quantify pulmonary volumes and calculate the extension of the anatomic emphysema. The reduction of mA from 240 to 80 lowers the estimated dose by 30%, without compromising the accuracy of the results. Our study achieved a highly significant correlation between the results obtained with the two spiral CT techniques and between these results and the respiratory function tests. In clinical practice, the easiest way to reduce the dose in spiral CT of the lung is to reduce the tube current. The low-dose method allows a significant reduction in radiation exposure. Further studies are required to establish to what extent the dose can be reduced without increasing in quantum noise and thereby compromising the quality of the study.

Adult↗
PubMedDate not supplied

Hyperdense mucoid impaction in allergic bronchopulmonary aspergillosis: CT appearance.

Allergic bronchopulmonary aspergillosis is an immunologic pulmonary disease characterised by proximal bronchiectasis with normal peripheral branchings and mucoid impactions in patients with asthma. The pathologic damage consists of mucoid impaction containing macrophages, several eosinophils, fungal hyphae, scaled-off epithelium (Curshman spirals) and calcium oxalate crystals. On CT, the mucoid impaction of the bronchial tree generally shows slightly hyperhydric density. The originality and peculiarity of our case is the presence of high-density mucoid impaction inside an atelectatic area.

Adult↗
PubMedDate not supplied

[Duplex Doppler study of the transplanted kidney].

The authors examined 34 renal transplant recipients with Duplex US, i.e. real-time sonography associated with pulsed Doppler, thus obtaining morphological and structural data about transplanted kidneys as well as hemodynamic information. Special emphasis was put on intrarenal vascular impedance and the relative resistive index, first mentioned by Rifkin in 1987. US diagnosis was compared with the results obtained at both biopsy and clinical follow-up. Only long-term renal transplants were considered; the patients were examined for a rise in serum creatinine level or for the onset of other signs/symptoms related to renal allografts. Our results confirm the utility of pulsed Doppler US in the diagnosis of renal transplant rejection, and allow reference values to be established for the resistive index. In agreement with literature data and assuming 0.9 as a resistive index value, Duplex-Doppler US specificity in diagnosing acute rejection was 100%, and sensitivity was 50%. However, the authors believed it more useful to assume 0.8 as a reference value for the resistive index, for it allows more renal transplant rejection episodes to be diagnosed, both acute and chronic, with an acceptable combination of specificity, sensitivity and predictive value. While the differential diagnosis of acute and chronic rejection is hardly ever possible with Duplex US alone, the combined use of Duplex US and real-time US makes it nearly always possible. As far as intrarenal impedance is concerned, our results seem to disagree with the scattered literature data on the subject, and to point towards its possible significant (though not extreme) increase also in case of chronic rejection.

Adolescent↗
PubMedDate not supplied

[Pulmonary edema in renal insufficiency].

Forty-nine cases of pulmonary edema in nephropatic patients were studied. The most frequent radiologic findings are discussed. The unreliability of a precise differentiation between "cardiac" and "renal" patterns of pulmonary edema in nephropatic patients is emphasized.

Acute Kidney Injury↗
PubMedDate not supplied

[Rounded atelectasis of the lung].

Rounded atelectasis is an uncommon but increasingly recognized form of pulmonary collapse that often mimics a pulmonary neoplasm. It is suggested that these lesions can occur many years after exposure to asbestos or exudative pleural effusions. The authors report 16 cases of rounded atelectasis seen during a period of over 10 years, 9 of which in the last 18 months. They describe the plain film, tomographic and CT appearances of the lesion. The radiographic features that allow a diagnosis are rounded or oval shadows lying along the posterior surface of the lower lobe, adjacent to thickened pleura. Lateral tomography and CT show the blood vessels and bronchi curving toward the mass and converging on one edge, like a comet tail. Differentiation of rounded atelectasis from neoplastic disease is essential in avoiding unnecessary thoracotomy.

Aged↗
PubMedDate not supplied

[Radiologic evaluation of bronchial asthma (author's transl)].

The physiopathologic and anatomic findings of bronchial asthma are shortly reviewed. A description follows of the radiologic patterns based on personal experience. Only seldom the radiologic investigations provide the possibility to reach the correct diagnosis of bronchial asthma. But they always complete the clinical evaluation and allow the demonstration of the numerous and frequent complications which influence the evolution and prognosis of the disease.

Asthma↗
PubMedDate not supplied

[The correlation between radiological and haemodynamic pictures in the diagnosis of pulmonary hypertension in chronic obstructive diseases (author's transl)].

A comparison between the radiographical findings and the haemodynamic data was made in 53 cases of chronic bronchial obstruction. The results were used in an assessment of the reliability of standard chest X-rays in the diagnosis of pulmonary hypertension. Reference is also made to quantitative indices. Several cases are presented by way of example.

Adult↗
PubMedDate not supplied

[Signs of inflammatory activity in thoracic sarcoidosis. A high-resolution computerized tomography study].

Sarcoidosis is characterized by the presence of non-caseating granulomas. Lymphadenopathy and diffuse parenchymal abnormalities often involve the chest. This study was aimed at finding out signs that could be suggestive of disease activity and if the lesions are reversible after therapy. Sixty-three patients underwent chest radiography, high resolution CT, functional studies, bronchoalveolar lavage and 67Ga scintigraphy. Twenty-three patients were followed-up. Lymphadenopathies, nodular opacities and acinar opacities resolved after steroid therapy; bronchiolectasies, bronchiectasies, septal thickening and parenchymal distorsion did not disappeared after therapy and are therefore considered as irreversible lesions. Ground glass opacities are an uncommon finding; they are due to fibrosis or to widespread interstitial granulomas rather than alveolitis. The prognostic meaning of ground glass opacities is uncertain. Therefore, disease activity findings are mainly lymphadenopathies, nodules and consolidations. Nevertheless these findings not necessarily imply a bad prognosis, as acute sarcoidosis seems to respond well to steroid therapy, even with complete remission. It remains debated if a CT study is worthwhile in all the new cases of sarcoidosis or only in the clinically more severe ones.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[The assessment of the severity of pulmonary edema by computed tomography. A comparison between high-resolution computed tomography, objective evaluation with density masks and functional tests].

The results of high-resolution computed tomography (HRCT) were correlated with those of pulmonary function tests, chest films and CT expiratory density mask values in the evaluation of pulmonary emphysema in 33 symptomatic subjects. Emphysema was quantitated with both subjective and objective measurements. Conventional chest films were useful to diagnose severe emphysema but its actual extent was more reliably evaluated with CT scoring systems. HRCT and density mask correlated well with function tests, but the former method exhibited stronger correlation with carbon monoxide diffusion capacity. The opposite was true for hyperinflation and expiratory obstruction variables. Subjective CT estimates, which are quick and easy to perform, were seen to correspond more specifically to the pathophysiologic derangement and should therefore be used to evaluate the anatomic extent of disease. The functional severity of emphysema correlated only with the overall extent of disease and not with its regional distribution in the upper or lower lungs. Finally, in 4 cases (12.1%) with low CT scores, FEV1 was reduced but diffusion capacity values were normal. In one of these patients HRCT showed signs of bronchiolitis. In fact, small airway disease might be a more critical factor in determining functional impairment than the actual anatomical emphysema.

Adult↗
PubMedDate not supplied

Hemodynamic estimation of chronic cor pulmonale by Doppler echocardiography. Clinical value and comparison with other noninvasive imaging techniques.

Pulmonary arterial pressure (PAP) represents an important prognostic factor in patients affected by chronic obstructive pulmonary disease (COPD). A noninvasive diagnostic approach is offered by several imaging techniques, such as chest X-ray, nuclear medicine, real-time sonography, color Doppler US, CT and MRI. However, at present a quantitative assessment of PAP is not achieved with reasonable precision with any of these techniques. Tricuspid regurgitation can be estimated by continuous wave Doppler but it may be difficult in patients with COPD. On the contrary, the severity of pulmonary hypertension can be accurately assessed with pulsed Doppler echocardiography from the subxiphoid region, using a general purpose US device. Nineteen adult patients with COPD were studied by duplex-Doppler from an oblique subxiphoid approach and right heart catheterization. The study was diagnostic in all cases with quality Doppler recordings. A significant relationship was found between AcT and pulmonary mean or systolic pressure at rest. An accurate prediction of PAP in COPD is possible by means of pulsed-Doppler also in low-grade hypertension. This technique is considered a simple and reliable adjunct to the noninvasive evaluation of COPD and represents a satisfactory alternative to the classical parasternal approach preferred by cardiologists but often not suitable for emphysematous patients. Radiologists who routinely use a general purpose US device are encouraged to try this new technique in the study of heart disease.

Adult↗