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Massimo Midiri

Publications and source records attributed to Massimo Midiri.

At least 37 records · Page 2Linked to original sources
PubMed2004

Liver haemangiomas undetermined at grey-scale ultrasound: contrast-enhancement patterns with SonoVue and pulse-inversion US.

The objective of this study was to describe the spectrum of contrast-enhancement patterns of hepatic haemangiomas undetermined at grey-scale ultrasound (US) on SonoVue-enhanced pulse-inversion (PI) US. Twenty patients (11 women, nine men) with 35 haemangiomas (size range: 1-7 cm; mean: 3.1 cm) undetermined at baseline US underwent PI at low M.I. (0.05-0.08) after i.v. injection of SonoVue. All haemangiomas were confirmed by typical helical computed tomography (CT) and/or magnetic resonance imaging (MRI) findings. US examinations were videotaped and then reviewed by two experienced radiologists blinded to the final diagnosis. Readers evaluated by consensus the baseline echogenicity and the dynamic enhancement pattern of each lesion, in comparison with adjacent liver parenchyma. After administration of SonoVue, 31/35 (88%) haemangiomas showed peripheral hyperechoic nodules in the arterial phase, followed by progressive centripetal fill-in, which was complete in 25/35 cases and incomplete in 6/35 cases. Three out of 35 (9%) haemangiomas showed rapid and complete fill-in in the arterial phase, which persisted in the portal and delayed phases. Finally, 1/35 haemangiomas (3%) showed a rim of arterial contrast enhancement with progressive and complete centripetal fill-in in portal-venous and delayed phases. In conclusion, PI after the administration of SonoVue enabled the depiction of typical contrast-enhancement patterns in haemangiomas undetermined at baseline US.

Adult↗
PubMed2004

Diagnostic work-up of arrhythmogenic right ventricular cardiomyopathy by cardiovascular magnetic resonance.

Cardiovascular magnetic resonance (CMR) has become a widespread diagnostic tool. Since its introduction, CMR has been used to image patients with a known or suspected arrhythmogenic right ventricular cardiomyopathy (ARVC). Several abnormalities have been found and described by CMR and at present this diagnostic tool is considered very important for the diagnosis. However, the diagnosis of ARVC relies upon the fulfillment of both clinical and functional criteria and CMR can provide several but not all the information useful for the diagnosis. Furthermore, some findings such as evidence of right ventricular epicardial fat, once considered a peculiar marker of ARVC, have been shown to possess a low specificity. This document was prepared by representatives of the three Italian official Organizations involved in CMR. Its main scope is to highlight the problems encountered when studying patients with suspected ARVC at CMR, to indicate the basic technical equipment needed, to recommend a proper imaging protocol and to offer a consensus on the main features relevant for the diagnosis.

Arrhythmogenic Right Ventricular Dysplasia↗
PubMed2004

Acute traumatic acromioclavicular joint lesions: role of ultrasound versus conventional radiography.

PURPOSE: To assess the diagnostic potential of ultrasound as compared to conventional radiography in quantifying the anatomic and structural damage and determining the grade of acute traumatic lesions of the acromioclavicular (AC) joint. MATERIALS AND METHODS: From September 2001 to September 2002, 18 patients (16 men, 2 women; age range: 17-78 years) who came to our Emergency Service with clinically suspected acute traumatic AC joint lesion were examined by ultrasonography with a variable frequency linear-array transducer (7.5-12 Mhz). The morphology of the AC joint peri-articular ligaments and soft tissues, distance between the edge of the acromion and the lateral margin of the clavicle, distance between the superior edge of the coracoid and the inferior margin of the clavicle were evaluated. Conventional radiography was performed prior to ultrasound using routine antero-posterior (A-P), single-film stress and "outlet" projections. All patients subsequently underwent clinical follow-up for a mean period of six months. RESULTS: On US examination, all patients presented AC ligament lesion associated with consistent intra- and extra-articular sero-haemorrhagic effusion. Six of the 18 patients had suffered indirect trauma. Diastasis of the AC joint with ligament lesion not associated with involvement of coracoclavicular (CC) joint and with ligament integrity was observed. Twelve of the 18 patients had direct trauma. Changes to AC and CC ligaments with consequent diastasis of both joints were observed. Measurements of AC and CC distance obtained on US examination corresponded to those obtained at conventional radiography in the A-P projection. At clinical follow-up, no variation in the previously established diagnosis was recorded in any patient. CONCLUSIONS: If appropriate methodology and adequate transducers are used, ultrasound is an accurate and reliable technique for the evaluation of acute AC joint injuries, complementing and correlating well with conventional radiography.

Acromioclavicular Joint↗
PubMed2003

Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound.

The aim of this study was to describe gray-scale appearance of liver parenchyma and focal nodular hyperplasia (FNH) by pulse inversion (PI) ultrasound (US) at baseline and after contrast agent administration in patients with normal and fatty liver. Sixteen consecutive patients (12 women, 4 men) with 29 previously diagnosed FNHs (15 of 29 located in normal liver and 14 of 29 in fatty liver) underwent PI US before and after SH U 508A (Levovist) injection. Signal intensity values were measured within the FNHs and the adjacent liver parenchyma in selected images. Baseline echogenicity of fatty liver was higher (15.19 +/- 2.90 dB +/- SD) than normal liver (10.91 +/- 3.15 dB +/- SD; p<0.001). After Levovist administration, normal livers (7 of 16) showed a statistically significant increase of echogenicity (16.59 +/- 3.81 dB +/- SD; p<0.001) in comparison with fatty livers (9 of 16; 15.75 +/- 3.12 dB +/- SD). The FNHs located in normal liver showed baseline echogenicity higher (12.29 +/- 3.22 dB +/- SD) than that of FNHs arising in fatty liver (7.06 +/- 2.43 dB +/- SD; p<0.001). After Levovist administration, FNHs located in normal liver showed a statistically significant increase of echogenicity (25.30 +/- 4.62 dB +/- SD) in comparison with FNHs located in fatty liver (13.58 +/- 3.54 dB +/- SD; p<0.001); the latter always showed mean values of echogenicity lower than surrounding liver parenchyma. In our series decreased contrast-enhancement pattern of both fatty liver and FNHs located in fatty liver was the most prominent finding when Levovist is administered. Contrast washout was a distinctive feature of FNH arising from the fatty liver.

Adult↗
PubMed2003

Potential myocardial iron content evaluation by magnetic resonance imaging in thalassemia major patients treated with Deferoxamine or Deferiprone during a randomized multicenter prospective clinical study.

The purpose of this study was to evaluate if the variations of heart magnetic resonance imaging in beta-thalassemia major patients treated with Deferoxamine B mesylate (DF) or Deferiprone (L1) chelation therapy is a useful tool of the indirect myocardial iron content determination. For this reason, a prospective study was carried out. Seventy-two consecutive patients with beta-thalassemia major (35 treated with DF and 37 with L1) were studied. The main outcome results were laboratory parameters including determination of the liver iron concentration (LIC) and magnetic resonance imaging (MRI) of the heart and liver. The heart to muscle signal intensity ratios (HSIRs) were significantly increased in both the DF (t = -2.8; p < 0.01) and L1 (t = -3.1; p < 0.01) groups after one year of treatment No statistically significant difference in the values of HSIRs was present between the two groups at the beginning of treatment (p = 0.25; t = 1.13), and after one year of treatment (p = 0.20; t = 1.28). The HSIR were inversely correlated to the LIC (r = -0.52; p < 0.001) but not with ferritin levels (r = 0.10; p = 0.18). A positive correlation was found between the variation of HSIRs and that of the liver signal intensity ratios (r=0.52; p < 0.001), and a mild correlation (r = 0.40; p < 0.001) was found between the gamma glutamyltransferase (gammaGt) levels and the HSIRs values. Our data confirm that heart MRI is sensitive enough to detect significant variations of the mean HSIR during iron chelation with DF or L1.

Administration, Oral↗
PubMed2003

Cardiac complications in thalassemia: noninvasive detection methods and new directions in the clinical management.

The natural history of thalassemia has shown substantial change during these years. This applies for each aspect of the pathology (for example, endocrinological, hepatological and psychological) and also for the pathology that has presented and still presents the main cause of death: myocardial dysfunction. In this review, the pathophysiology of cardiac complications, possible role of myocarditis, new knowledge on pathogenesis, and noninvasive detection methods for iron overload in the heart are pointed out. Prophylaxis of cardiomyopathy and new therapy strategies of myocardial dysfunction, including the impact of the new chelation treatment, are discussed.

Cardiomyopathies↗
PubMed2003

The role of MRI in traumatic rupture of the diaphragm. Our experience in three cases and review of the literature.

PURPOSE: To evaluate the role and effectiveness of Magnetic Resonance Imaging (MRI) in blunt diaphragmatic injuries by reviewing the literature and our experience in three cases. MATERIALS AND METHODS: We reviewed the medical records and MRI findings of three patients with diaphragmatic injury due to blunt abdominal trauma. All patients were previously examined with chest X-ray and CT and later with MRI at our institution. Coronal and sagittal SE TI-w and fast SE T2-w sequence images were acquired. All patients underwent surgery. RESULTS: MRI showed a 5.5 cm tear in the left hemidiaphragmatic dome with herniation of the stomach and colon into the thoracic cavity in the first case; a 1 cm tear in the diaphragmatic dome with herniation of the stomach and posterior abscess in the second case; and an 8 cm breach in the left diaphragm with visceral herniation in the third case. CONCLUSIONS: The major advantage of MRI lies in its capability of directly acquiring coronal and sagittal images allowing evaluation of the entire diaphragm, both in normal and in pathological conditions. In our experience, MRI showed the exact site and size of the diaphragmatic rupture in all cases. However, this technique cannot be performed in emergency situations or in multitrauma patients. Therefore, in agreement with the literature, helical CT remains the modality of choice in traumatic patients. MR imaging is useful only in doubtful cases and in haemodynamically stable patients.

Adolescent↗
PubMed2003

Atypical liver hemangiomas: contrast-enhancement patterns with SH U 508A and pulse-inversion US.

AIM: To describe the enhancement patterns of atypical hepatic haemangiomas with Pulse Inversion Harmonic Imaging (PIHI) using SH U 508A (Levovist). MATERIALS AND METHODS: Twenty-five patients (15 women, 10 men; age range: 29-65 years, mean: 48.2 years) with 28 hepatic haemangiomas (size: 1.5 - 11.5 cm; mean: 4.6 cm) underwent PIHI before and after i.v. administration of Levovist. Selected images obtained at baseline and 25-30s, 55-60s and 240s after Levovist injection were sequentially reviewed to determine the changes in echogenicity of haemangiomas in comparison to surrounding liver parenchyma. RESULTS: At the baseline US study, 22/28 (79%) haemangiomas revealed highly inhomogeneous echotexture; 5/28 (18%) were homogeneously hypoechoic and 1/28 (3%) was isoechoic with respect to hepatic parenchyma. After Levovist administration, 16/28 (57%) haemangiomas showed peripheral hyperechoic nodules in the arterial phase with progressive centripetal fill-in in portal and late phases; such fill-in was complete in 14/16 cases and incomplete in 2/16. Four of twenty-eight (14%) haemangiomas revealed a rapid and complete homogeneous fill-in on arterial phase that lasted throughout the portal and late phases. Finally, 8/28 (29%) showed a rim-like enhancement with progressive and complete centripetal fill-in on portal and late phases. CONCLUSIONS: According to our results, PIHI with Levovist allows demonstration of typical enhancement patterns in most of atypical haemangiomas, thus providing useful diagnostic information for their characterization.

Adult↗
PubMedDate not supplied

Deferiprone versus deferoxamine in patients with thalassemia major: a randomized clinical trial.

Deferiprone has been suggested as an effective oral chelation therapy for thalassemia major. To assess its clinical efficacy, we compared deferiprone with deferoxamine in a large multicenter randomized clinical trial. One-hundred forty-four consecutive patients with thalassemia major and serum ferritin between 1500 and 3000 ng/ml were randomly assigned to deferiprone (75 mg/kg/day) (n = 71) or deferoxamine (50 mg/kg/day) (n = 73) for 1 year. The main measure of efficacy was the reduction of serum ferritin. Liver and heart iron contents were assessed by magnetic resonance. Liver iron content and fibrosis stage variations were assessed on liver biopsy by the Ishak score in all patients willing to undergo liver biopsy before and after treatment. The mean serum ferritin reduction was 222 +/- 783 ng/ml in the deferiprone and 232 +/- 619 ng/ml in the deferoxamine group (P = 0.81). No difference in the reduction of liver and heart iron content was found by magnetic resonance between the two groups. Thirty-six patients accepted to undergo repeat liver biopsy: 21 in the deferiprone and 15 in the deferoxamine group. Their mean reduction of liver iron content was 1022 +/- 3511 microg/g of dry liver and 350 +/- 524, respectively (P = 0.4). No difference in variation of the Ishak fibrosis stage was observed between the two groups. Treatment was discontinued because of reversible side effects in 5 patients in the deferiprone group (3 hypertransamin/asemia and 2 leukocytopenia) and in none in the deferoxamine group. These findings suggest that deferiprone may be as effective as deferoxamine in the treatment of thalassemia major with few mild and reversible side effects.

Adolescent↗
PubMedDate not supplied

CT and MR imaging evaluation of hepatic adenoma.

Hepatic adenoma is a rare benign epithelial tumor that is usually encountered in young women who use oral contraceptives. It is clinically significant because of the risk of hemorrhage and of its low-grade malignancy potential. Adenomas usually are mildly hypervascular at contrast-enhanced CT and MR imaging, and heterogeneous due to the presence of hemorrhage, necrosis, calcifications and fat. The objective of our study was to illustrate the CT and MR imaging findings of hepatic adenoma.

Adenoma↗
PubMedDate not supplied

[Radiofrequency thermoablation in the treatment of primary and secondary liver tumours].

Radiofrequency thermoablation is a locoregional procedure based on the use of electromagnetic waves that induce movement and consequently the production of heat. This is the basis for the coagulative necrosis produced in the tissues. The method, experimented with and developed in the '90s, is today extensively used in the treatment of focal hepatic lesions, both primary and secondary. The factors that condition the procedure are related essentially to the characteristics of the tumours and to the possibility of obtaining a predictable area of necrosis that guarantees the radicality of the treatment. As regards primary neoplasms, it should be stressed that the treatment for hepatocellular carcinoma is implemented only in a small percentage of cases due to both the stage of the cirrhosis and because a wide resection is not justified for small-sized lesions or for recurrences after resection. As far as liver metastases are concerned, particularly those from the colon-rectum, surgery is becoming increasingly indicated. Obviously the conditions are decidedly less demanding than those of surgery in liver parenchyma with cirrhosis. Radiofrequency thermal ablation, even in this condition, has a place as an alternative or in combination with liver resection, particularly during recurrences or in cases of multiple metastases that require extensive extirpative operations. The authors present their experience over the period from February 1999 to December 2002 in 82 patients, 71 with hepatocellular carcinoma and 11 with metastases, treated with radiofrequency thermoablation. Depending upon the site, the number of lesions and the Child-Pugh functional classes in patients with cirrhosis, 117 treatments were carried out: the percutaneous approach was used in 77 cases and the open procedure in 36, while the thermoablation was combined with surgical resection in 4 cases. The results are examined on the basis of perioperative morbidity and mortality and local recurrence, and the time of hospitalisation is compared in the different patient groups. The authors conclude favourably for this procedure, which is associated with an extremely low percentage of complications and with an almost total lack of perioperative mortality, and in some cases may be a valid alternative and in other cases a useful complement to resection treatment.

Adult↗
PubMedDate not supplied

Use of saline chaser in the intravenous administration of contrast material in non-invasive coronary angiography with 16-row multislice Computed Tomography.

PURPOSE: To investigate the impact of saline bolus chaser in coronary angiography with a 16-row multislice CT (16-MSCT) scanner. MATERIALS AND METHODS: 32 patients were divided in two groups for contrast material (cm) administration: group 1 (140 ml at 4 ml/s), and group 2 (100 ml at 4 ml/s followed by 40 ml of saline chaser at 4 ml/s). All patients underwent ECG-gated coronary angiography with a 16-MSCT scanner. The attenuation at the origin coronary vessels was assessed. Three regions of interest were drawn throughout the data-set: ascending aorta (ROI1); descending aorta (ROI2); pulmonary artery (ROI3). The attenuation in the superior vena cava was recorded (ROI4). The average attenuation and the slope were calculated in each ROI. RESULTS: The average attenuation in the coronary vessels was not significantly different in the two groups. The attenuation value in the superior vena cava was significantly inferior in group 2. CONCLUSIONS: 16-row MSCT coronary angiography with bolus chaser allows optimal vessel enhancement with a lower dose of cm and a lower enhancement of the superior vena cava and the right heart.

Adult↗
PubMedDate not supplied

Virtual bronchoscopy in patients with central endobronchial stenosing lesions. Technique optimisation with single slice spiral CT.

PURPOSE: To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy. MATERIALS AND METHODS: Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy. RESULTS: The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed. CONCLUSIONS: The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.

Adult↗
PubMedDate not supplied

Diagnostic work up of arrhythmogenic right ventricular cardiomyopathy by cardiovascular magnetic resonance (CMR). Consensus statement.

Cardiovascular Magnetic Resonance (CMR) has become a widespread diagnostic tool. Since its introduction CMR has been used to image patients with known or suspected arrhythmogenic right ventricular cardiomyopathy (ARVC). Several abnormalities have been found and described by CMR and at present this diagnostic tool is considered very important for the diagnosis. However, the diagnosis of ARVC relies upon the fulfillment of both clinical and functional criteria and CMR can provide several but not all the information useful for the diagnosis. Furthermore, some findings such as evidence of right ventricular epicardial fat once considered a peculiar marker of ARVC, have been shown to possess a low specificity. This document was prepared by representatives of the three Italian official Organizations involved in CMR. Its main scope is to highlight the problems encountered when studying patients with suspected ARVC by CMR, to indicate the basic technical equipment needed, to recommend a proper imaging protocol and to offer a consensus on the main diagnostic features relevant for the diagnosis.

Arrhythmogenic Right Ventricular Dysplasia↗
PubMedDate not supplied

Thoracic cardiovascular imaging with 16-row multislice Computed Tomography and retrospective ECG-gating. Technical note.

PURPOSE: To apply the retrospective ECG-gating to the 16-row MSCT scan of intrathoracic vessels. MATERIALS AND METHODS: Fourty-eight patients underwent MSCT with a new 16-row scanner (Sensation 16-Siemens) for the study of the great intrathoracic vessels. In group 1 (33 patients) a retrospectively ECG-gated protocol was applied; in the control-group 2 (15 patients) a conventional MSCT protocol for thoracic imaging was applied. Images were scored regarding 1) the presence or absence of artefacts determined by breath-hold, beam hardening and mis-triggering; 2) the visualisation (optimal, mild and poor) of great intrathoracic vessels (aorta, pulmonary arteries and veins); 3) the visualisation (presence or absence) of proximal, mid and distal coronary arteries (left main, left anterior descending, circumflex, and right coronary artery). RESULTS: Ascending aorta showed motion artefacts in 3 (20%) cases in group 2 and none in group 1. In group 1, proximal LAD, CX, and RCA were assessable in 94%, 91%, and 91%, respectively. Left main coronary artery was assessable in 32 (97%) and 10 (67%) cases for group 1 and 2, respectively. In group 2, proximal segments of left anterior descending (LAD), circumflex (CX), and right coronary artery (RCA), were almost not assessable. CONCLUSIONS: The retrospectively ECG-gated 16-row MSCT provides more information regarding ascending aorta and coronary arteries.

Adult↗
PubMedDate not supplied

Introduction to coronary imaging with 64-slice computed tomography.

The aim of this article is to illustrate the main technical improvements in the last generation of 64-row CT scanners and the possible applications in coronary angiography. In particular, we describe the new physical components (X-ray tube-detectors system) and the general scan and reconstruction parameters. We then define the scan protocols for coronary angiography with the new generation of 64-row CT scanners to enable radiologists to perform a CT study on the basis of the diagnostic possibilities.

Algorithms↗