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Biomedical subjects

R Passariello

Publications and source records attributed to R Passariello.

At least 19 recordsLinked to original sources
PubMed1992

Identification of coronary artery by-pass grafts: reliability of MRI in clinical practice.

In order to test MRI ability to detect the number and the sites of coronary artery by-pass grafts (CABGs), 22 patients with CABGs were studied. The detection of a neo-vessel in even one of the examination slices was considered as positive for the study, disregarding the difference between its origin and course. With such a criterion, MRI total percentage of vascular bridges identification resulted in 76.1% (51/67) with very low values for CABGs implanted on diagonal, obtuse marginal and posterior descending vessels (11/24 = 45.8%). These results lead to the conclusion that, although MRI has some advantages in the identification of CABGs implanted on the main coronary vessels in the early post-operative period, its extensive use cannot be proposed at the present state of the art.

Adult↗
PubMed1992

Carotid arteries: evaluation with low-field-strength MR angiography.

Magnetic resonance (MR) angiography of neck vessels was performed with a 0.2-T permanent magnet by using a two-dimensional, time-of-flight technique. Thirty-one patients were included in the study. The imaging parameters used included a repetition time of 60 msec, an echo time of 10 msec, a 90 degrees flip angle, and a 192 x 256 matrix; 40-50 sequential two-dimensional sections were acquired through the neck. Stenosis was graded on a scale of 1-5. Correlation of digital and MR angiography was made in the clinically nonrelevant cases (stenoses of grades 1 and 2), with overestimation to grade 3 in six cases. Two grade 3 stenoses were overestimated as grade 4. Severe stenoses were correctly characterized in all but one case, which was underestimated because of a segmental short extension of the stenotic lesion. Obstructions were found in two cases. Areas with a lack of signal were observed in four patients with severe stenosis and in two with tortuous arteries. Correct diagnosis, however, was achieved with analysis of the maximum intensity projection animation display. Low-field-strength MR angiography has the same clinical value as that performed with high field strengths.

Adult↗
PubMed1992

Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery.

The aim of this study was to evaluate the evolution of lumbar disk herniation in patients treated without surgery. Sixty-nine patients with a lumbar disk herniation proved at magnetic resonance (MR) imaging underwent a follow-up MR imaging study. The disk herniations evaluated during both MR imaging examinations were measured and classified into four categories according to the change in size that occurred. The patients were also divided into three clinical classes on the basis of the clinical outcome. Sixty-three percent of the patients showed a reduction of disk herniation of more than 30% (48% had a reduction of more than 70%), while only 8% demonstrated worsening of the clinical picture. These findings suggest that lumbar disk herniation may be primarily a medical (nonsurgical) disease and that MR imaging could play an important role in management of and research into the disorder.

Adult↗
PubMed1992

Arteriography in diagnosing hepatocellular carcinoma.

The diagnostic role of arteriography in the evaluation of hepatocellular carcinoma is pointed out. In the identification of large lesions angiography achieves a sensitivity of 100%. However, when evaluating small lesions (under 5 or 3 cm in diameter), the sensitivity is reported to be 82-89%. To increase the sensitivity, different special techniques have been developed which require angiographic placement of a catheter. These include CT arteriography, CT arterial portography and CT after intraarterial injection of iodized oil. Particularly with the two latter techniques, the sensitivity in identification of small hepatocellular carcinoma reaches a value of 91-95%. Angiography can also be proposed for the characterization of neoplastic lesions in cirrhotic livers. Its specificity is 72% in the differential diagnosis of hepatocellular carcinoma and adenomatous hyperplastic nodules. Small grade I hepatocellular carcinoma can simulate this benign lesion at angiography, as well as at histology. Finally, angiography may still play a role in the preoperative staging of hepatocellular carcinoma both for the diagnosis of satellite lesions and for the identification of vascular invasion.

Angiography↗
PubMed1992

[Magnetic resonance imaging of the esophagus with lumen opacification using a specific contrast agent].

A new contrast agent has been developed for the opacification of the esophageal lumen in Magnetic Resonance (MR) Imaging. The contrast agent consists of an emulsion of low-density and high-viscosity barium paste employed for the CT study of the esophagus (E.Z.E.M., Westbury, USA) and a small amount of Gadolinium-DTPA (Magnevist, Schering, Germany), diluted in 3 ml of saline solution. In vitro evaluation of the contrast solution showed high-signal intensity on T1-weighted SE sequences. The study was subsequently performed on 5 healthy volunteers and 30 subjects with clinical indication for MR Imaging of the chest. The complete opacification of the esophagus was obtained in 12 of the 16 patients (75%) who presented no pathological involvement of the esophagus. The esophageal lumen was completely opacified in 8 patients with esophageal carcinoma and in 1 case of esophageal leiomyoma. In the cases with esophageal carcinoma, lumen opacification allowed the evaluation of tumor growth (concentric or eccentric), a more detailed definition of tumor extent, with assessment of neoplastic wall thickening, and the evaluation of the possible infiltration of adjacent organs. Lumen opacification was obtained in 8 of 10 patients (80%) affected with other chest conditions secondarily involving the esophagus. In these cases, lumen opacification helped to localize the esophagus and to evaluate its involvement by adjacent tumors.

Adult↗
PubMed1992

[Magnetic resonance in the staging of multiple myeloma].

The authors retrospectively reviewed the MR examinations of 46 patients with clinical and laboratory findings of monoclonal gammopathies (MG). All cases had been submitted to radiographic examination which had shown skeletal involvement in 22 cases and osteoporosis in 11, with rupture of the vertebral body in 3 patients. Scintigraphy had been performed on all patients and CT on 12; 36 patients were subsequently submitted to follow-up (at 6, 12 and 24 months). MR examinations were performed with dedicated coils and standard sequences for the subjects with skeletal localizations on X-ray images. The extant cases, with no radiographic evidence of skeletal involvement, were submitted to MRI of the spine, skull and pelvis. In agreement with clinical and laboratory findings and with follow-up results (in 36 patients), MRI diagnosed MG with no skeletal involvement in 13 cases, osteoporosis in 8 (with rupture of the vertebral body in 2), asymptomatic non-progressive myeloma in 4, solitary myeloma in 3, and multiple myeloma in 18 cases. The good identification of bone marrow and its multiplanarity make MRI the method of choice in the study of patients with suspected or known gammopathies. If compared with other modalities, MRI is more sensitive and accurate in depicting the tumor, its size and relationship to periskeletal tissues, and its possible multifocality. Moreover, the technique has proven to be a valid tool during the follow-up, showing tumor response to therapy.

Bone Diseases↗
PubMed1991

Evaluation of hematoma by MRI in follow-up of aorto-femoral bypass.

We selected a population of 20 patients with atherosclerotic disease, submitted to implantation of aorto-femoral bypass graft. These patients were studied by MRI with T1- and T2-weighted sequences (w.s.) using a 0.5 T superconductive magnet. Investigation was performed at 1 wk, 1, 3, and 6 mo after dacron implantation, to evaluate the normal evolution of hematoma and the potential development of complications. At the first week examination, hematoma presented medium signal intensity on T1 w.s. and high signal intensity on T2 w.s.; at 1 mo control the amount of hematoma was slightly reduced and we found persistence of high signal intensity on T2 w.s.; progressive reduction of size and signal intensity on T2 w.s. was noted at 3 mo control, in patients operated for peripheral vascular disease; on the other hand we found persistence of high signal intensity in T2 w.s. in patients treated for abdominal aortic aneurysms; only after 6 mo it was evident in all patients fibrotic evolution of the collection and low signal intensity in both T1 and T2 w.s. Thus, MRI study was useful in the evaluation of patency, morphology, and in detection of intraluminal thrombosis, but also in the characterization of periprosthetic hematoma.

Aged↗
PubMed1991

Intraarterial portography with gadopentetate dimeglumine: improved liver-to-lesion contrast in MR imaging.

Magnetic resonance imaging during arterial portography (MRAP) was performed by the authors in a selected group of 12 patients with hepatic lesions. A low dose of gadopentetate dimeglumine (4 mL of a 0.5-mol/L solution, corresponding to a dose of 0.05-0.07 mmol/kg) was injected into the superior mesenteric artery during acquisition of breath-holding gradient-echo or rapid acquisition spin-echo images. Images were always acquired during the first passage of gadopentetate dimeglumine through the liver parenchyma. An increase in liver-to-lesion contrast was obtained with MRAP imaging (contrast-to-noise ratio = 8 +/- 1.8 vs 19 +/- 2.7). Signal intensity enhancement of the liver was high (signal-to-noise ratio = 9.48 +/- 2.42), while the lesion presented no significant enhancement (signal-to-noise ratio = 0.55 +/- 0.22). Lobar portal vein thrombosis was detected in one patient owing to lack of enhancement of the left lobe of the liver. No side effects related to administration of iodinated and paramagnetic contrast agents were observed. This new technique provides specific enhancement of liver parenchyma with improved liver-to-lesion contrast.

Adult↗
PubMed1991

[Acute instability of the shoulder in athletes. The role of magnetic resonance in therapy planning].

Magnetic resonance imaging (MRI) of the shoulder was performed to evaluate both the actual role of this technique in the study and staging of acute shoulder instability, and its potentials as diagnostic tool, with particular reference to treatment planning. Seventeen athletes with acute shoulder instability were examined. All MRI examinations, subsequent to plain radiographs, were performed within 48 hours from the traumatic event. After MRI examination, 14 patients underwent physiotherapy (2 cases were subsequently submitted to arthrotomy), and only 3 cases underwent surgical treatment in the acute phase (2 arthrotomies and 1 arthroscopy). These cases, submitted to MRI in the acute phase and subsequently to surgery, showed anterior glenoid labrum involvement with good evidence of associated skeletal lesions (Hill-Sachs lesions in 1); changes in the inferior glenohumeral ligament complex (2 cases) were also observed. In the other examined cases, MRI always provided accurate information on the glenoid labra and the anterior capsular mechanism. When the superior glenohumeral ligament was investigated (9 cases of 17), no alterations were observed. Acting as natural contrast, the presence of joint effusion allows good visualization, on T1-weighted sequences, of the structures involved by the traumatic events. Contrast resolution improvement could be obtained by employing gradient-echo T2 weighted sequences, which proved to be quite valuable for a correct depiction of the lesions involving the inferior glenohumeral ligament complex. In conclusion, MRI can be considered as a valuable diagnostic method for the early evaluation of the acute shoulder instability, since it provides information of the utmost importance for the subsequent therapeutical approach.

Adolescent↗
PubMed1991

[Magnetic resonance: the usefulness of gradient-echo refocusing sequences in the diagnosis of aneurysms of the abdominal aorta].

Sixteen patients bearing aneurysms of the abdominal aorta were studied by means of a 0.5 T MR unit. Spin-echo T1-weighted sequences and gradient-echo refocusing sequences were performed. All patients were previously submitted to US; in 8 cases angio CT was performed, and in 6 patients angiography of the abdominal aorta. A comparative analysis with the US findings showed a high correlation coefficient for the maximum diameters (R = 0.93) while site and size evaluations were not accurate. A very high correlation coefficient for the maximum diameters (0.97) was found at the comparative analysis with CT findings, while in two cases an erroneous suprarenal location was described. Angiographic examination provided valuable information about renal and iliac involvement, but the maximum diameters could not be accurately assessed. Spin-echo MRI allowed good evaluation of the maximum size, of location and extent of the aneurysm, as well as of iliac involvement; this technique, however, was useless in the characterization of the thrombus. Gradient-echo refocusing sequences have proven very useful for the identification of endoluminal contours and for the correct evaluation of the thrombus. Spin-echo sequences, on the contrary, accurately assessed only 7 cases, whereas the diagnosis was uncertain in the remaining 4 patients.

Aged↗
PubMed1991

[Mediastinal lymphatic staging of bronchial cancer. Respective value of x-ray computed tomography and magnetic resonance imaging. Radio-surgical comparison].

Fifty patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. Results of CT and MR were compared with the surgical and pathology findings. No statistically significant difference was found between the two imaging methods for the evaluation of node involvement (N2). MR appear to be superior to CT in the aortopulmonary and subcarinal areas.

Adult↗
PubMed1991

[Pathologic conditions in pregnancy. Preliminary evaluation of the effectiveness of magnetic resonance].

Some authors suggested that MR imaging could represent an effective diagnostic alternative in the study of pathologic conditions of mother and fetus during pregnancy. To verify the actual role of MR imaging, we examined 20 patients in the 2nd and 3rd trimester of gestation, after a preliminary US examination. Fifteen patients presented fetal or placental pathologies; in 4 patients the onset of the pathologic condition occurred during pregnancy; in 1 case of US diagnosis of fetal ascites, MR findings were normal and the newborn was healthy. As for placental pathologies, our series included a case of placental cyst, two hematomas between placenta and uterine wall, and two cases of partial placenta previa. As for fetal malformations, we evaluated a case of omphalocele, one of Prune-Belly syndrome, a case of femoral asymmetry, one of thanatophoric dwarfism, a case of thoracopagus twins with cardiovascular abnormalities, two fetal hydrocephali, and three cases of pyelo-ureteral stenosis. As for maternal pathologies during pregnancy, we observed a case of subserous uterine fibromyoma, one of right hydronephrosis, one of protrusion of lumbar intervertebral disk, and a large ovarian cyst. In our experience, MR imaging exhibited high sensitivity and a large field of view, which were both useful in the investigation of the different conditions occurring during pregnancy. In the evaluation of fetal and placental abnormalities, especially during the 3rd trimester, the diagnostic yield of MR imaging suggested it as a complementary technique to US for the evaluation of fetal malformations and of intrauterine growth retardation.

Adult↗
PubMed1991

[Magnetic resonance in condylo-meniscal incoordination pathology of the temporomandibular joint. Indications, diagnostic accuracy and optimization of study techniques].

Up to 28% of the population is affected with pathologic conditions involving the temporo-mandibular joint (TMJ), most of them related to uncoordinated disk motion. To date, these pathologies have been evaluated by means of different diagnostic tools, the latest of which is MR imaging. The authors examined with low-field (0.2 T) MR imaging 15 normal volunteers and 20 patients suffering from temporo-mandibular joint disk dysfunction. The study was aimed at comparing the results obtained with low-field MR imaging with literature data on the subject. A standard technique employing low-field MR imaging was also assessed on normal subjects for the management of the patients with TMJ pathologies. The pathological TMJs were then evaluated, each of them examined with arthroscopy and/or surgery. MR imaging was capable of identifying the meniscus in all cases, together with its morphology, signal, location, and movements during opening and closure of the mouth. Disk dislocation were always correctly identified. The point of re-capture in the cases with spontaneous reduction was easily ascertained. The simultaneous imaging of both the right and the left TMJs allowed the joints to be compared at the same degree of mouth opening, so that motion asymmetries were easily detected. High agreement was observed between MR, arthroscopic and surgical findings. Our experience points to MR imaging as the examination of choice in the evaluation of TMJ diseases. The best results are obtained when both joints are simultaneously imaged, on the sagittal and coronal planes, during opening and closure of the mouth, and possibly in a cine-animation display format.

Arthroscopy↗