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S Magnaldi

Publications and source records attributed to S Magnaldi.

27 records · Page 2Linked to original sources

Impact of technology and technique on the performance of the intravenous D.S.A. of the carotid arteries.

Intravenous Digital Subtraction Angiography (i.v. D.S.A.) was performed at the carotid bifurcation level in 259 patients with clinical or physical findings of a Cerebrovascular Insufficiency (C.V.I.). The angiographic examinations have been performed during two different periods, basically differing for the technology of the digital equipment and for the technique used. The personal experience showed how these two factors are important in determining the quality of the image and therefore the accuracy of the i.v. studies. Images of good quality of the common and internal carotid arteries have been obtained in 73% and 54% of the cases of the first period and in 93% and 82% of the cases of the second period. The role of the i.v. D.S.A. in the management of the C.V.I. depends not only upon the quality of the images, but also upon the surgical policy and from the availability of ultrasounds.

Angiography↗

[Contrast media in venous digital angiography: ionic or non-ionic?].

Nonionic contrast media (cm) are more and more widely employed in vascular radiology. These cm are the choice in some conventional arteriographies owing to their better tolerability. In intravenous digital subtraction angiography (DSA) the analysis of the personal material and of the literature allows to state that: the image quality with ionic and non ionic cm is similar; the tolerability of nonionic cm is slightly superior; the cardiac and renal toxicity of nonionic cm is slightly lower; reactions to nonionic cm take place with a lower frequency; the price of nonionic cm is considerably higher. Therefore nonionic cm seem to be slightly superior to ionic agents on the basis of these data and they should be theoretically preferred. The only doubt to their routine use in intravenous DSA is the high cost. Therefore we prefer to employ them in risk patients only, as ionic cm in current use are safe and cheap.

Brain↗

Routine evaluation of arteriopathies of the lower extremities by digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) was performed in 119 patients with lower extremity ischemia using a 14" amplifier. Four injections of contrast medium were usually necessary for a complete evaluation of this vascular region. Images of good quality were obtained in most cases; movement artifacts and a faint opacification accounted for any poor results, which occurred mainly under the knee. The technique of pixel shifting turned out to be very useful to remove movement artifacts. The "measuring field" allowed us to minimize the problem of the inhomo geneous saturation of the amplifier. In 8% of the cases an intra-arterial DSA has been performed after an unsatisfactory intravenous examination. Conventional angiography appears to be no longer necessary.

Aged↗

[Clinical magnetic resonance spectroscopy. The state of the art].

Magnetic resonance spectroscopy is a noninvasive technique which allows the study of the chemical composition of tissue. In the first part of this paper the authors describe the physical principles and the technical features of spectroscopy, including spectral acquisition, localization techniques and peak quantification. The second part of the paper regards the evaluation of the biological significance of the peaks observed in the most frequently studied spectra (31P and 1H). The third part concerns the clinical feasibility of magnetic resonance spectroscopy: in order to employ spectroscopy in the clinical practice, this technique should be able to fulfill such requirements as tissue characterization, metabolic quantification, therapy follow-up, biochemical understanding of the physiopathologic phenomena and pH evaluation. The fourth and last part of this paper deals with the clinical applications of spectroscopy. The authors consider the results of other research groups in the spectroscopic evaluation of the striate muscle, the central nervous system, heart, liver and some other organs. Then they describe some preliminary personal results in cerebral spectroscopy (41 healthy subjects studied with 31P and 5 with 1H) and liver spectroscopy (19 healthy subjects studied with 31P and 9 healthy subjects and 9 patients with liver steatosis studied with 1H). The authors conclude that the problem of the potential clinical application of spectroscopy is still open. So far the use of this technique is limited to research centers, which should point out the clinical role of spectroscopy.

Humans↗

[Leukodystrophies: clinical aspects and findings with computerized tomography and magnetic resonance imaging].

Leukodystrophies are inherited white matter diseases due to abnormalities occurring in myelin synthesis and/or maintenance. The most common types of these rare childhood conditions are represented by adrenoleukodystrophy, metachromatic leukodystrophy, Canavan's, Alexander's, Krabbe's, and Pelizaeus-Merzbacher's diseases. Most of them are lethal during childhood, with the exception of the adrenoleukodystrophy-adrenomyeloneuropathy complex, which sometimes, during its early phases, may be cured with a dietary therapy. The aims of this paper are: 1) the description of inheritance factors, pathogenesis, pathological and clinical findings of each of the most frequent childhood leukodystrophies; 2) the description of the most common patterns of these conditions on CT and MR imaging; 3) the evaluation of the diagnostic capabilities of these two imaging techniques and the comparison of their results. Finally, some of the therapies suggested for the mild forms of these conditions are discussed. The evaluation of leukodystrophic patients with CT and MR imaging shows both imaging modalities to have high sensitivity, thanks to the detection of abnormally myelinated areas, which appear hypodense on CT and hyperintense on T2-weighted MR images. Frequently, both imaging modalities exhibit high specificity as well: they allow a differential diagnosis between the different types through the demonstration of their location in the early stages and of their mode of spread. The most typical example is represented by adrenoleukodystrophy, which is the most common type of leukodystrophy: the frequent occipito-parietal onset and the anterior and caudal progression allow a correct diagnosis to be made on CT and MR images in most cases. The comparison between CT and MR findings demonstrates a slight superiority of the latter: multiplanarity and high contrast resolution make MR imaging more sensitive than CT in the detection of both caudal spread and involvement of optic and acoustic nervous pathways. Furthermore, MR imaging allows a safe follow-up in children with leukodystrophy.

Adrenoleukodystrophy↗

[Modular project of the Picture Archiving and Communication System (PACS). Preliminary clinical experience. II].

In the previous paper in this volume the PAC System installed in the Radiology Department of the University of Trieste has been described and its advantages and limitations have been analyzed, mainly from an operational point of view. This paper deals with the clinical evaluation of the system in ordinary operative conditions. A series of cases with specific characteristics was monitored in order to reveal different performances in both diagnostic process and conclusions using the PACS viewing console (DW) vs. conventional CRT film images on alternators. In a first test, 100 routine (not pre-selected) brain CT cases were independently analyzed by 4 radiologists, each of them giving 2 interpretations of the same case, one based on film and the other on PACS. The data were analyzed by conventional statistical methods, showing a substantial agreement of the results obtained with the 2 modalities. A second test concerned the evaluation of 100 lumbar intervertebral disks by CT, with the same procedure as above. Four radiologists were again asked to decide on film and PACS images about normality, protusion, or herniation of the disks. The results demonstrate the possibility of adequately reporting on the PACS monitor and stress the need of an adequate training period and the efficacy of the image processing capabilities of the system.

Brain Diseases↗

[Echography and computerized tomography in the diagnosis of complex abdominal lesions].

Complex abdominal lesions include a variety of pathologies, such as septated, infected, and hemorrhagic cysts, abscesses, tumors, and fluid collections of different etiology. These lesions present diagnostic difficulties with both Ultrasonography (US) and Computed Tomography (CT), since findings may not be present or, when present, are not specific. Keeping these limitations in mind, we evaluated 105 patients (111 abdominal lesions) with both US and CT in order to compare their adequacy in predicting the nature of the lesion. On the basis of US and CT results, complex abdominal lesions were divided in four classes: class I includes 43 cases in which both examinations gave the same contribution to the definition of the nature of the lesion, class II (14 lesions, mainly sepimentated cysts), in which US was superior to CT, class III includes 45 cases in which CT was superior to US, mainly in case of hemorrhagic cysts, abscesses, fluid collections and, less frequently, cystic tumors; class IV includes 9 cases in which US and CT results were complementary, which allowed the nature of the lesion to be defined. In conclusion, US and CT enable the identification and the characterization of complex abdominal lesions; an association of the two investigations enhances their diagnostic value. As a rule, CT is superior when the content of the lesion is either gas or hemorrhage, and in the definition of its peripheral wall. US is always superior in assessing septa, and sometimes even vegetations.

Abdomen↗

[Cardiac complications of intravenous digital angiography. Comparison of ionic and nonionic contrast media].

The review of 1405 digital intravenous subtraction angiographies carried out in the period may 1982-february 1985 showed in about 2% of the cases cardiac symptoms, which arose during or after the examination. In the great majority of the cases the symptomatology was characterized by angina pectoris. In order to better understand these data and analysing the results of the literature, a trial has been performed in 100 patients who underwent DSA. They have been divided into two groups in which two different contrast media, ionic (sodium meglumine diatrizoate) and non ionic (iopamidol) have been randomly injected. A detailed cardiologic anamnesis has been collected and EKG has been performed before and after each injection with pre-established gaps. The results showed that the incidence of cardiac symptoms and EKG variations is lesser with the non ionic contrast medium: therefore this agent is to be preferred at least in patients at risk from cardiologic point of view.

Acute Disease↗