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V Cantisani

Publications and source records attributed to V Cantisani.

13 recordsLinked to original sources
PubMed2006

Transrectal colour Doppler contrast sonography in the diagnosis of local recurrence after radical prostatectomy--comparison with MRI.

OBJECTIVE: To assess the usefulness of colour power-Doppler transrectal sonography before/after contrast agent in the detection of local recurrence in patients with rising prostate-specific antigen values after radical prostatectomy and to compare with magnetic resonance imaging . MATERIALS AND METHODS: 18 patients with rising prostate-specific antigen values after prostatectomy underwent digital rectal examination, bone scintigraphy, magnetic resonance imaging, transrectal colour power-Doppler sonography before/after contrast agent, and transrectal sonography-guided biopsy. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated. Results were correlated using McNemar binomial 2-tailed P-test. RESULTS: Baseline and contrast-enhanced transrectal colour power-Doppler sonography and contrast-enhanced magnetic resonance imaging identified recurrent disease in 6, 10 and 10 patients, respectively. Biopsy confirmed recurrence in 10 patients, but was positive also in 2 additional patients who were negative at contrast-enhanced transrectal colour power-Doppler sonography and contrast-enhanced magnetic resonance imaging. The remaining 6 patients were negative also at diagnostic imaging and biopsy after 30 days. Grey-scale transrectal sonography values were: sensitivity 91.7 %, specificity 66 %, PPV 91.6 %, NPV 40 %. Baseline colour power-Doppler transrectal sonography values were: sensitivity 38.5 %, specificity 85 %, diagnostic accuracy 50 %, PPV 83.3 %, NPV 33.3 %. Contrast enhanced colour power-Doppler transrectal sonography and magnetic resonance imaging values were: sensitivity 76.9 %, specificity 100 %, diagnostic accuracy 83.3 %, PPV 100 %, NPV 62.5 %. CONCLUSION: Contrast-enhanced transrectal colour power-Doppler sonography increases specificity in the detection of local recurrence after prostatectomy. Magnetic resonance imaging yields equivalent accuracy. Biopsy remains the diagnostic gold standard, but the use of imaging methods may reduce the number of biopsies.

Aged↗
PubMed2004

Does multidetector-row CT eliminate the role of diagnostic laparoscopy in assessing the resectability of pancreatic head adenocarcinoma?

BACKGROUND: We hypothesized that the high-quality images from multidetector-row computed tomography (MDCT) would lead to improved sensitivity and specificity for predicting resectable pancreatic head adenocarcinoma, thus diminishing the value of staging laparoscopy. METHODS: Forty four consecutive patients underwent thin-section dual-phase MDCT to stage their tumor, followed by an attempted pancreaticoduodenectomy. Four radiologists who were blinded to the operative outcome reviewed the scans and graded the presence of distant and nodal metastases, as well as the degree of arterial and portal involvement. The radiologic criteria for resectability were no distant metastasis, a patent portal vein, and < 50% arterial involvement. RESULTS: The overall resectability for this cohort was 52% (23/44). The 21 unresectable cases, included five liver metastases, three peritoneal metastases, and 13 locally invasive tumors. The negative margin resection rate was 34% (15/44). There were no portal vein resections. The sensitivity and specificity of MDCT for predicting resectability were 96% (22/23) and 33% (7/21), respectively. In this cohort, the positive and negative predictive values were 61% (22/36) and 87.5% (7/8), respectively. As determined by univariate logistic regression, only the degree of arterial involvement was a significant predictor of resectability (p = 0.02). As determined by multivariate logistic regression using both arterial and portal involvement, arterial involvement was predictive (p = 0.03) but portal vein involvement was not (p = 0.45). CONCLUSIONS: Despite the improvements in image quality obtained with multidetector-row technology, CT imaging remains a relatively nonspecific test for predicting resectability in patients with adenocarcinoma of the head of the pancreas. Minimally invasive modalities with higher specificity, particularly laparoscopy, continue to have an important role in staging pancreatic head adenocarcinoma.

Adenocarcinoma↗
PubMed2002

Interventional radiology techniques in the treatment of complications due to videolaparoscopic cholecystectomy.

INTRODUCTION: The development of videolaparoscopic cholecystectomy (VLC) has represented an important achievement in the search for minimally invasive surgical procedures, and especially in the surgical management of such a common and costly disease as cholelithiasis. However, the literature shows that, while VLC carries a similar mortality rate to open surgery, it has a greater incidence (2-5 times) of iatrogenic injury to the biliary tract and hepatic hilum [3, 5, 10, 25, 28]; this incidence further increases in cases of so-called "hard cholecystis" [10, 13, 25, 28, 30]. An equally minimally invasive technique is therefore needed to treat these lesions; this technique should be effective and safe, allow for shorter hospital stays and lower costs, and be made available at all the centres where VLC is performed. MATERIAL AND METHODS: We evaluated 60 patients (28 women and 22 men, age range 41-71) with 24 peritoneal collections (14 bilomas, 10 abscesses), 35 biliary stenosis (clips, chronic-developing lesions), and 2 vascular lesions as direct iatrogenic post-LC injuries. The most frequent clinical symptoms were jaundice, pain, sepsis, abdominal distension, and abdominal colic due to retained common bile duct stones. We carried out 60 percutaneous biliary reconstruction procedures, 44 biliary drainages (4 internal, 4 external), 6 combined radiological-endoscopic approaches with the Rendez-Vous technique, and 2 embolisations. RESULTS: All procedures had 100% technical success; the biliary reconstruction procedures had a 2% morbidity rate (sepsis, cholangitis). The clinical emergencies (choleperitoneum, haemoperitoneum, severe jaundice) resolved in 72 hours for 55 of the 60 patients (92%). The combined percutaneous-endoscopic procedures with the biliary Rendez-Vous technique were successfully performed in 5 out of 6 cases, allowing reconstruction of bile duct continuity and remission of symptoms, without the need to resort to surgical anastomosis. At a recent follow-up of the patients who had been managed only percutaneously, one showed patency of the bile ducts and had the stent removed after 18 months, and two showed optimal functioning of the stent that was still in place after 5 and 8 months respectively; two patients were lost to follow-up. Primary biliary patency at 60 months from biliary reconstruction was 75%. Maximum and immediate dilatation was obtained at the first attempt in most cases. Reoperation was avoided in 59 out of 60 patients. Only one patient with full transection of the common bile duct was reoperated on after insertion of a biliary drainage catheter. The overall length of hospital stays was between 1 and 4 weeks. CONCLUSIONS: Interventional radiology carried out according to indications seems to be the most natural way to treat the complications of VLC. It spares the patients, who opted for a minimally invasive technique like VLC, the need to undergo open surgery, and allows for shorter hospital stays and more efficient cost management for the hospital.

Adult↗
PubMed2001

Prenatal testicular torsion: sonographic appearance in the newborn infant.

The prenatal diagnosis of spermatic cord torsion is often really difficult and the diagnosis is usually retrospective. Herein, we report a case of a male newborn baby who presented at delivery with an enlarged, swollen and tender scrotum. US showed an enlarged right testis, with dishomogeneous texture, fluid collection between the testis and the tunica vaginalis and large hydrocele. Differential diagnosis included hydrocele complicated by infection or hemorrhage, testicular tumor or postnatal testicular torsion. Color and power Doppler did not reveal any flow signal, and the diagnosis of antenatal torsion with initial necrosis was made. The role of color Doppler US is emphasized in directing the patient to emergency surgical exploration, when testicular salvage may be possible. Delayed surgical treatment can be proposed, when the diagnosis of antenatal torsion has a high degree of certainty. However, the Doppler examination of a newborn baby's testis is a very difficult challenge even for an experienced radiologist.

Adult↗
PubMed2001

[Computed tomography evaluation of metastasis of cutaneous melanoma].

PURPOSE: To assess the value of Computed Tomography (CT) in the diagnosis and in morphologic characterization of metastatic melanoma. MATERIALS AND METHODS: The data of total body CT of 124 consecutive patients with melanoma having a Breslow index 1 mm or a positive sentinel lymph node have been retrospectively reviewed. RESULTS: The CT scan showed loco-regional and/or distant metastases in 36 patients (39%). Ten of these (28%) had metastases only to lymph nodes, whereas 26 patients (72%) had multiple metastases. Nodal, pulmonary, brain, subcutaneous, hepatic, adrenal, bone, gastrointestinal, breast and abdominal wall metastases were detected in 80.6%, 47.2%, 25%, 25%, 16.7%, 13.9%, 11.1%, 5.6%, 5.6% and 2.8% of the patients respectively. All the patients with metastases also had a positive sentinel lymph nodes and/or symptoms of metastatic disease. CONCLUSIONS: CT fails to reveal any characteristic feature of metastatic melanoma, but it is of value in the diagnosis of loco-regional and distant metastases in III stage disease.

Adolescent↗
PubMed2000

Contrast-enhanced color Doppler US in malignant portal vein thrombosis.

PURPOSE: To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis. MATERIAL AND METHODS: Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis. RESULTS: Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%. CONCLUSION: Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.

Aged↗
PubMedDate not supplied

Large retroperitoneal hibernoma in an adult male: CT imaging findings with pathologic correlation.

Hibernoma is a rare benign tumor consisting primarily of brown fatty tissue. It is usually seen in locations where normal brown adipose tissue is found in fetuses and infants such as the periscapular or interscapular region, the neck, the axilla, the thorax, and, more rarely, the retroperitoneum. We report the computed tomographic findings and pathologic features of a large retroperitoneal hibernoma discovered in an adult male. Radiologists and surgeons should be aware that hibernoma should be included in the differential diagnosis of a large fatty retroperitoneal soft tissue tumor.

Adult↗
PubMedDate not supplied

Usual and unusual causes of extrahepatic cholestasis: assessment with magnetic resonance cholangiography and fast MRI.

Cholestasis may result from hepatocellular (intrahepatic) disease or biliary tract (extrahepatic) abnormalities. Etiologies causing extrahepatic cholestasis are extremely diverse and invasive procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), were previously required to establish the diagnosis. Due to refinements of magnetic resonance imaging (MRI) techniques, the patient with extrahepatic cholestasis currently can be evaluated noninvasively, and the information revealed frequently exceeds the findings obtained by ERCP and PTC. In this essay, we illustrate the classic MR cholangiographic (MRC) and MRI features of a variety of disorders causing extrahepatic cholestasis, including non-neoplastic disorders of the biliary tract (congenital abnormalities, infectious processes, iatrogenic disorders, and postsurgical complications) and neoplastic conditions (e.g., tumors of the pancreas, biliary tree, liver, ampulla, and regional lymph nodes). In most cases, familiarity with the key MRC features in addition to information obtained via cross-sectional MR images provide sufficient information for adequate lesion characterization.

Bile Ducts, Extrahepatic↗
PubMedDate not supplied

Fatal, complete splenic infarction and hepatic infection due to disseminated Trichosporon beigelii infection: CT findings.

We report on a 56-year-old woman with acute lymphocytic leukemia who presented with right upper quadrant pain, fever, nausea, and vomiting. Laboratory studies confirmed fungemia with Trichosporum beigelii, and contrast-enhanced computed tomography of the abdomen demonstrated numerous low-attenuation liver lesions and a hypodense spleen with capsular enhancement suggestive of complete splenic infarction. Subsequent splenectomy confirmed that the spleen was completely infarcted and infiltrated with Trichosporum. The patient had a difficult postoperative course and died despite aggressive antifungal therapy.

Antifungal Agents↗
PubMedDate not supplied

Small solitary pulmonary nodules: assessment of enhancement and enhancement patterns in benign and malignant tumours by high resolution computed tomography.

Our aim was to determine the accuracy of quantitative and qualitative findings of contrast-enhanced computed tomography (CT) by means of differential analysis of small uncalcified solitary pulmonary nodules and to compare the CT diagnosis with the results of transthoracic needle biopsies (TTNB). We assessed a consecutive series of 109 patients with 66 malignant or 45 benign pulmonary nodules before TTNB and surgery with contrast and high resolution computed tomography (HRCT). Pulmonary nodules were classified as small when equal to or smaller than 15 mm and large when larger than 15 mm. Diagnostic accuracy of CT qualitative evaluation was 95% for large nodules and 92% for small nodules. Specificity was 92% for small nodules, 80% for large nodules. Enhancing regular septa were observed in 28 hamartomas (80%) while except for two cases (3%), inner septa were absent or irregular in malignant tumours. TTNB accuracy was 70% for small nodules and 94% for large ones. Low-enhancing hamartomas are more frequent in Italy than in the US where the prevalence of high-enhancing granulomas in benign nodules reduces the specificity of quantitative CT analysis. We propose that certain geographic areas would benefit from enhanced-CT in place of TTNB in managing lung nodules equal to or less than 1.5 cm.

Adenocarcinoma↗
PubMedDate not supplied

Evaluation of effectiveness of a computer system (CAD) in the identification of lung nodules with low-dose MSCT: scanning technique and preliminary results.

PURPOSE: Evaluation of the effectiveness of computer-aided diagnosis (CAD) in the identification of pulmonary nodules. MATERIALS AND METHODS: Two observers (A1, A2) with different levels of experience independently evaluated 20 chest MSCT studies with and without the aid of a CAD system (LungCheck, R2 Technology, Inc). The study parameters were as follows: 140 kVs, 40 mAs, collimation 4 x 1 mm, slice thickness 1.25 mm, reconstruction interval 1.0 mm. The observers analysed the images with and without CAD and evaluated: 1) nodule size (longer axis); 2) number and location of nodules; 3) reading time for each observer. The gold standard was represented by the evaluation of both readers in consensus with the aid of the CAD system. RESULTS: Without CAD support the two readers identified 77 (A1) and 79 (A2) nodules and with CAD 81 (A1) and 82 (A2) nodules. Working in consensus the two observers identified 81 nodules without the aid of the CAD and 84 nodules with the aid of CAD. Total number of nodules identified by CAD was 104, 25 of which were false positive and 5 false negative. The average reading time with the aid of the CAD decreased by as much as 40% for both the observers. CONCLUSIONS: The preliminary results of our study suggest that the CAD technique is an accurate automatic support tool in the identification of pulmonary nodules. It reduces reading time and automatically supplies the size, volume, density and number of nodules, thus being useful both in screening programmes and in the follow-up of cancer patients, in whom comparison of the images is particularly difficult.

Adult↗