Publications by authors named "Antonio Basile"

133 Publications

Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery.

Diagnostics (Basel) 2021 Apr 22;11(5). Epub 2021 Apr 22.

Diagnostic and Interventional Radiology Department, Ospedale Di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy.

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks.

Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach.

Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients.

Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.
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http://dx.doi.org/10.3390/diagnostics11050750DOI Listing
April 2021

Liquid and Solid Embolic Agents in Gonadal Veins.

J Clin Med 2021 Apr 9;10(8). Epub 2021 Apr 9.

Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia"-University Hospital "Policlinico-San Marco", University of Catania, Via Santa Sofia n° 78, 95123 Catania, Italy.

Male varicocele and pelvic congestion syndrome (PCS) are common pathologies with high predominance in young patients, having a high impact on the quality of life and infertility. Lately, the use of different endovascular embolization techniques, with various embolizing agents, shows good technical results and clinical outcomes. With the aim of presenting the "state of the art" of endovascular techniques for the treatment of male varicocele and PCS, and to discuss the performance of the different embolic agents proposed, we conducted an extensive analysis of the relevant literature and we reported and discussed the results of original studies and previous meta-analyses, providing an updated guide on this topic to clinicians and interventional radiologists. We have also underlined the technical aspects for the benefit of those who approach this type of interventional treatment. Our review suggests promising results in both the endovascular embolic treatment of male varicocele and PCS; for varicocele, a success rate of between 70% and 100% and a recurrence rate of up to 16% is reported, while for PCS it has been found that technical success is achieved in almost all cases of endovascular treatment, with a highly variable recurrence rate based on reports. Complications are overall rather rare and are represented by periprocedural pain, migration of embolic media and vascular perforations: severe adverse events have been reported very rarely.
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http://dx.doi.org/10.3390/jcm10081596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069975PMC
April 2021

May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report.

Am J Case Rep 2021 Apr 25;22:e928957. Epub 2021 Apr 25.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.

BACKGROUND May-Thurner syndrome, also known as Cockett's syndrome, is characterized by vascular alterations due to stenosis of the left iliac vein, usually caused by compression against the vertebral column by the right iliac artery. Doppler ultrasound represents the first level of examination for the study of this vascular pathology, and allows a very accurate study of the lower-limb vessels. We describe an unusual presentation with double stenosis of the left common iliac vein. CASE REPORT A 73-year-old woman came to the clinic for acute onset of worsening dyspnea, with lymphedema of the left lower limb, and was examined using ultrasound and multidetector computed tomography. The Doppler ultrasound exam showed 2 compressions of the common iliac vein by the right and left iliac artery due to a combination of osteophytosis of the vertebral column and reduced distance between the left iliac vein and the spine. CONCLUSIONS May-Thurner syndrome should be suspected in patients with symptoms of venous stasis of the left lower limb. Doppler ultrasound identified stenosis of the common iliac vein and the consequent flow changes. Failure to diagnose and treat May-Thurner syndrome could expose patients to very serious risks to their health.
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http://dx.doi.org/10.12659/AJCR.928957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083791PMC
April 2021

A man with the rare simultaneous combination of three abdominal vascular compression syndromes: median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome.

Radiol Case Rep 2021 Jun 28;16(6):1264-1270. Epub 2021 Mar 28.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radiodiagnostic and Radiotherapy Unit, Catania, Italy.

Median arcuate ligament syndrome and superior mesenteric artery syndrome are well-known abdominal compression syndromes, the coexistence of which is rarely described in literature. In addition, due to the common pathogenesis, anterior nutcracker syndrome may occur simultaneously to superior mesenteric artery syndrome. To our knowledge, this is the first case reporting combination of these 3 syndromes detected with ultrasound, Computed Tomography and upper gastrointestinal fluoroscopic exam. A 69-year-old man came to our attention for rapid weight loss, postprandial epigastric pain and recurrent vomiting for at least 6 months. Doppler ultrasound showed both celiac artery and left renal vein stenosis with simultaneous left varicocele. Computed tomography showed a reduction of aortomesenteric space causing both left renal vein and duodenal stenosis, this latter confirmed by upper gastrointestinal fluoroscopic exam. The diagnosis of these three vascular compression syndromes (MALS, SMAS, and anterior NCS) has been formulated, based on clinical and imaging findings. We assumed that the postprandial crises caused by median arcuate ligament syndrome may induce a reduction of meals consumption and progressive weight loss which can be a cause of anterior nutcracker syndrome and superior mesenteric artery syndrome onset. Doppler ultrasound, in expert hands, allows to accurately diagnosing these syndromes which are often underestimated. Failure to recognize it and inadequate treatment could have serious consequences for patients' health.
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http://dx.doi.org/10.1016/j.radcr.2021.02.065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026914PMC
June 2021

Two Cases of Spontaneous Isolated Dissection of Superior Mesenteric Artery in One Night: Report of a (Noninvasive) Double Challenge.

Am J Case Rep 2021 Apr 13;22:e929538. Epub 2021 Apr 13.

Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-San Marco", Catania, Italy.

BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare but potentially fatal condition. Although many cases of SID-SMA have been reported in the literature in recent years because of the increased use of contrast-enhanced computed tomography (CT) scanning, optimal management has not yet been firmly established. CASE REPORT We report 2 cases of SID-SMA that were managed with stenting and angioplasty via transfemoral access. In case 1 a 54-year-old man presented with diffuse abdominal pain without Blumberg sign. Laboratory data were unremarkable. Abdominal CT scanning revealed SID-SMA and initial bowel ischemia. The angiogram revealed a dissected true lumen of SMA with a narrowing of the ileo-colic artery managed, respectively, with self-expandable stent placement and angioplasty. In case 2, a 45-year-old man presented with severe abdominal cramping and pain of 3 days' duration. Physical examination revealed abdominal tenderness with positive Blumberg sign. Laboratory tests showed leukocytosis and increased lactate dehydrogenase. Abdominal CT scan revealed SID-SMA and initial bowel ischemia. After an SMA angiogram, 2 self-expandable stents were placed and an angioplasty was performed. Although a postprocedural angiogram showed good patency of the SMA in both patients, the first patient had a recurrence of abdominal pain after 5 days with a new narrowing tract of the SMA and more inferiorly a dissection with aneurysm of a false lumen, detected on CT scan, treated respectively with stenting and coils. CT follow-up showed successful morphological results in both patients. CONCLUSIONS In our experience, endovascular treatment of SID-SMA is safe and effective, including in cases of recurrence and postprocedural evolution.
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http://dx.doi.org/10.12659/AJCR.929538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053640PMC
April 2021

Clinically Suspected Segmental Arterial Mediolysis of the Splanchnic Arteries: A Report of 2 Rare Cases.

Am J Case Rep 2021 Apr 8;22:e929013. Epub 2021 Apr 8.

Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies, University Hospital 'Policlinico - Vittorio Emanuele', University of Catania, Catania, Italy.

BACKGROUND Segmental arterial mediolysis (SAM) is an uncommon vascular pathology characterized by arteriopathy, mainly of medium-sized abdominal splanchnic vessels, without an atherosclerotic, inflammatory, infectious, or autoimmune underlying etiology. Segmental arterial mediolysis is clinically heterogeneous and symptoms may be completely nonspecific. The knowledge of radiological features of segmental arterial mediolysis and the exclusion of other pathologies should direct early diagnosis and refer patients for correct treatment. CASE REPORT In the last 2 years, we treated 2 different adult patients (an 89-year-old woman and a 52-year-old man) with spontaneous visceral bleeding, admitted to the Emergency Department due to acute onset of abdominal pain, anemia, and computed tomographic angiography (CTA) evidence of aneurysmatic, and stenotic alterations of splanchnic arteries. Based on clinical, laboratory, and radiological features, segmental arterial mediolysis was suspected. These 2 patients were referred to our Interventional Radiology Department and treated with super-selective transcatheter arterial embolization (TAE), performed by a minimally invasive approach, allowing an immediate clinical improvement with regression of symptoms and avoiding major surgical treatment. CONCLUSIONS In patients with clinical, laboratory, and radiological signs of acute and/or chronic abdominal bleeding and radiological findings suggesting segmental arterial mediolysis, mini-invasive endovascular treatment is a safe, extremely reliable, and secure procedure and appears to be the first-choice treatment when available. Since abdominal bleeding could have fatal consequences in these patients, timely diagnosis and endovascular therapy are essential to treat visceral vascular alterations due to segmental arterial mediolysis.
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http://dx.doi.org/10.12659/AJCR.929013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042417PMC
April 2021

Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn's Disease?

Medicina (Kaunas) 2021 Mar 15;57(3). Epub 2021 Mar 15.

Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia"-Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia, 78-95123 Catania, Italy.

To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn's disease (CD), using surgical specimens as the histopathological reference standard. : Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis ( = 0.01). Pre-stenotic bowel dilatation positively correlated with FS ( = 0.002). The ADC value negatively correlated with FS ( < 0.001) and was different between FS grades ( < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate-severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.
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http://dx.doi.org/10.3390/medicina57030265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000737PMC
March 2021

A non-alcohol-related case of Madelung's disease: Challenging patient with progressive jugular vein distension.

Radiol Case Rep 2021 May 19;16(5):1183-1187. Epub 2021 Mar 19.

Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University of Catania, Via Santa Sofia 78, 92123 Catania, Italy.

Madelung's disease or multiple symmetric lipomatosis (MSL) is a rare benign disease characterized by abnormal, multiple and symmetric fat depositions in the subcutaneous layer, involving head, neck, back, trunk and also upper and lower limbs. MSL may be related to alcohol abuse or metabolic disorders; it may be both silent or clinically manifest. We describe a case of a 48-yo man with β-thalassemia admitted to medicine department for neck swelling without fever or respiratory symptoms. Patient denied a history of alcoholism and laboratory exam excluded metabolic disorders. Doppler ultrasound, contrast Enhanced-CT and Magnetic Resonance Imaging exams of the neck showed a symmetric, non-encapsulated fat deposition causing extrinsic compression of the right jugular vein without thrombosis. Once excluded the possibility of malignancy, patient's history, clinical, and radiological findings suggest the diagnosis of non-alcohol-related MSL disease. Knowing MSL imaging findings and its degree is crucial to guide towards the right management. Our patient did not require surgical treatment and an US follow-up is needed in order to detect any possible evolution.
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http://dx.doi.org/10.1016/j.radcr.2021.02.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985283PMC
May 2021

The Seurat spleen.

Abdom Radiol (NY) 2021 Mar 2. Epub 2021 Mar 2.

Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy.

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http://dx.doi.org/10.1007/s00261-021-02993-1DOI Listing
March 2021

The role of ultrasound imaging in vascular compression syndromes.

Ultrasound J 2021 Feb 8;13(1). Epub 2021 Feb 8.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy.

Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May-Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
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http://dx.doi.org/10.1186/s13089-020-00202-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870731PMC
February 2021

Pelvic Congestion Syndrome.

Semin Ultrasound CT MR 2021 Feb 9;42(1):3-12. Epub 2020 Jul 9.

Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy.

Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. It may occur either alone or in combination with vulvar varicosities and/or lower extremity venous insufficiency. Although transcatheter venography represent the gold standard for PCS diagnosis, it is performed after inconclusive noninvasive imaging such as Doppler Ultrasound, CT scan, and MRI. Once diagnosis has been confirmed, management of PCS include medical, surgical, and endovascular therapy. Medical and surgical treatments have been shown to be less effective than transcatheter pelvic vein embolization. This latter has been proven to be a safe, effective, and durable therapy for the treatment of PCS. Numerous studies have shown their results in PCS endovascular treatment, but neither of them has been subjected to an adequate randomized controlled trial. A well-designed randomized controlled trial is urgently needed to assess transcatheter embolization clinical success.
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http://dx.doi.org/10.1053/j.sult.2020.07.001DOI Listing
February 2021

The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders.

J Vasc Surg Venous Lymphat Disord 2021 May 30;9(3):568-584. Epub 2021 Jan 30.

Connecticut Image Guided Surgery, Fairfield, Conn.

As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable classification instrument. Misleading historical nomenclature, such as the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology. Based on a perceived need, the American Vein and Lymphatic Society convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the Symptoms-Varices-Pathophysiology ("SVP") classification for PeVD, includes three domains-Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVP. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with the Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP instrument accurately defines the diverse patient populations with PeVD, an important step in improving clinical decision making, developing disease-specific outcome measures and identifying homogenous patient populations for clinical trials.
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http://dx.doi.org/10.1016/j.jvsv.2020.12.084DOI Listing
May 2021

Posterior nutcracker syndrome: a case report.

J Med Case Rep 2021 Feb 1;15(1):42. Epub 2021 Feb 1.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catania, Italy.

Background: Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which require  more accurate study  with contrast-enhanced computed tomography. Management can be conservative in younger patients with mild hematuria due to the high spontaneous remission rate and invasive with open surgical and endovascular interventions. We describe a very rare case with compression of the left renal vein due to an osteophyte of the spine.

Case Presentation: A 62-year-old Caucasic male came to our radiology department for chronic hepatitis B virus (HBV)-related liver disease follow-up and mild scrotal pain. The ultrasound examination revealed a compression of the left retro-aortic renal vein in the aorto-vertebral space caused by an osteophyte. Duplex Doppler ultrasound revealed flow congestion in the left renal vein and renal failure; power Doppler ultrasound showed left varicocele.

Conclusions: Doppler ultrasound is the first-line imaging and allows the detection of all the typical signs of posterior nutcracker: left renal vein stenosis, flow congestion and renal failure. Nutcracker syndrome should be suspected in older patients with left varicocele associated with hematuria. Failure to diagnose and treat these patients could have serious consequences for their health.
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http://dx.doi.org/10.1186/s13256-020-02617-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849074PMC
February 2021

Endovascular treatment of a rare case of haemobilia caused by both pseudoaneurysm and a giant hepatic haemangioma.

Radiol Case Rep 2021 Mar 8;16(3):693-697. Epub 2021 Jan 8.

Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania, 95123, Italy.

Haemobilia is defined as bleeding from the biliary system due to abnormal communication between a blood vessel and the bile ducts. Melena or hematemesis, abdominal pain and jaundice represent the pathognomonic triad for haemobilia, but clinical presentation and aetiology of this entity are extremely variable. We report a case of a 50-year-old man with melena and anaemia and a clinical history of multivalvular endocarditis in which an extremely rare presence of 2 uncommon causes of haemobilia was found, such as a mycotic pseudoaneurysm and a giant hepatic haemangioma, both treated by transarterial embolization. In the management of haemobilia, TAE has been proven to be the treatment of choice because it combines a diagnostic angiography with therapeutic intervention in a minimally invasive, safe and effective way. Physician and radiologist should keep in mind also the uncommon aetiologies of haemobilia, knowing that the source of bleeding could be more than just one.
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http://dx.doi.org/10.1016/j.radcr.2020.12.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809172PMC
March 2021

CIRSE Standards of Practice on Peri-operative Anticoagulation Management During Interventional Radiology Procedures.

Cardiovasc Intervent Radiol 2021 Apr 20;44(4):523-536. Epub 2021 Jan 20.

Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.

This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for peri-operative anticoagulation management during interventional radiology procedures.
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http://dx.doi.org/10.1007/s00270-020-02763-4DOI Listing
April 2021

Quantitative Evaluation of Fibrosis in IPF Patients: Meaning of Diffuse Pulmonary Ossification.

Diagnostics (Basel) 2021 Jan 12;11(1). Epub 2021 Jan 12.

Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University-Hospital Policlinico "G. Rodolico-S. Marco", University of Catania, 95123 Catania, Italy.

To investigate the role of diffuse pulmonary ossification (DPO) in disease severity in a population of Idiopathic Pulmonary Fibrosis (IPF) patients. This retrospective study was carried out on 95 IPF patients-44 with DPO on high resolution computed tomography (HRCT) and 51 with no calcifications detected on HRCT. Pulmonary Function Tests (PFTs) acquired nearest to the HRCT were collected. Images were analyzed by two radiologists using a qualitative method, based on HRCT fibrosis visual score, and using a quantitative method, based on histogram-based analysis. The Spearman's rank correlation coefficient was used to measure the strength and direction of the linear relationship between HRCT fibrosis score and PFTs; in addition, Spearman's rank correlation coefficient was used to explore the relationships between HRCT fibrosis score and quantitative index and between quantitative indexes and PFTs. A weak correlation between HRCT fibrosis score and PFTs was proven (r =-0.014 and = 0.9347 for FVC (Forced Vital Capacity), r = -0.379 and = 0.0174 for DLCO (Carbon monoxide diffusing capacity)). We found a moderate negative correlation between HRCT fibrosis score and kurtosis (r = -0.448, = 0.004272) and skewness (r = -0.463, = 0.003019) and a weak positive correlation with High Attenuation Area (HAA)% (r = 0.362, = 0.0235). Moreover, a moderate linear correlation between Quantitative Indexes and FVC (r = 0.577, = 0.000051 for kurtosis and FVC, r = 0.598, = 0.000023 for skewness and FVC, r = -0.519, = 0.0000364 for HAA% and FVC) and between quantitative indexes and DLCO (r = 0.469, = 0.001508 for kurtosis, and DLCO, r = 0.474, = 0.001309 for skewness and DLCO, r = -0.412, = 0.005996 for HAA% and DLCO) was revealed. To better investigate the influence of DPO in disease progression, a longitudinal evaluation should be performed.
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http://dx.doi.org/10.3390/diagnostics11010113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828113PMC
January 2021

From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review.

Diagnostics (Basel) 2021 Jan 11;11(1). Epub 2021 Jan 11.

Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy.

Left renal vein (LRV) entrapment, also known as nutcracker phenomenon if it is asymptomatic, is characterized by abnormality of outflow from the LRV into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) stenosis. Nutcracker syndrome, on the other hand, includes a well-defined set of symptoms, and the severity of these clinical manifestations is related to the severity of anatomic and hemodynamic findings. With the aim of providing practical guidance for nephrologists and radiologists, we performed a review of the literature through the PubMed database, and we commented on the definition, the main clinical features, and imaging pattern of this syndrome; we also researched the main therapeutic approaches validated in the literature. Finally, from the electronic database of our institute, we have selected some characteristic cases and we have commented on the imaging pattern of this disease.
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http://dx.doi.org/10.3390/diagnostics11010101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826835PMC
January 2021

The Role of Ultrasound in Dunbar Syndrome: Lessons Based on a Case Report.

Am J Case Rep 2020 Nov 8;21:e926778. Epub 2020 Nov 8.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy.

BACKGROUND Dunbar syndrome is a rare vascular alteration caused by the abnormal course of the median arcuate ligament of the diaphragm, which in some patients causes chronic compression of the celiac artery and can cause non-specific symptoms such as diarrhea, retro-sternal pain, vomiting, swelling, and nausea, or a typical symptomatic triad with weight loss, post-prandial abdominal pain, and epigastric murmur. Color Doppler ultrasound and duplex Doppler ultrasound provide a complete diagnostic framework of this disease. CASE REPORT We describe a case of 55-year-old man with post-prandial epigastric pain, significant weight loss, and several episodes of retro-sternal pain. He underwent multidetector computed tomography of the abdomen and color duplex Doppler ultrasound examination of the celiac artery that highlighted stenosis of the celiac artery, more severe in expiratory apnea. The computed tomography showed the typical aspect of the celiac artery, with the "hook sign". A duplex Doppler ultrasound examination showed a significant increase in peak speed (226 cm/s) due to severe stenosis of the celiac artery by the median arched ligament of the diaphragm. CONCLUSIONS This case is unique due to the severity of the celiac artery stenosis and the unusual clinical presentation of the patient who had frequent episodes of retro-sternal pain. The significant increase in peak velocity in the celiac artery in expiratory apnea, if associated with the typical symptomatology in the absence of other alterations of the splanchnic vessels, can be considered, in our opinion, sufficient for the diagnosis of Dunbar syndrome.
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http://dx.doi.org/10.12659/AJCR.926778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656089PMC
November 2020

Proximal and distal radial artery approaches for endovascular percutaneous procedures: anatomical suitability by ultrasound evaluation.

Radiol Med 2021 Apr 5;126(4):630-635. Epub 2020 Nov 5.

Department of Medical Surgical Sciences and Advanced Technologies "G. F. Ingrassia" - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.

Purpose: To describe the variability of the radial artery (RA) diameters at 2 levels, proximal (pRA), within 2 cm to the styloid process, and distal (dRA) at the snuff box, both eligible accesses for percutaneous approach, and to correlate these diameters with population features.

Methods: A total of 700 patients (377 females, 323 males) have been enrolled from July 2018 to March 2019. The diameters of left and right RA were measured using ultrasound (US) examination. Diameters of pRA and dRA were compared between different sex and CRF (tabagism, hypertension, hyperlipidemia, BMI > 30, diabetes) using multivariate analysis and unpaired t test; the feasibility of radial access was evaluated considering a diameter ≥ of 2 mm as a cut-off or a vessel/sheath ratio >1. The time needed to perform each assessment of the four vessels was recorded.

Results: The average proximal diameter of pRA was 2.58 mm (sd = 0.58 mm). The caliber of the dRA resulted 19.5% lower than the proximal one, with an average diameter of 1.99 mm (sd = 0.47 mm). On unpaired t test, a significant difference was reported for two of the parameters taken into account: sex and a BMI > 30.

Conclusion: Our results show that 88% of patients have an estimated radial artery caliber suitable for pTRA at US examination. Males and patients with BMI > 30 show a higher mean pRA and dRA; thus, they could be the ideal candidates for radial access.
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http://dx.doi.org/10.1007/s11547-020-01299-4DOI Listing
April 2021

Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery.

Diagnostics (Basel) 2020 Oct 7;10(10). Epub 2020 Oct 7.

Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy.

Background: Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy.

Materials And Methods: 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs: <5.7 kPa, F0-1; 5.7-7.99 kPa, F2; ≥8 kPa, F3-4.

Results: We developed two logistic regression models using elastography-histology agreement (EHA) as the dependent variable and SLD as the independent variable. The model based on the second machine showed strongly more performant discriminative and calibration metrics (AIC 38.5, BIC 44.2, Nagelkerke Pseudo-R2 0.894, AUROC 0.90). The SLD cut-off value of 34.5 mm allowed a correct EHA with a sensitivity of 100%, a specificity of 93%, negative predictive value of 100%, positive predictive value of 87%, an accuracy of 96%, and positive likelihood ratio of 3.56.

Conclusion: The impact of SLD is machine-dependent and should be taken into consideration when interpreting LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in obese patients.
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http://dx.doi.org/10.3390/diagnostics10100795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601552PMC
October 2020

Screening for Fabry Disease in Kidney Transplant Recipients: Experience of a Multidisciplinary Team.

Biomedicines 2020 Oct 7;8(10). Epub 2020 Oct 7.

Organ Transplantation Unit, University Hospital of Catania, Department of Medical and Surgical sciences and Advanced Technologies, University of Catania, 95123 Catania, Italy.

Fabry disease (FD) is a rare cause of end-stage renal disease requiring kidney transplantation. Data on the incidence of unrecognized FD in kidney transplant recipients are scarce and probably underestimated. This study evaluated the incidence of FD in a population of kidney recipients, with a particular focus of the multidisciplinary approach for an early clinical assessment and therapeutic approach. Two hundred sixty-five kidney transplant recipients were screened with a genetic analysis for α-galactosidase A (GLA) mutation, with measurement of α-Gal A enzyme activity and Lyso Gb3 levels. Screening was also extended to relatives of affected patients. Seven patients (2.6%) had a GLA mutation. Two patients had a classic form of FD with Fabry nephropathy. Among the relatives, 15 subjects had a GLA mutation, and two had a Fabry nephropathy. The clinical and diagnostic assessment was completed after a median of 3.2 months, and mean time from diagnosis to treatment was 4.6 months. This study reported a high incidence of unrecognized GLA mutations in kidney transplant recipients. Evaluation and management by a multidisciplinary team allowed for an early diagnosis and treatment, and this would result in a delay in the progression of the disease and, finally, in better long-term outcomes.
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http://dx.doi.org/10.3390/biomedicines8100396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601128PMC
October 2020

Giant hepatic hemangioma case report: When is it time for surgery?

Ann Med Surg (Lond) 2020 Oct 12;58:4-7. Epub 2020 Aug 12.

General Surgery, Department of Oncological Surgery, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy.

We describe a case of a 30-year-old man who complained intermitted pain in right abdominal flank; a large cavernoumatos hemangioma - up to 6 cm in size - was revealed in the fifth hepatic segment using Ultrasonography and MRI (Magnetic Resonance Imaging). Indications for treatment - based on imaging features and clinical data - are briefly discussed in our report, providing also a review of existing literature.
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http://dx.doi.org/10.1016/j.amsu.2020.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451996PMC
October 2020

Feasibility of routine ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula dysfunction.

J Vasc Access 2020 Jul 25:1129729820943076. Epub 2020 Jul 25.

Nephrology and Dialysis Unit, Asst Fatebenefratelli Sacco, Milano, Italy.

Background: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis.

Methods: The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination.

Results: Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty.

Conclusion: Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.
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http://dx.doi.org/10.1177/1129729820943076DOI Listing
July 2020

Multidisciplinary Approach to Interstitial Lung Diseases: Nothing Is Better than All of Us Together.

Diagnostics (Basel) 2020 Jul 17;10(7). Epub 2020 Jul 17.

Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123 Catania, Italy.

Interstitial Lung Diseases (ILDs) are a large family of disorders characterized by inflammation and/or fibrosis of areas of the lung dedicated to gas exchange. In this Special Issue entitled "Clinical and Radiological Features of Interstitial Lung Diseases", we collected a series of contributions in which a multidisciplinary approach was crucial for the correct diagnostic assessment of ILD. Sharing knowledge between different specialties can significantly improve diagnostic approaches and the management of ILD patients.
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http://dx.doi.org/10.3390/diagnostics10070488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400249PMC
July 2020

Imaging patterns of early stage lung cancer for the thoracic surgeon.

J Thorac Dis 2020 Jun;12(6):3349-3356

1Section of Thoracic Surgery, Department of General Surgery and Medical Specialities, 2Section of Radiology, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", Policlinico University Hospital, Catania, Italy.

In the modern era, thoracic surgeons are experiencing an increase interest in imaging patterns of early stage lung cancer due to the introduction of the ground glass opacity in clinical practice, and for the necessity to an accurate cancer localization to perform the appropriate type of resection. In this brief review we analyze the latest news regarding imaging patterns of early pulmonary nodules with special emphasis to ground glass opacity.
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http://dx.doi.org/10.21037/jtd.2020.02.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330749PMC
June 2020

Complications in Idiopathic Pulmonary Fibrosis: Focus on Their Clinical and Radiological Features.

Diagnostics (Basel) 2020 Jul 3;10(7). Epub 2020 Jul 3.

Regional Centre for Interstitial and Rare Lung Disease, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy.

Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease with uncertain origins and pathogenesis; it represents the most common interstitial lung disease (ILD), associated with a pathological pattern of usual interstitial pneumonitis (UIP). This disease has a poor prognosis, having the most lethal prognosis among ILDs. In fact, the progressive fibrosis related to IPF could lead to the development of complications, such as acute exacerbation, lung cancer, infections, pneumothorax and pulmonary hypertension. Pneumologists, radiologists and pathologists play a key role in the identification of IPF disease, and in the characterization of its complications-which unfortunately increase disease mortality and reduce overall survival. The early identification of these complications is very important, and requires an integrated approach among specialists, in order to plane the correct treatment. In some cases, the degree of severity of patients having IPF complications may require a personalized approach, based on palliative care services. Therefore, in this paper, we have focused on clinical and radiological features of the complications that occurred in our IPF patients, providing a comprehensive and accurate pictorial essay for clinicians, radiologists and surgeons involved in their management.
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http://dx.doi.org/10.3390/diagnostics10070450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399856PMC
July 2020

May Thurner syndrome: description of a case with unusual clinical onset.

J Ultrasound 2020 Jun 23. Epub 2020 Jun 23.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catania, Italy.

May-Thurner syndrome (MTS) is a congenital vascular alteration that is part of a restricted category of very rare vascular syndromes that have in common the compression of an arterial or venous vessel. MTS, first described in 1957, is due to compression of the left common iliac vein against the lumbar spine by the adjacent common iliac artery. It can cause chronic thrombosis of the left lower limb and can give edema, pain, claudication, thrombophlebitis, and, in severe cases, pulmonary embolism. Color Doppler and duplex Doppler ultrasound allow us to easily locate the deep vein thrombosis, to measure its extension, and to highlight the vascular changes typical of MTS: compression and consequent hypertension of the left common iliac vein. The therapy depends on the degree of venous stasis and on the presence of venous thrombosis; generally, it consists of the administration of short- or long-term anticoagulant and thrombolytic drugs. In cases of severe stenosis of the left common iliac vein, the first-choice treatment consists of positioning a vascular stent, which resolves compression and significantly reduces chronic thrombotic episodes. We describe a case of MTS with an unusual clinical onset with pulmonary embolism.
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http://dx.doi.org/10.1007/s40477-020-00497-0DOI Listing
June 2020

Cystic Interstitial Lung Diseases: A Pictorial Review and a Practical Guide for the Radiologist.

Diagnostics (Basel) 2020 May 27;10(6). Epub 2020 May 27.

Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia"-Radiology Unit I. University hospital "Policlinico-Vittorio Emanuele" Via Santa Sofia 78, 95123 Catania, Italy.

A cyst is a round circumscribed area of low attenuation, surrounded by epithelial or fibrous wall. Cysts can frequently occur on chest computed tomography (CT) and high-resolution computed tomography (HRCT); multiple parenchymal cysts of the lungs are the most typical feature of cystic lung interstitial diseases, characterizing a wide spectrum of diseases-ranging from isolated lung disorders up to diffuse pulmonary diseases. The aim of this review is to analyze scientific literature about cystic lung interstitial diseases and to provide a practical guide for radiologists, focusing on the main morphological features of pulmonary cysts: size, shape, borders, wall, location, and distribution. These features are shown on free-hand drawings and related to HRCT images, in order to help radiologists pursue the correct differential diagnosis between similar conditions.
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http://dx.doi.org/10.3390/diagnostics10060346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345690PMC
May 2020

True congenital multicystic disease of the pancreas in the infant: a very rare case.

J Ultrasound 2020 May 22. Epub 2020 May 22.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catania, Italy.

The most frequent pancreatic cysts in patients of developmental age are pseudocysts, neoplastic cysts, posttraumatic cysts, and parasitic cysts. Retention cysts, duplication cysts, and congenital cysts are called true cysts. Among the true cysts, congenital cysts are very rare and include 1% of all pancreatic cysts. The finding of true congenital pancreatic cysts in children under 3 years represents a very rare event; less than 30 have been described in the literature. We describe the case of a 3-year-old male who came to our observation for abdominal pain and underwent an abdomen ultrasound examination. The ultrasound examination showed unilocular sub-centimeter cystic lesions, distributed throughout the pancreatic parenchyma. The patient was, therefore, not subjected to any treatment, and after a few days, the symptoms regressed spontaneously. This description probably represents the first case in the literature of "congenital multicystic disease" of the pancreas.
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http://dx.doi.org/10.1007/s40477-020-00472-9DOI Listing
May 2020