Publications by authors named "Davide Caramella"

125 Publications

Humeral greater tuberosity osteolysis as a complication of intraosseous calcification migration: natural history depicted by imaging.

Acta Biomed 2021 04 30;92(S1):e2021052. Epub 2021 Apr 30.

Department of Interventional and Diagnostic Radiology Azienda Ospedaliero-Universitaria Pisana.

Migration of calcification within the bone leading to greater tuberosity osteolysis is a peculiar complication of the calcifying tendinitis of the rotator cuff. The case of a 38-year-old woman complaining of right shoulder pain, which had been going on for one year, is hereby described. The evolution of the infraspinatus tendon calcifying tendinitis leading to osteolysis of the greater tuberosity of the humerus is depicted by imaging and, particularly, by the MR and CT features changing over time. In this paper we focus on the importance of both MR and CT exams in the diagnostic process of the different phases of the disease. The correlation between clinical symptoms and imaging features is also helpful for imaging interpretation: the most painful phase corresponds to the migration of the calcification, whereas pain tends to decrease when the osteolysis develops. Awareness of the existence of this condition may prevent unnecessary invasive procedures.
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http://dx.doi.org/10.23750/abm.v92iS1.8370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142746PMC
April 2021

Post-mortem CMR in a model of sudden death due to myocardial ischemia: validation with connexin-43.

Eur Radiol 2021 Apr 20. Epub 2021 Apr 20.

Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy.

Objectives: We sought to evaluate the effectiveness of post-mortem cardiac magnetic resonance (PM-CMR) for the identification of myocardial ischemia as cause of sudden cardiac death (SCD) when the time interval between the onset of ischemia and SCD is ≤ 90 min.

Methods: PM-CMR was performed in 8 hearts explanted from pigs with spontaneous death caused by occlusion of the left anterior descending coronary artery: 4 with SCD after ≤ 40 min of coronary occlusion and 4 between 40 and 90 min. PM-CMR included conventional T1 and T2-weighted image and T1, T2, and T2* mapping techniques. Imaging data were compared and validated with immunohistochemical evaluation of the altered proportion and redistribution of phosphorylated versus non-phosphorylated connexin 43 (CX43 and npCX43, respectively), an established molecular marker of myocardial ischemia.

Results: At T2-weighted images, the ischemic core was hypointense (core/remote ratio 0.67 ± 0.11) and surrounded by and hyperintense border zone. Compared to remote myocardium, the ischemic core had higher T1 (p = 0.0008), and lower T2 (p = 0.007) and T2* (p = 0.002). Cytoplasmatic npX43 and the npCX43/CX43 ratio were significantly higher in animals deceased > 40 min than in others.

Conclusion: PM-CMR can reliably detect early signs of myocardial damage induced by ischemia, based on conventional pulse sequences complemented by a novel ad hoc application of quantitative mapping techniques.

Key Points: • Post-mortem MRI may help to understand cause of sudden cardiac death. • Post-mortem MRI allows detection of signs of myocardial ischemia as cause of sudden cardiac death within 90 and 40 min following coronary occlusion as demonstrated in a pig model of myocardial ischemia. • Signs of myocardial ischemia using conventional and mapping MRI technique are associated with the immunohistochemical changes of phosphorylated and dephosphorylated connexin-43 which is an established molecular marker of myocardial ischemia.
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http://dx.doi.org/10.1007/s00330-021-07890-1DOI Listing
April 2021

Ultra-high frequency ultrasonography (UHFUS)-guided minor salivary gland biopsy: A promising procedure to optimize labial salivary gland biopsy in Sjögren's syndrome.

J Oral Pathol Med 2021 May 15;50(5):485-491. Epub 2021 Feb 15.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy.

Background: Sjögren's syndrome (SS) is an autoimmune disease characterized by an inflammatory infiltrate of exocrine salivary and lachrymal glands. Diagnosis is complex, and minor salivary gland biopsy and subsequent focus score (FS) calculation appear of extreme importance in the diagnostic work-up of the disease. Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique, which is gaining an increasingly important role in intraoral imaging. This study aims at exploring the usefulness of UHFUS for obtaining valuable labial salivary gland samples to assess the histopathological features of SS patients.

Methods: Patients with clinical suspect of SS and eligible for minor salivary gland biopsy were enrolled. UHFUS scan of the lower lip was performed. Glandular echostructure was classified according to Outcome Measures in Rheumatology (OMERACT) scoring system. The glands to be sampled were selected on the basis of UHFUS evaluation and biopsied. The areas of the samples were recorded and compared with those obtained without UHFUS guidance. The correlation between UHFUS grade and labial gland FS was also assessed.

Results: The areas of the samples obtained with UHFUS guidance were significantly higher (7.25 ± 3.98 mm ) than those obtained by conventional procedures (5.79 ± 3.49 mm , P = .02). UHFUS correlated significantly with the salivary gland FS (r = .532, P = .001).

Conclusion: UHFUS seems a promising tool in SS diagnostic algorithm, being able to provide a valuable support to the biopsy procedure. Further studies are mandatory to confirm the role of UHFUS in SS.
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http://dx.doi.org/10.1111/jop.13162DOI Listing
May 2021

Ultra-high frequency ultrasound (UHFUS) applications in Sjogren syndrome: narrative review and current concepts.

Gland Surg 2020 Dec;9(6):2248-2259

Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Primary Sjogren's syndrome (SS) is a systemic autoimmune chronic inflammatory disease with predominant involvement of the exocrine glands, particularly the salivary glands (SGs). The role of salivary glands ultrasound (SGUS) in the work-up of patients with primary Sjogren syndrome (SS) is progressively increasing due to its useful support in diagnosis and follow-up as a widely available, repeatable, non-invasive and safe technique. Although SGUS is not yet included in the dominant primary SS classification, several studies supported its inclusion in the American College of Rheumatology/European League Against Rheumatism criteria. In this context, a novel imaging technique, ultra-high frequency ultrasound (UHFUS), is being explored. Compared to the frequencies used in conventional ultrasound (US) (up to 22 MHz), UHFUS operates with higher frequencies (30-100 MHz) allowing for outstanding image resolution, up to 30 µm. UHFUS permits the scan of both major and minor SGs, opening new avenues for the integration of tissue and imaging biomarkers. Although further studies are needed to confirm its role, this novel imaging technique might lead to several potential improvements, including earlier diagnosis, reduction of unnecessary and inadequate biopsies and better management and follow-up of patients with primary SS.
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http://dx.doi.org/10.21037/gs-20-529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804531PMC
December 2020

A comprehensive assessment of physical image quality of five different scanners for head CT imaging as clinically used at a single hospital centre-A phantom study.

PLoS One 2021 14;16(1):e0245374. Epub 2021 Jan 14.

Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy.

Nowadays, given the technological advance in CT imaging and increasing heterogeneity in characteristics of CT scanners, a number of CT scanners with different manufacturers/technologies are often installed in a hospital centre and used by various departments. In this phantom study, a comprehensive assessment of image quality of 5 scanners (from 3 manufacturers and with different models) for head CT imaging, as clinically used at a single hospital centre, was hence carried out. Helical and/or sequential acquisitions of the Catphan-504 phantom were performed, using the scanning protocols (CTDIvol range: 54.7-57.5 mGy) employed by the staff of various Radiology/Neuroradiology departments of our institution for routine head examinations. CT image quality for each scanner/acquisition protocol was assessed through noise level, noise power spectrum (NPS), contrast-to-noise ratio (CNR), modulation transfer function (MTF), low contrast detectability (LCD) and non-uniformity index analyses. Noise values ranged from 3.5 HU to 5.7 HU across scanners/acquisition protocols. NPS curves differed in terms of peak position (range: 0.21-0.30 mm-1). A substantial variation of CNR values with scanner/acquisition protocol was observed for different contrast inserts. The coefficient of variation (standard deviation divided by mean value) of CNR values across scanners/acquisition protocols was 18.3%, 31.4%, 34.2%, 30.4% and 30% for teflon, delrin, LDPE, polystyrene and acrylic insert, respectively. An appreciable difference in MTF curves across scanners/acquisition protocols was revealed, with a coefficient of variation of f50%/f10% of MTF curves across scanners/acquisition protocols of 10.1%/7.4%. A relevant difference in LCD performance of different scanners/acquisition protocols was found. The range of contrast threshold for a typical object size of 3 mm was 3.7-5.8 HU. Moreover, appreciable differences in terms of NUI values (range: 4.1%-8.3%) were found. The analysis of several quality indices showed a non-negligible variability in head CT imaging capabilities across different scanners/acquisition protocols. This highlights the importance of a physical in-depth characterization of image quality for each CT scanner as clinically used, in order to optimize CT imaging procedures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245374PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808662PMC
June 2021

Ultra-high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study.

Skin Res Technol 2021 Jan 6. Epub 2021 Jan 6.

Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: Intraoral ultra-high frequency ultrasound (UHFUS) is an emerging technique in oral medicine, due to its possibility to provide submillimeter resolution imaging of superficial mucosal structures. In this study, the potential role of UHFUS in the diagnosis of oral pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) is assessed.

Materials And Methods: Consecutive patients with suspected oral PV or MMP were enrolled. All patients underwent clinical examination, laboratory tests, intraoral UHFUS scan, and biopsy. Histology and direct immunofluorescence were set as benchmark for diagnosis confirmation. The sensitivity and specificity of UHFUS compared to histology were assessed. Mann-Whitney test was performed to evaluate the presence of differences in the echogenicity of PV and MMP. P-value was set at P < 0.05.

Results: Twenty-five patients were included. Thirteen patients were diagnosed with PV, and twelve with MMP. The UHFUS features of PV and MMP lesions were described. Image analysis showed statistically significant differences between the echogenicity of PV and MMP lesions (P < 0.05). Good concordance between UHFUS and histology was found. UHFUS showed 75% sensitivity in the diagnosis of PV and 66.7% in the diagnosis of MMP.

Conclusions: UHFUS appears a valuable tool in the diagnosis of PV and MMP. Although histology and immunofluorescence remain the gold standard, UHFUS role in the diagnostic algorithm of PV and MMP seems promising as a chair-side tool consistently enhancing clinical evaluation of oral bullous lesions.
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http://dx.doi.org/10.1111/srt.13000DOI Listing
January 2021

Technical evaluation of image quality in synthetic mammograms obtained from 15° and 40° digital breast tomosynthesis in a commercial system: a quantitative comparison.

Phys Eng Sci Med 2021 Mar 23;44(1):23-35. Epub 2020 Nov 23.

Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy.

Digital breast tomosynthesis (DBT) has recently gained interest both for breast cancer screening and diagnosis. Its employment has increased also in conjunction with digital mammography (DM), to improve cancer detection and reduce false positive recall rate. Synthetic mammograms (SMs) reconstructed from DBT data have been introduced to replace DM in the DBT + DM approach, for preserving the benefits of the dual-acquisition modality whilst reducing radiation dose and compression time. Therefore, different DBT models have been commercialized and the effective potential of each system has been investigated. In particular, wide-angle DBT was shown to provide better depth resolution than narrow-angle DBT, while narrow-angle DBT allows better identification of microcalcifications compared to wide-angle DBT. Given the increasing employment of SMs as supplement to DBT, a comparison of image quality between SMs obtained in narrow-angle and wide-angle DBT is of practical interest. Therefore, the aim of this phantom study was to evaluate and compare the image quality of SMs reconstructed from 15° (SM) and 40° (SM) DBT in a commercial system. Spatial resolution, noise and contrast properties were evaluated through the modulation transfer function (MTF), noise power spectrum, maps of signal-to-noise ratio (SNR), image contrast, contrast-to-noise ratio (CNR) and contrast-detail (CD) thresholds. SM expressed higher MTF than SM, but also lower SNR and CNR levels. SM and SM were characterized by slight different texture, and a different behavior in terms of contrast was found. SM provided better CD performances than SM. These results suggest that the employment of wide/narrow-angle DBT + SM images should be optimized based on the specific image task.
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http://dx.doi.org/10.1007/s13246-020-00948-2DOI Listing
March 2021

Ultra-high frequency ultrasonography of labial glands is a highly sensitive tool for the diagnosis of Sjögren's syndrome: a preliminary study.

Clin Exp Rheumatol 2020 Jul-Aug;38 Suppl 126(4):210-215. Epub 2020 Oct 23.

Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Objectives: Ultra-high frequency ultrasonography (UHFUS) has been recently introduced in oral medicine due to its ability to image small anatomical structures including labial salivary glands (LSG). To date no ultrasonography morphological studies of labial salivary glands (LSG) have been carried out in SS. In this pilot study we aimed at analysing the distribution of UHFUS findings in LSG of patients with suspected SS, focusing in particular on the association with patients' oral dysfunction, antibody profiles and histopathology.

Methods: Consecutive patients undergoing a LSG biopsy for clinically suspected SS were included in this study between January 2018 and January 2020. Intraoral UHFUS scan of the lip mucosa was performed with Vevo MD equipment, using a 70 MHz probe with a standardised protocol. LSG were assessed by using a four-grade semiquantitative scoring system (0-3), similar to the OMERACT scoring system used for major salivary glands. The distribution of UHFUS grades was compared in patients stratified according their final diagnosis, patients antibody profiles and LSG histopathology.

Results: We included 128 patients with suspected SS: out of them, 54 (42.2%) received a final diagnosis of SS, made according to the ACR 2016 criteria and 74 (57.8%) were diagnosed as no-SS sicca controls. We found that LSG inhomogeneity was significantly greater in patients with SS than in no-SS subjects (p<0.0001). We also found that higher UHFUS pattern of inhomogeneity (i.e. grade 2 and 3) were significantly more frequent in both SSA+/SSB- and SSA+/SSB+ patients (p=0.001). A normal UHFUS pattern, by contrast, was significantly more common in SSA-/SSB- subjects (i.e. 15/83 (18.1%) vs. 1/33 (3%) vs. 0/12 (0%), p=0.001). Finally, LSG inhomogeneity was significantly associated with both the number of foci (p<0.001) and focus score (p<0.001). Particularly, we found that both the number of foci and the FS were significantly higher in patients presenting a UHFUS grading of 2 and 3 with respect to those presenting a UHFUS grading of 0 and 1 (p=0.01).

Conclusions: This preliminary study demonstrates the optimal feasibility of UHFUS and its high sensitivity in identifying negative patients on subsequent lip biopsy, thus avoiding invasive procedures in selected cases. Further studies are in progress to define the clinical and predictive role of the various patterns observed and their added value with respect to traditional salivary gland ultrasonography.
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October 2020

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection.

Updates Surg 2021 Feb 25;73(1):233-249. Epub 2020 Sep 25.

Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.

Pancreatectomy with arterial resection is a treatment option in selected patients with locally advanced pancreatic cancer. This study aimed to identify factors predicting cancer-specific survival in this patient population. A single-Institution prospective database was used. Pre-operative prognostic factors were identified and used to develop a prognostic score. Matching with pathologic parameters was used for internal validation. In a patient population with a median Ca 19.9 level of 19.8 U/mL(IQR: 7.1-77), cancer-specific survival was predicted by: metabolic deterioration of diabetes (OR = 0.22, p = 0.0012), platelet count (OR = 1.00; p = 0.0013), serum level of Ca 15.3 (OR = 1.01, p = 0.0018) and Ca 125 (OR = 1.02, p = 0.00000137), neutrophils-to-lymphocytes ratio (OR = 1.16; p = 0.00015), lymphocytes-to-monocytes ratio (OR = 0.88; p = 0.00233), platelets-to-lymphocytes ratio (OR = 0.99; p = 0.00118), and FOLFIRINOX neoadjuvant chemotherapy (OR = 0.57; p = 0.00144). A prognostic score was developed and three risk groups were identified. Harrell's C-Index was 0.74. Median cancer-specific survival was 16.0 months (IQR: 12.3-28.2) for the high-risk group, 24.7 months (IQR: 17.6-33.4) for the intermediate-risk group, and 39.0 months (IQR: 22.7-NA) for the low-risk group (p = 0.0003). Matching the three risk groups against pathology parameters, N2 rate was 61.9, 42.1, and 23.8% (p = 0.04), median value of lymph-node ratio was 0.07 (IQR: 0.05-0.14), 0.04 (IQR:0.02-0.07), and 0.03 (IQR: 0.01-0.04) (p = 0.008), and mean value of logarithm odds of positive nodes was - 1.07 ± 0.5, - 1.3 ± 0.4, and - 1.4 ± 0.4 (p = 0.03), in the high-risk, intermediate-risk, and low-risk groups, respectively. An online calculator is available at www.survivalcalculator-lapdac-arterialresection.org . The prognostic factors identified in this study predict cancer-specific survival in patients with locally advanced pancreatic cancer and low Ca 19.9 levels undergoing pancreatectomy with arterial resection.
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http://dx.doi.org/10.1007/s13304-020-00883-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889566PMC
February 2021

Radiation dose management systems-requirements and recommendations for users from the ESR EuroSafe Imaging initiative.

Eur Radiol 2021 Apr 21;31(4):2106-2114. Epub 2020 Sep 21.

University of Crete Heraklion, Heraklion, Greece.

The European Directive 2013/59/Euratom requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on "Dose Management" with the aim to provide European recommendations on the implementation of dose management systems (DMS) in clinical practice. The WG follows Action 4: "Promote dose management systems to establish local, national, and European diagnostic reference levels (DRL)" of the EuroSafe Imaging Call for Action 2018. DMS are designed for medical practitioners, radiographers, medical physics experts (MPE) and other health professionals involved in imaging to support their tasks and duties of radiation protection in accordance with local and national requirements. The WG analysed requirements and critical points when installing a DMS and classified the individual functions at different performance levels. KEY POINTS: • DMS are very helpful software tools for monitoring patient exposure, optimisation, compliance with DRLs and quality assurance. • DMS can help to fulfil dosimetric aspects of the European Directive 2013/59/Euratom. • The EuroSafe WG analyses DMS requirements and gives recommendations for users.
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http://dx.doi.org/10.1007/s00330-020-07290-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979596PMC
April 2021

Side-branch intraductal papillary mucinous neoplasms of the pancreas: outcome of MR imaging surveillance over a 10 years follow-up.

Eur J Radiol Open 2020 21;7:100250. Epub 2020 Aug 21.

Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy.

Purpose: To evaluate the outcome of a MR imaging procotol in assessing the evolution of individuals with branch duct - intraductal papillary mucinous neoplasms (BD-IPMN) without worrisome features (WF) and/or high risk stigmata (HRS) at the time of the diagnosis in a follow-up period of at least 10 years.

Material And Methods: A retrospective revision of a prospectively collected radiological database including a total number of 600 patients who were investigated and diagnosed with "presumed" diagnosis of BD-IPMN at MRI/MRCP at our Department since 2008 was performed. Inclusion criteria were: 1) absence of worrisome features and/or high-risk stigmata at the time of diagnosis (baseline); 2) a radiological follow-up with abdominal MRI/MRCP of at least 10 years. Changes in cysts size, development of WF, HRS and pancreatic cancer, and any other modification during the follow-up were retrospectively analysed by two observers in consensus.

Results: Sixty-nine patients fulfilled all the inclusion criteria. During surveillance, the cysts remained dimensionally unchanged or slightly reduced in size in 26.2% and 4.3% of cases respectively, whereas cyst enlargement was demonstrated in 69.5% of cases. Median annual growth rate was of 0.97 ± 0.87 mm/yr (range 0.13-5.0). WF and HRS developed in 10/69 (14.5%) and 3/69 (4.3%) cases, respectively. The incidence of pancreatic cancer in patients with BD-IPMN was 2.9%.

Conclusion: Our data confirm the low risk of pancreatic cancer development in patients with BD-IPMN, thus justifying an imaging follow-up. Worrisome features and high-risk stigmata were promptly identified during the follow-up, supporting the utility of our surveillance MR imaging protocol.
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http://dx.doi.org/10.1016/j.ejro.2020.100250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452648PMC
August 2020

Ultra-High Frequency Ultrasound, A Promising Diagnostic Technique: Review of the Literature and Single-Center Experience.

Can Assoc Radiol J 2020 Jul 28:846537120940684. Epub 2020 Jul 28.

Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique which finds several applications in diverse clinical fields. The range of frequencies between 30 and 100 MHz allows for high spatial resolution imaging of superficial structures, making this technique suitable for the imaging of skin, blood vessels, musculoskeletal anatomy, oral mucosa, and small parts. However, the current clinical applications of UHFUS have never been analyzed in a consistent multidisciplinary manner. The aim of this study is to revise and discuss the current applications of UHFUS in different aspects of research and clinical practice, as well as to provide some examples of the current work-in-progress carried out in our center.

Materials And Methods: A literature search was performed in order to retrieve articles reporting the applications of UHFUS both in research and in clinical settings. Inclusion criteria were the use of frequencies above 30 MHz and study design conducted in vivo on human subjects.

Results: In total 66 articles were retrieved. The majority of the articles focused on dermatological and vascular applications, although musculoskeletal and intraoral applications are emerging fields of use. We also describe our experience in the use of UHFUS as a valuable diagnostic support in the fields of dermatology, rheumatology, oral medicine, and musculoskeletal anatomy.

Conclusion: Ultra-high frequency ultrasonography application involves an increasing number of medical fields. The high spatial resolution and the superb image quality achievable allow to foresee a wider use of this novel technique, which has the potential to bring innovation in diagnostic imaging.
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http://dx.doi.org/10.1177/0846537120940684DOI Listing
July 2020

Average absorbed breast dose (2ABD): an easy radiation dose index for digital breast tomosynthesis.

Eur Radiol Exp 2020 07 7;4(1):38. Epub 2020 Jul 7.

Dipartimento di Fisica E.Fermi, Università di Pisa, L.go B.Pontecorvo n.3, 56127, Pisa, Italy.

Background: To propose a practical and simple method to individually evaluate the average absorbed dose for digital breast tomosynthesis.

Methods: The method is based on the estimate of incident air kerma (k) on the breast surface. An analytical model was developed to calculate the k from the tube voltage, tube load, breast thickness, x-ray tube yield, and anode-filter combination. A homogeneous phantom was employed to simulate the breast in experimental measurements and to assess the dose-depth relationship. The k values were employed to calculate the "average absorbed breast dose" (2ABD) index. Four mammographic units were used to develop and test our method under many conditions close to clinical settings. The average glandular dose (AGD) calculated following the method described by Dance et al., and the 2ABD computed through our method (i.e., from the exposure parameters) were compared in a number of conditions.

Results: A good agreement was obtained between the k computed through our model and that measured under different clinical conditions: discrepancies < 6% were found in all conditions. 2ABD matches with a good accuracy the AGD for a 100% glandular-breast: the minimum, maximum, and mean differences were < 0.1%, 7%, and 2.4%, respectively; the discrepancies increase with decreasing breast glandularity.

Conclusions: The proposed model, based on only few exposure parameters, represents a simple way to individually calculate an index, 2ABD, which can be interpreted as the average absorbed dose in a homogeneous phantom, approximating a 100% glandular breast. The method could be easily implemented in any mammographic device performing DBT.
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http://dx.doi.org/10.1186/s41747-020-00165-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338293PMC
July 2020

Role of pre-procedural CT imaging on catheter ablation in patients with atrial fibrillation: procedural outcomes and radiological exposure.

J Interv Card Electrophysiol 2021 Apr 13;60(3):477-484. Epub 2020 May 13.

Second Division of Cardiology, New Santa Chiara Hospital Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.

Background: Cardiac computed tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. The aim of the study was to determine the impact of pre-procedural cardiac CT with 3D reconstruction on procedural outcomes and radiological exposure in patients who underwent radiofrequency catheter ablation (RFA) of AF.

Methods: In this registry, 493 consecutive patients (age 62 ± 8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent first procedure of RFA were included. A pre-procedural CT scan was obtained in 324 patients (CT group). Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3D electroanatomical navigation system. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT group) and without (no CT group) pre-procedural cardiac CT.

Results: Acute PV isolation was obtained in all patients, with a comparable overall complication rate between CT and no CT group (4.3% vs 3%, p = 0.7). No differences were observed about mean duration of the procedure (231 ± 60 vs 233 ± 58 min, p = 0.7) and fluoroscopy time (13 ± 10 vs 13 ± 8 min, p = 0.6) among groups. Cumulative radiation dose resulted significantly higher in the CT group compared with no CT group (8.9 ± 24 vs 4.8 ± 15 mSv, P = 0.02). At 1 year, freedom from AF/atrial tachycardia were comparable among groups (CT group, 227/324 (70%), vs no CT group,119/169 (70%), p = ns).

Conclusions: Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure.
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http://dx.doi.org/10.1007/s10840-020-00764-4DOI Listing
April 2021

Imaging of the vulnerable carotid plaque: Role of imaging techniques and a research agenda.

Neurology 2020 05 11;94(21):922-932. Epub 2020 May 11.

From the University Cardiology (I.F., C.P., R.D.C.) and Radiology Divisions (D.C.), Pisa University Hospital; Dipartimento di Patologia Chirurgica (I.F., D.C., C.P., R.D.C.), Medica, Molecolare e dell'Area Critica, University of Pisa Medical School, Italy; Department of Clinical Sciences (J.N.), Malmö University Hospital, University of Lund, Sweden; and Fondazione VillaSerena per la Ricerca (R.D.C.), Città Sant' Angelo, Pescara, Italy.

Objectives: Atherothrombosis in the carotid arteries is a main cause of ischemic stroke and may depend on plaque propensity to complicate with rupture or erosion, in turn related to vulnerability features amenable to in vivo imaging. This would provide an opportunity for risk stratification and-potentially-local treatment of more vulnerable plaques. We here review current information on this topic.

Methods: We systematically reviewed the literature for concepts derived from pathophysiologic, histopathologic, and clinical studies on imaging techniques attempting at identifying vulnerable carotid lesions.

Results: Ultrasound, MRI, CT, and nuclear medicine-based techniques, alone or with multimodality approaches, all have a link to pathophysiology and describe different-potentially complementary-aspects of lesions prone to complications. There is also, however, a true paucity of head-to-head comparisons of such techniques for practical implementation of a thorough and cost-effective diagnostic strategy based on evaluation of outcomes. Especially in asymptomatic patients, major international societies leave wide margins of indecision in the advice to techniques guiding interventions to prevent atherothrombotic stroke.

Conclusions: To improve practical management of such patients-in addition to the patient's vulnerability for systemic reasons-a more precise identification of the vulnerable plaque is needed. A better definition of the diagnostic yield of each imaging approach in comparison with the others should be pursued for a cost-effective translation of the single techniques. Practical translation to guide future clinical practice should be based on improved knowledge of the specific pathophysiologic correlates and on a comparative modality approach, linked to subsequent stroke outcomes.
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http://dx.doi.org/10.1212/WNL.0000000000009480DOI Listing
May 2020

Discovering a new anatomy: exploration of oral mucosa with ultra-high frequency ultrasound.

Dentomaxillofac Radiol 2020 Oct 29;49(7):20190318. Epub 2020 May 29.

Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Objectives: Ultra-high frequency ultrasound (UHFUS) is a recently developed diagnostic technique involving the use of ultrasound frequencies up to 70 MHz, allowing to obtain 30 µm resolution of targets located within 1 cm from the surface. Oral mucosa can be affected by diverse pathological conditions, which are currently investigated by means of clinical examination. In this scenario, intraoral UHFUS can provide additional information and support clinical assessment of oral mucosa. In this preliminary study, typical features of normal oral mucosa are described, in order to set a benchmark for the future identification of oral soft tissue alterations.

Methods: Twenty healthy subjects (10 males and 10 females, mean age 30 years) were enrolled and underwent intraoral UHFUS examination. In all the subjects, tongue, buccal mucosa, gingiva, lip mucosa, and palate were scanned, and images acquired. Intraoral UHFUS scan included Brightness-mode and Doppler mode acquisitions performed with a standardized protocol. UHFUS images were postprocessed and analyzed using a dedicated software. UHFUS-based biomarkers (epithelial thickness, echogenicity, and vascularization) were employed for image description.

Results: Normal oral anatomy of the different sites analyzed was described. For all the sites, UHFUS biomarkers were characterized, and information on typical aspect of oral mucosa was retrieved.

Conclusions: In this explorative study, we suggest a potential role for intraoral UHFUS in the study of oral mucosa, giving insights into the possibility to improve the assessment, diagnosis, and management of the conditions involving oral mucosa. UHFUS seems a promising tool, which could potentially support clinical examination in daily oral medicine practice.
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http://dx.doi.org/10.1259/dmfr.20190318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549524PMC
October 2020

Cardiac Computed Tomography Perfusion: Contrast Agents, Challenges and Emerging Methodologies from Preclinical Research to the Clinics.

Acad Radiol 2021 01 25;28(1):e1-e13. Epub 2020 Mar 25.

CNR Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy.

Computed Tomography (CT) has long been regarded as a purely anatomical imaging modality. Recent advances on CT technology and Contrast Agents (CA) in both clinical and preclinical cardiac imaging offer opportunities for the use of CT in functional imaging. Combined with modern ECG-gating techniques, functional CT has now become a reality allowing a comprehensive evaluation of myocardial global and regional function, perfusion and coronary angiography. This article aims at reviewing the current status of cardiac CT perfusion and micro-CT perfusion with established and experimental scanners and contrast agents, from clinical practice to the experimental domain of investigations based on animal models of heart diseases.
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http://dx.doi.org/10.1016/j.acra.2019.12.026DOI Listing
January 2021

The efficacy of Ultra-High Frequency Ultrasonography in the diagnosis of intraoral lesions.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Apr 26;129(4):401-410. Epub 2019 Sep 26.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: The aim of the present study was to evaluate the diagnostic efficacy of ultra-high frequency ultrasound (UHFUS) imaging of intraoral soft tissue lesions.

Study Design: The study included 160 patients presenting with oral soft tissue lesions classified into 4 categories: autoimmune diseases, mucosal growths, potentially (pre)malignant lesions, and oral cancer. Each lesion was evaluated by means of intraoral UHFUS, through B-mode and C-mode acquisitions of the area of interest. The UHFUS findings were compared with the histopathologic findings.

Results: All values for sensitivity, specificity, and negative predictive value exceeded 90%. Sensitivity was perfect (100%) for mucosal growths and oral cancer. Specificity was almost perfect for all 4 categories of lesions, ranging from 97% to 99%. Values for positive predictive value ranged from 83% to 99%.

Conclusions: UHFUS was beneficial in imaging the oral mucosa and the superficial aspects of the underlying soft tissue in detail because of the high spatial resolution of the technique. Consistent patterns were recognized for different categories of lesions. UHFUS holds the promise of being a valuable support to the clinician in terms of diagnosis, treatment, and follow-up of oral lesions.
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http://dx.doi.org/10.1016/j.oooo.2019.09.012DOI Listing
April 2020

Reductions in perceived stress following Transcendental Meditation practice are associated with increased brain regional connectivity at rest.

Brain Cogn 2020 03 13;139:105517. Epub 2020 Jan 13.

MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy. Electronic address:

Transcendental Meditation (TM) is defined as a mental process of transcending using a silent mantra. Previous work showed that relatively brief period of TM practice leads to decreases in stress and anxiety. However, whether these changes are subserved by specific morpho-functional brain modifications (as observed in other meditation techniques) is still unclear. Using a longitudinal design, we combined psychometric questionnaires, structural and resting-state functional magnetic resonance imaging (RS-fMRI) to investigate the potential brain modifications underlying the psychological effects of TM. The final sample included 19 naïve subjects instructed to complete two daily 20-min TM sessions, and 15 volunteers in the control group. Both groups were evaluated at recruitment (T0) and after 3 months (T1). At T1, only meditators showed a decrease in perceived anxiety and stress (t = 2.53, p = 0.02), which correlated negatively with T1-T0 changes in functional connectivity among posterior cingulate cortex (PCC), precuneus and left superior parietal lobule. Additionally, TM practice was associated with increased connectivity between PCC and right insula, likely reflecting changes in interoceptive awareness. No structural changes were observed in meditators or control subjects. These preliminary findings indicate that beneficial effects of TM may be mediated by functional brain changes that take place after a short practice period of 3 months.
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http://dx.doi.org/10.1016/j.bandc.2020.105517DOI Listing
March 2020

Cone-Beam Computed Tomography vs. Multi-Slice Computed Tomography in paleoimaging: where we stand.

Homo 2020 Feb;71(1):63-72

Division of Paleopathology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Italy.

Paleopathology and anthropology are fields of research which have benefited from the use of diagnostic imaging since its introduction in the clinical setting. The deriving discipline, that is, paleoimaging, has effectively employed several diagnostic techniques. However, while Multi-Slice Computed Tomography (MSCT) has found its role in paleoimaging, Cone-Beam Computed Tomography (CBCT), despite its several advantages with regard to MSCT, is still struggling to find a clear position in this field. The aim of our study is to evaluate the possible advantages CBCT could bring to paleoimaging. We describe the characteristics and role of CBCT in clinical applications, in forensic and legal medicine, and in paleopathology. We report the study of an ancient mandible by means of CBCT and MSCT, in order to compare the quality of the images in terms of spatial resolution. CBCT allows to obtain good quality images of mineralized tissues. Moreover, the possibility of imaging metallic manufacts makes the technique suitable for the study not only of bony remains, but also of museum and archaeological artifacts. Our study highlights the strengths of CBCT as a valid imaging technique for the study of ancient bone remains and manufacts. A revision of the current uses of CBCT is provided and gives insights into the possible role it can cover in bioarchaeological studies. Further evaluation is needed in terms of possible applications of this technique to paleopathology. We strongly encourage the use of CBCT in paleoimaging, and suggest a broader application of the technique to the study of archaeological samples.
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http://dx.doi.org/10.1127/homo/2020/1063DOI Listing
February 2020

Advanced evaluation of hidradenitis suppurativa with ultra-high frequency ultrasound: A promising tool for the diagnosis and monitoring of disease progression.

Skin Res Technol 2020 Jul 11;26(4):513-519. Epub 2019 Dec 11.

Department of Dermatology, University of Pisa, Pisa, Italy.

Background: Hidradenitis suppurativa is a chronic inflammatory skin disease. An ultrasound staging (SOS-HS) using frequencies from 7 to 18 MHz has been proposed to evaluate the severity of the disease.

Materials And Methods: We retrospectively evaluated the most significant lesions in 50 patients with hidradenitis suppurativa (32 females and 18 males, aged from 12 to 68 years old), who had undergone high-frequency ultrasound (HFUS) (18-22 MHz) and ultra-high frequency ultrasound (UHFUS) (48 and 70 MHz). A MyLab™ Touch system (Esaote) equipped with a 18-22 MHz linear probe was used for the HFUS, and a Vevo MD (VisualSonics) was used for the UHFUS, equipped with two linear probes (70 and 48 MHz).

Results: A total of 116 lesions were observed, of which 66 were fluid collections, 32 were tunnels, 6 pseudocysts, 5 bridge scars, 5 tombstone comedones, and 2 granulation tissues. Structures that had already been described with HFUS were then observed with UHFUS but with a better definition. In addition, structures that had not been detected by HFUS were also observed with UHFUS such as drop-shaped hair follicles, micro-tunnels, and microcysts.

Conclusion: Ultra-high frequency ultrasound provides a better understanding of hidradenitis suppurativa. Patients can be monitored more effectively thereby preventing the most severe changes.
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http://dx.doi.org/10.1111/srt.12823DOI Listing
July 2020

Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS.

J Ultrasound 2020 Dec 18;23(4):515-520. Epub 2019 Nov 18.

Department of Radiology, Careggi University Hospital, Florence, Italy.

Purpose: To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam.

Methods: In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern.

Results: Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation.

Conclusions: CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.
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http://dx.doi.org/10.1007/s40477-019-00413-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588569PMC
December 2020

Intraoral Ultra-High Frequency Ultrasound study of oral lichen planus: A pictorial review.

Skin Res Technol 2020 Mar 24;26(2):200-204. Epub 2019 Sep 24.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, Pisa, Italy.

Background: Ultra-High Frequency Ultrasound (UHFUS) is a recently introduced diagnostic technique involving the use of higher frequencies compared to conventional ultrasound. Among the several fields of application, intraoral usage of UHFUS appears still limited. We report the intraoral evaluation of Oral Lichen Planus (OLP) by means of UHFUS and describe typical UHFUS aspect of different forms of presentation of OLP.

Materials And Methods: Patients with clinical and histological diagnosis of OLP were enrolled in the study. OLP lesions were evaluated by means of intraoral UHFUS performed at 70 MHz, using B-mode and C-mode, in order to characterize the echostructure of each form of presentation.

Results: Fifty patients in total were enrolled, and UHFUS features were described for different OLP forms. All the lesions showed a thick, hypoechoic superficial layer in the mucosal stratum, suggesting that such UHFUS alteration can be pathognomonic of OLP.

Conclusion: Ultra-High Frequency Ultrasound was able to differentiate superficial alterations of the oral mucosa, giving insight on possible applications of UHFUS in the study of OLP beyond clinical and histological investigations. Due to a limited study sample, we cannot draw firm conclusions. However, it is reasonable to think that UHFUS evaluation of OLP may provide useful information to the clinician.
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http://dx.doi.org/10.1111/srt.12777DOI Listing
March 2020

Percutaneous Venous Angioplasty in Patients with Multiple Sclerosis and Chronic Cerebrospinal Venous Insufficiency: A Randomized Wait List Control Study.

Ann Vasc Surg 2020 Jan 22;62:275-286. Epub 2019 Aug 22.

Unit of Vascular Surgery, Department of Traslational Research and New Technologies in Medicine and Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Background: Venous percutaneous transluminal angioplasty (vPTA) in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) have shown contradictory results. The aim of the study is to evaluate the efficacy of the procedure in a randomized wait list control study.

Methods: 66 adults with neurologist-confirmed diagnosis of MS and sonographic diagnosis of CCSVI were allocated into vPTA-yes group (n = 31) or vPTA-not group (n = 35, control group). vPTA was performed immediately 15 days after randomization in the PTA-yes group and 6 months later in the control group. Evoked potentials (EPs), clinical-functional measures (CFMs), and upper limb kinematic measures (ULKMs) were measured at baseline (T0) and six months after in both groups, just before the venous angioplasty in the vPTA-not group (T1).

Results: Comparing the vPTA-yes and vPTA-not group, the CFM-derived composite functional outcome showed 11 (37%) versus 7 (20%) improved, 1 (3%) versus 3 (8%) stable, 0 versus 7 (20%) worsened, and 19 (61%) versus 18 (51%) mixed patients (χ = 8.71, df = 3, P = 0.03). Unadjusted and adjusted (for baseline confounding variables) odds ratio at 95% confidence interval were, respectively, 1.93 (1.3-2.8), P value 0.0007, and 1.85 (1.2-1.7), P value 0.002. EP- and ULKM-derived composite functional outcome showed no significant difference between the two groups.

Conclusions: Venous angioplasty can positively impact a few CFMs especially for the quality of life but achieving disability improvement is unlikely.
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http://dx.doi.org/10.1016/j.avsg.2019.05.018DOI Listing
January 2020

Early Tumor Shrinkage and Depth of Response Evaluation in Metastatic Pancreatic Cancer Treated with First Line Chemotherapy: An Observational Retrospective Cohort Study.

Cancers (Basel) 2019 Jul 4;11(7). Epub 2019 Jul 4.

Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy.

Early tumor shrinkage (ETS) and depth of response (DoR) predict favorable outcomes in metastatic colorectal cancer. We aim to evaluate their prognostic role in metastatic pancreatic cancer (PC) patients treated with first-line modified-FOLFIRINOX (FOLFOXIRI) or Gemcitabine + Nab-paclitaxel (GemNab). Hence, 138 patients were tested for ETS, defined as a ≥20% reduction in the sum of target lesions' longest diameters (SLD) after 6-8 weeks from baseline, and DoR, i.e., the maximum percentage shrinkage in the SLD from baseline. Association of ETS and DoR with progression-free survival (PFS) and overall survival (OS) was assessed. ETS was reached in 49 patients (39.5% in the FOLFOXIRI, 29.8% in the GemNab group; = 0.280). In the overall population, ETS was significantly associated with better PFS (8.0 vs. 4.8 months, < 0.001) and OS (13.2 vs. 9.7 months, = 0.001). Median DoR was -27.5% (-29.4% with FOLFOXIRI and -21.4% with GemNab, = 0.016): DoR was significantly associated with better PFS (9.0 vs. 6.7 months, < 0.001) and OS (14.3 vs. 11.1 months, = 0.031). Multivariate analysis confirmed both ETS and DoR are independently associated with PFS and OS. In conclusion, our study added evidence on the role of ETS and DoR in the prediction of outcome of PC patients treated with first-line combination chemotherapy.
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http://dx.doi.org/10.3390/cancers11070939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678367PMC
July 2019

Evidence-based Clinical Decision Support Systems for Suspected Pulmonary Embolism: Are We Ready to Go?

Acad Radiol 2019 08 22;26(8):1084-1086. Epub 2019 May 22.

Department of Diagnostic and Interventional Radiology, University of Pisa. Via Paradisa, 2 - 56100 Pisa, Italy.

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http://dx.doi.org/10.1016/j.acra.2019.04.007DOI Listing
August 2019

Cone Beam CT study of a case of eosinophilic granuloma of the mandible in a young patient.

BMJ Case Rep 2019 May 5;12(5). Epub 2019 May 5.

Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.

Eosinophilic granuloma (EG) is a rare bony disease deriving from abnormal proliferation of histiocytes, and is the most common form of presentation of Langerhans cell histiocytosis. EG predominantly affects the axial skeleton. However, when localised in the head and neck district, mandibular lesions account for the majority of cases. Mandibular lesions can mimic other pathological conditions, making biopsy fundamental for differential diagnosis. Treatment depends on the severity of the disease, ranging from pharmacological treatment to surgical approach. However, EG is also reported to possibly undergo spontaneous resolution. In this case report, we describe a rare case of EG with particularly aggressive behaviour in a young patient. Initially, local pharmacological treatment with intralesional administration of corticosteroids lead to worsening of the symptoms, increase in lesion's dimensions, and disruption of the cortical bone. A more invasive therapeutic approach involving radical surgery was then performed, with consequent resolution of the disease.
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http://dx.doi.org/10.1136/bcr-2018-228455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506101PMC
May 2019

3 T MR perfusion of solid pancreatic lesions using dynamic contrast-enhanced DISCO sequence: Usefulness of qualitative and quantitative analyses in a pilot study.

Magn Reson Imaging 2019 06 14;59:105-113. Epub 2019 Mar 14.

Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. Electronic address:

Purpose: To assess the usefulness of qualitative and quantitative analyses of pancreatic focal diseases by using the dynamic contrast-enhanced Differential Subsampling with Cartesian Ordering (DISCO) sequence at 3 T MR device.

Materials And Methods: Ten patients without pancreatic diseases and twenty-five patients with pathologically confirmed pancreatic focal disease (ductal adenocarcinoma, n = 14; endocrine tumour, n = 8; focal chronic pancreatitis, n = 3), underwent MRI by 3 T-device. Multiphasic contrast-enhanced MR perfusion, consisting of a 3D axial navigator, based free-breathing T1-weighted DISCO sequence, was repeated for 5 min. A dose of 0.1 mL/kg of Gadobutrolo with a 20 mL saline flush was injected at a flow rate of 5 mL/s. Perfusion MRI were processed using a dedicated software package (GeniQ; GE Healthcare), obtaining both a time-signal-intensity curve (TSIC) and perfusion maps for each healthy pancreatic parenchyma and focal disease. The TSIC were grouped into four types according to their shapes and the MR perfusion parameters (Ktrans, Kep, Ve, IAUGC) were calculated. The one-way analysis of variance and the Student's t-test were used to correlate the quantitative and qualitative parameters with the tissue histology.

Results: All 10 patients with healthy pancreas presented a TSIC-type 1; TSIC-type 2 was observed in all 14 ductal adenocarcinomas and in one neuroendocrine tumour; TSIC-type 3 was recognized in the remaining 7 neuroendocrine neoplasms; TSIC-type 4 was identified in all 3 focal chronic pancreatitis. All perfusion parameters were significantly different (p < 0.0001) for each type of lesion. Furthermore, Ve was also very useful to discriminate between normal and pathological tissues (p = 0.0005).

Conclusion: Qualitative and quantitative analyses of contrast-enhanced 3 T MR perfusion, using the dynamic contrast-enhanced DISCO sequence, could be considered an interesting tool to improve the diagnosis of focal pancreatic diseases, of solid lesions in particular. Further investigations with prospective larger sample studies are required to confirm these preliminary results.
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http://dx.doi.org/10.1016/j.mri.2019.03.001DOI Listing
June 2019

Three-Dimensional Echographic Evaluation of Carotid Artery Disease.

J Cardiovasc Echogr 2018 Oct-Dec;28(4):218-227

Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy.

The introduction of three-dimensional echography (3D echo) in vascular field is not recent, but it still remains a seldom-used technique because of the costs of ultrasound probe and the need of dedicated laboratories. Therefore, despite significant prognostic implications, the high diagnostic accuracy in plaque definition, and the relative ease of use, 3D echo in vascular field is a niche technique. The purpose of this review is mainly clinical and intends to demonstrate the potential strength of a 3D approach, including technical aspects, in order to present to clinicians and imagers the appealing aspects of a noninvasive and radiation-free methodology with relevant diagnostic and prognostic correlates in the assessment of carotid atherosclerosis. A comprehensive literature search (since 1990s to date) using the PubMed, MEDLINE, and Cochrane libraries databases has been conducted. Articles written in English have been assessed, including reviews, clinical trials, meta-analyses, and interventional/observational studies. Manual cross-referencing was also performed, and relevant references from selected articles were reviewed. The search was limited to studies conducted in humans. Search terms, retrieved also with PubMed Advanced search and AND/OR Boolean operators (mainly in title and abstract), included three-dimensional, echo, stroke/transient ischemic attack, predictors, carotid, imaging, and biomarkers.
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http://dx.doi.org/10.4103/jcecho.jcecho_57_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341847PMC
February 2019