Publications by authors named "Francesco Mazzei"

33 Publications

Dual energy CT in gland tumors: a comprehensive narrative review and differential diagnosis.

Gland Surg 2020 Dec;9(6):2269-2282

Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.

Dual energy CT (DECT)with image acquisition at two different photon X-ray levels allows the characterization of a specific tissue or material/elements, the extrapolation of virtual unenhanced and monoenergetic images, and the quantification of iodine uptake; such special capabilities make the DECT the perfect technique to support oncological imaging for tumor detection and characterization and treatment monitoring, while concurrently reducing the dose of radiation and iodine and improving the metal artifact reduction. Even though its potential in the field of oncology has not been fully explored yet, DECT is already widely used today thanks to the availability of different CT technologies, such as dual-source, single-source rapid-switching, single-source sequential, single-source twin-beam and dual-layer technologies. Moreover DECT technology represents the future of the imaging innovation and it is subject to ongoing development that increase according its clinical potentiality, in particular in the field of oncology. This review points out recent state-of-the-art in DECT applications in gland tumors, with special focus on its potential uses in the field of oncological imaging of endocrine and exocrine glands.
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http://dx.doi.org/10.21037/gs-20-543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804546PMC
December 2020

Magnetic resonance lymphangiography: with or without contrast?

Diagn Interv Radiol 2020 Nov;26(6):587-595

Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

Lymphedema is an important medical issue around the world, caused by an anomalous collection of fluid in soft tissue due to congenital malformations or stenosis or obstruction of lymphatic vessels. Magnetic resonance lymphangiography (MRL) is an emerging technique focused on noninvasive or minimally invasive imaging of lymphatics with the goal to diagnose and treat lymphedema. This review will briefly discuss lymphatic imaging starting with lymphography and radionuclide lymphoscintigraphy up to the newest methods, focusing on MRL, a rising technique, and highlighting the technical aspects fundamental for achieving high-resolution MRL.
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http://dx.doi.org/10.5152/dir.2020.19482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664753PMC
November 2020

Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position.

Cancers (Basel) 2020 Aug 21;12(9). Epub 2020 Aug 21.

Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.

Background: To assess the feasibility, image quality and diagnostic value of contrast-enhanced breast magnetic resonance imaging (MRI) performed in a supine compared to a prone position.

Methods: One hundred and fifty-one patients who had undergone a breast MRI in both the standard prone and supine position were evaluated retrospectively. Two 1.5 T MR scanners were used with the same image resolution, sequences and contrast medium in all examinations. The image quality and the number and dimensions of lesions were assessed by two expert radiologists in an independent and randomized fashion. Two different classification systems were used. Histopathology was the standard of reference.

Results: Two hundred and forty MRIs from 120 patients were compared. The analysis revealed 134 MRIs with monofocal (U), 68 with multifocal (M) and 38 with multicentric (C) lesions. There was no difference between the image quality and number of lesions in the prone and supine examinations. A significant difference in the lesion extension was observed between the prone and supine position. No significant differences emerged in the classification of the lesions detected in the prone compared to the supine position.

Conclusions: It is possible to perform breast MRI in a supine position with the same image quality, resolution and diagnostic value as in a prone position. In the prone position, the lesion dimensions are overestimated with a higher wash-in peak than in the supine position.
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http://dx.doi.org/10.3390/cancers12092364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564182PMC
August 2020

MRL as one-shot examination for patients suffering from lymphedema.

Radiol Med 2020 Aug 17;125(8):798-799. Epub 2020 Mar 17.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy.

MR lymphangiography (MRL) is an emerging technique focalized on a noninvasive or minimally invasive imaging of lymphatics with the goal to treat and plan lymphedema. Doctor Cellina M. and colleagues clearly underlined the possible role of MRL with volume calculation as an objective mark also in evaluating response to treatment. In this Letter to the Editor, we would like to highlight the rising role of MRL, pointing out the advantages of both the non-contrast and contrast-enhanced approach, in lymphatic vessels study.
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http://dx.doi.org/10.1007/s11547-020-01162-6DOI Listing
August 2020

Non-occlusive Mesenteric Ischemia as a Fatal Complication in Acute Pancreatitis: A Brief Radiological Comment.

Dig Dis Sci 2020 05 24;65(5):1553-1555. Epub 2020 Feb 24.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy.

Non-occlusive mesenteric ischemia (NOMI) is the result of the reduction of mesenteric blood supply, due to mesenteric arterial vasoconstriction secondary to hypotension in cases of shock, septicemia, dehydration, heart surgery, or major abdominal surgery. NOMI represents a complex and often misdiagnosed syndrome. Imaging, and in particular CT, has a remarkable importance in NOMI, and despite its complexity, it could allow an early diagnosis and an improved management resulting in life-threatening therapeutic approaches, much better than in the past, provided it is correctly performed and interpreted by experienced radiologists.
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http://dx.doi.org/10.1007/s10620-020-06150-4DOI Listing
May 2020

Update in diagnostic imaging of the thymus and anterior mediastinal masses.

Gland Surg 2019 Sep;8(Suppl 3):S188-S207

Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

Anterior mediastinal masses include a wide spectrum of malignant and benign pathologies with a large percentage represented by thymic lesions. Distinguishing these masses on diagnostic imaging is fundamental to guide the proper management for each patient. This review illustrates possibilities and limits of different imaging modalities to diagnose a lesion of the anterior mediastinum with particular attention to thymic disease.
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http://dx.doi.org/10.21037/gs.2019.05.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755948PMC
September 2019

Magnetic resonance imaging of the sacroiliac joints in SpA: with or without intravenous contrast media? A preliminary report.

Radiol Med 2019 Nov 13;124(11):1142-1150. Epub 2019 Mar 13.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy.

Object: Active sacroiliitis based on magnetic resonance imaging (MRI) without intravenous (I.V.) contrast material injection is considered sufficient for the diagnosis of spondyloarthritis (SpA), according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. This work shows the added value of administering I.V. contrast material when evaluating the response to tumor necrosis factor (TNF) antagonists therapy, on the extension of bone marrow oedema (BMO) and pathological enhancement (osteitis/synovitis) in the sacroiliac joints (SIJs) on MRI.

Materials And Methods: Forty-three patients (25 females and 18 males, mean age of 54 ± 16.60 years, range 22-75 years) with a clinical diagnosis of SpA and active sacroiliitis at MRI with I.V. contrast material, were considered for a follow-up MRI after 6 months of TNF antagonists therapy. Disease activity was monitored by a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire. Descriptive statistics, Student's t test and Cohen's kappa were used. P < 0.05 was considered statistically significant.

Results: Thirty-eight patients were finally included in the study; 36 of them showed an improvement on clinical assessment after therapy. Score's difference (improvement) after treatment was calculated in the MRI sequences both with and without contrast agent (respectively, mean value and range 3.18, 0-12 with contrast and 1.63, 0-7 without contrast). This improvement was statistically significant in each group (P value of 7.097e-08 with contrast and 6.741e-06 without contrast), and there was a significant difference between the two group too (P-value of 8.598e-07). Cohen's kappa for dichotomous variables showed a better agreement between the post-contrast MRI findings and BASDAI (K = 0.53, agreement = 92.11%, P = 0.0001) than MRI without contrast and BASDAI (K = 0.11, agreement = 57.89%, P = 0.06).

Conclusions: The evaluation of enhancement is a reliable tool for the assessment of the response to therapy in SIJs involvement in SpA, better than BMO; hence, it should be advised in the MRI of these patients.
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http://dx.doi.org/10.1007/s11547-019-01016-wDOI Listing
November 2019

Occupational Lung Diseases: Underreported Diagnosis in Radiological Practice.

Semin Ultrasound CT MR 2019 Feb 3;40(1):36-50. Epub 2018 Nov 3.

Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Italy.

Underreporting of occupational lung diseases is a widespread problem in clinical practice. In Europe there is not a common regulation even for the recognition of occupational cancers. Furthermore epidemiologic data on occupational interstitial lung diseases, in general, is limited by no standardized diagnostic criteria, varied physician awareness and training, limitations inherent to the various data sources, and the long latency period. Therefore, to optimize the management of the patient with occupational pathology, the collaboration and skills of the multidisciplinary at the service of the patient, play a fundamental role. In particular, radiologists should give substance to a clinical suspicion on an anamnestic basis and at the same time should recognize patterns of illness that can lead to the emergence of stories of misunderstood exposures. This article aims to provide an overview of the main occupational lung diseases with attention to diagnostic possibilities of the different imaging techniques. The issue of the radiological error is investigated, providing tools to minimize it in the daily practice.
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http://dx.doi.org/10.1053/j.sult.2018.10.019DOI Listing
February 2019

Efficacy of Second-Look Ultrasound with MR Coregistration for Evaluating Additional Enhancing Lesions of the Breast: Review of the Literature.

Biomed Res Int 2018 21;2018:3896946. Epub 2018 Oct 21.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy.

Contrast enhanced magnetic resonance imaging (CE-MRI) has acquired a central role in the field of diagnosis and evaluation of breast cancer due to its high sensitivity; on the other hand, MRI has shown a variable specificity because of the wide overlap between the imaging features of benign and malignant lesions. Therefore, when an additional breast lesion is identified at CE-MRI, a second look with targeted US is generally performed because it provides additional information to further characterise the target lesion and makes it possible to perform US-guided biopsies which are costless and more comfortable for patients compared with MRI-guided ones. Nevertheless, there is not always a correspondence between CE-MR findings and targeted US due to several factors including different operator's experience and position of patients. A new technique has recently been developed in order to overcome these limitations: US with MR coregistration, which can synchronise a sonography image and the MR image with multiplanar reconstruction (MPR) of the same section in real time. The aim of our study is to review the literature concerning the second look performed with this emerging and promising technique, showing both advantages and limitations in comparison with conventional targeted US.
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http://dx.doi.org/10.1155/2018/3896946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215588PMC
February 2019

Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery: Don't forget the reperfusion process!

Br J Radiol 2019 01 4;92(1093):20180736. Epub 2018 Oct 4.

Department of Medicine, Surgery and Neuroscience, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

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http://dx.doi.org/10.1259/bjr.20180736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435074PMC
January 2019

Gastric Cancer Maximum Tumour Diameter Reduction Rate at CT Examination as a Radiological Index for Predicting Histopathological Regression after Neoadjuvant Treatment: A Multicentre GIRCG Study.

Gastroenterol Res Pract 2018 15;2018:1794524. Epub 2018 Mar 15.

Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.

Aim: To investigate the role of maximum tumour diameter (D-max) reduction rate at CT examination in predicting histopathological tumour regression grade (TRG according to the Becker grade), after neoadjuvant chemotherapy (NAC), in patients with resectable advanced gastric cancer (AGC).

Materials And Methods: Eighty-six patients (53 M, mean age 62.1 years) with resectable AGC (≥T3 or N+), treated with NAC and radical surgery, were enrolled from 5 centres of the Italian Research Group for Gastric Cancer (GIRCG). Staging and restaging CT and histological results were retrospectively reviewed. CT examinations were contrast enhanced, and the stomach was previously distended. The D-max was measured using 2D software and compared with Becker TRG. Statistical data were obtained using "R" software.

Results: The interobserver agreement was good/very good. Becker TRG was predicted by CT with a sensitivity and specificity, respectively, of 97.3% and 90.9% for Becker 1 (D-max reduction rate > 65.1%), 76.4% and 80% for Becker 3 (D-max reduction rate < 29.9%), and 70.8% and 83.9% for Becker 2. Correlation between radiological and histological D-max measurements was strongly confirmed by the correlation index (c.i.= 0.829).

Conclusions: D-max reduction rate in AGC patients may be helpful as a simple and reproducible radiological index in predicting TRG after NAC.
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http://dx.doi.org/10.1155/2018/1794524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875045PMC
March 2018

Imaging of the thymus in myotonic dystrophy type 1.

Neurol Sci 2018 Feb 25;39(2):347-351. Epub 2017 Nov 25.

Unit of Neurology and Neurometabolic Disorders, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci 2, 53100, Siena, Italy.

The occurrence of thymoma in myotonic dystrophy type 1 (DM1) has been occasionally reported, and an increased risk of tumors has been observed. We performed imaging of the thymus in 22 patients carrying DMPK expansion. Clinical examination and routine instrumental exams were performed at the same time. We observed no thymic abnormalities in 13 subjects, thymic hyperplasia in eight patients, and an invasive thymoma in one case. Subjects with thymic abnormalities did not show peculiarities as regards clinical and electrophysiological features. We observed thymoma in one patient with an expansion in the higher range. Abnormalities of the thymus including hyperplasia and thymoma can be present in DM1, but do not seem to play a major role in DM1 pathogenesis. Further studies are needed to understand if some RNA splicing factors involved in DM1 and influenced by CTG expansion size could have a role in thymocytes proliferation.
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http://dx.doi.org/10.1007/s10072-017-3202-4DOI Listing
February 2018

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

World J Radiol 2017 Jul;9(7):304-311

Maria Antonietta Mazzei, Susanna Guerrini, Francesco Gentili, Luca Volterrani, Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.

Aim: To validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.

Methods: We conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years' experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.

Results: There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.

Conclusion: HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.
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http://dx.doi.org/10.4329/wjr.v9.i7.304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529319PMC
July 2017

High-resolution MR lymphangiography for planning lymphaticovenous anastomosis treatment: a single-centre experience.

Radiol Med 2017 Dec 2;122(12):918-927. Epub 2017 Aug 2.

Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.

Purpose: This article illustrates the feasibility of MR lymphangiography (MRL) for imaging lymphatic vessels in patients with lymphedema, its accuracy in distinguishing lymphatic vessels from veins, and its utility for planning Lymphaticovenous anastomosis (LVA) treatment.

Materials And Methods: We prospectively enrolled 30 patients (24 women, range 18-70, 17 cases of lower limb lymphedema, 6 cases of primary lymphedema). All the patients underwent MRL, using a 1.5T MR unit (Signa Twin Speed Hdxt; GE), after the subcutaneous injection of gadobenate dimeglumine (Gd-BOPTA) with a little dose of lidocaine into the interdigital webs of the dorsal foot or hand. Lymphatic vessels identified for the LVA at MRL were histologically confirmed after surgery. Enhancement of lymphatic vessels and veins at different times after injection of contrast medium and their diameters were measured.

Results: A total of 79 lymphatic vessels were clearly identified in 29 patients at MRL; their morphology was tortuous in 22 patients and rectilinear in 7, whereas, the adjacent veins were straight with focal bulging only at the level of venous valve; the enhancement kinetic of the two different structures were different (p < 0.05) but the mean diameter of affected lymphatic vessels was similar to the adjacent veins (p > 0.05). Thirty-four out of 38 specimens of presumed lymphatic vessels at MRL, collected during surgery, resulted positive at the immunoistochemical marker d2-40, with a significant association (Chi-square = 40.421, DF = 1, p < 0.05, contingency coefficent 0.644). One patient had an early complication 1 month after treatment.

Conclusions: MRL is easy and safe to use and combines extensive information on the anatomy and functionality of lymphatic vessels and veins in a single process; therefore, it could be useful in LVA treatment planning and evaluating possible super-microsurgical treatment complications in patients with lymphedema.
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http://dx.doi.org/10.1007/s11547-017-0795-xDOI Listing
December 2017

Incidental and Underreported Pleural Plaques at Chest CT: Do Not Miss Them-Asbestos Exposure Still Exists.

Biomed Res Int 2017 5;2017:6797826. Epub 2017 Jun 5.

Department of Medicine, Surgery and Neuroscience, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.

Pleural plaques (PPs) may be a risk factor for mortality from lung cancer in asbestos-exposed workers and are considered to be a marker of exposure. Diagnosing PPs is also important because asbestos-exposed patients should be offered a health surveillance that is mandatory in many countries. On the other hand PPs are useful for compensation purposes. In this study we aimed to evaluate the prevalence, as incidental findings, and the underreporting rate of PPs in chest CT scans (CTs) performed in a cohort of patients (1512) who underwent chest CT with a slice thickness no more than 1.25 mm. PPs were found in 76 out of 1482 patients (5.1%); in 13 out of 76 (17,1%) CTs were performed because of clinical suspicion of asbestos exposure and 5 of them (38%) were underreported by radiologist. In the remaining 63 cases (82.9%) there was no clinical suspicion of asbestos exposure at the time of CTs (incidental findings) and in 38 of these 63 patients (60.3%) PPs were underreported. Reaching a correct diagnosis of PPs requires a good knowledge of normal locoregional anatomy and rigorous technical approach in chest CT execution. However the job history of the patient should always be kept in mind.
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http://dx.doi.org/10.1155/2017/6797826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474542PMC
March 2018

MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View.

Biomed Res Int 2017 7;2017:2598358. Epub 2017 Mar 7.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy.

We propose a practical approach for performing high-resolution MR lymphangiography (MRL). We shall discuss and illustrate the technical approach for the visualization of lymphatic vessels in patients suffering from lymphedema, how to distinguish lymphatic vessels from veins, and MRL role in supermicrosurgery treatment planning. A brief review of literature, from a technical point of view, is also reported.
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http://dx.doi.org/10.1155/2017/2598358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359436PMC
April 2017

Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications.

World J Radiol 2016 May;8(5):530-6

Maria Antonietta Mazzei, Susanna Guerrini, Nevada Cioffi Squitieri, Dario Notaro, Luca Volterrani, Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.

Aim: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard.

Methods: For this prospective study we enrolled 163 patients (123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d.

Results: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively.

Conclusion: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases.
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http://dx.doi.org/10.4329/wjr.v8.i5.530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882410PMC
May 2016

Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting.

Br J Radiol 2016 5;89(1061):20150956. Epub 2016 Feb 5.

1 Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy.

Objective: To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting.

Methods: A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n = 8), autopsy (n = 2), angiography (n = 1) or endoscopy (n = 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, Kolmogorov-Smirnov (K-S) and Fisher's exact tests were used for statistical analysis.

Results: A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D = 0.75, p = 3.7 × 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p = 0.026), bowel wall thickening (p = 3.2 × 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p = 2.8 × 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p = 0.034).

Conclusion: Analysis of not only vessels findings but also mesentery and bowel CT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists.

Advances In Knowledge: CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting.
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http://dx.doi.org/10.1259/bjr.20150956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985474PMC
September 2016

Magnetic resonance lymphangiography: How to prove it?

J Magn Reson Imaging 2016 08 11;44(2):509-10. Epub 2016 Jan 11.

Department of Maxillofacial Surgery, "Sapienza" University of Rome, Rome, Italy.

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http://dx.doi.org/10.1002/jmri.25147DOI Listing
August 2016

Ischemic colitis diagnosed by magnetic resonance imaging during lenalidomide treatment in a patient with relapsed multiple myeloma.

Tumori 2016 Nov 11;102(Suppl. 2). Epub 2016 Nov 11.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena - Italy.

Introduction: Multiple myeloma is the second most common hematological neoplasm that also affects young patients. The progression-free survival after autologous stem cell transplant has improved with the introduction of several novel agents such as lenalidomide, which may, however, increase the risk of adverse events.

Methods: We describe the case of a 54-year-old woman with relapse of multiple myeloma 3 years after myeloablative allogeneic stem cell transplant who developed abdominal pain and bloody diarrhea following 7 months of lenalidomide therapy.

Results: Abdominal plain x-ray and magnetic resonance imaging (MRI) without intravenous contrast material showed left-sided and splenic flexure acute ischemic colitis with reperfusion phenomena. Continuous intravenous infusion of unfractionated heparin was given with metronidazole and meropenem and the patient improved within a few days. MRI performed 15 days later confirmed complete recovery of ischemic colitis.

Conclusions: To our knowledge there have been no previously reported cases of ischemic colitis during lenalidomide therapy as a single agent in relapsed or refractory multiple myeloma, in particular promptly diagnosed by MRI.
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http://dx.doi.org/10.5301/tj.5000392DOI Listing
November 2016

Reduced time CT perfusion acquisitions are sufficient to measure the permeability surface area product with a deconvolution method.

Biomed Res Int 2014 12;2014:573268. Epub 2014 Aug 12.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Viale Bracci 10, 53100 Siena, Italy.

Objective: To reduce the radiation dose, reduced time CT perfusion (CTp) acquisitions are tested to measure permeability surface (PS) with a deconvolution method.

Methods And Materials: PS was calculated with repeated measurements (n = 305) while truncating the time density curve (TDC) at different time values in 14 CTp studies using CTp 4D software (GE Healthcare, Milwaukee, WI, US). The median acquisition time of CTp studies was 59.35 sec (range 49-92 seconds). To verify the accuracy of the deconvolution algorithm, a variation of the truncated PS within the error measurements was searched, that is, within 3 standard deviations from the mean nominal error provided by the software. The test was also performed for all the remaining CTp parameters measured.

Results: PS maximum variability happened within 25 seconds. The PS became constant after 40 seconds for the majority of the active tumors (10/11), while for necrotic tissues it was consistent within 1% after 50 seconds. A consistent result lasted for all the observed CTp parameters, as expected from their analytical dependance.

Conclusion: 40-second acquisition time could be an optimal compromise to obtain an accurate measurement of the PS and a reasonable dose exposure with a deconvolution method.
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http://dx.doi.org/10.1155/2014/573268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145384PMC
September 2015

CT perfusion in the characterisation of renal lesions: an added value to multiphasic CT.

Biomed Res Int 2014 13;2014:135013. Epub 2014 Aug 13.

Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Viale Bracci 10, 53100 Siena, Italy.

Objective: To prospectively evaluate if computed tomography perfusion (CTp) could be a useful tool in addition to multiphasic CT in renal lesion characterisation.

Materials And Methods: Fifty-eight patients that were scheduled for surgical resection of a renal mass with a suspicion of renal cell carcinoma (RCC) were enrolled. Forty-one out of 58 patients underwent total or partial nephrectomy after CTp examination, and a pathological analysis was obtained for a total of 49 renal lesions. Perfusion parameters and attenuation values at multiphasic CT for both lesion and normal cortex were analysed. All the results were compared with the histological data obtained following surgery.

Results: PS and MTT values were significantly lower in malignant lesions than in the normal cortex (P < 0.001 and P = 0.011, resp.); PS, MTT, and BF values were also statistically different between oncocytomas and malignant lesions. According to ROC analysis, the accuracy, sensitivity, and specificity to predict RCC were 95.92%, 100%, and 66.7%, respectively, for CTp whereas they were 89.80%, 93.35%, and 50%, respectively, for multiphasic CT.

Conclusion: A significant difference between renal cortex and tumour CTp parameter values may suggest a malignant renal lesion. CTp could represent an added value to multiphasic CT in differentiating renal cells carcinoma from oncocytoma.
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http://dx.doi.org/10.1155/2014/135013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145536PMC
May 2015

Exploring the Influence of Environment on the Spatial Behavior of Older Adults in a Purpose-Built Acute Care Dementia Unit.

Am J Alzheimers Dis Other Demen 2014 Jun 31;29(4):311-9. Epub 2013 Dec 31.

Department of Geography and Centre on Aging, Victoria, BC, V8P 5C2, Canada

Limited research explores the experience of individuals with dementia in acute care geriatric psychiatry units. This observational case study examines the influence of the physical environment on behavior (wandering, pacing, door testing, congregation and seclusions) among residents in a traditional geriatric psychiatry unit who were then relocated to a purpose-built acute care unit. Purpose-built environments should be well suited to the needs of residents with dementia. Observed trends revealed differences in spatial behaviors in the pre- and post- environments attributable to the physical environment. Person-centred modifications to the current environment including concerted efforts to know residents are meaningful in fostering quality of life. Color coded environments (rooms vs dining areas etc.) to improve wayfinding and opportunities to personalize rooms that address the `hominess' of the setting also have potential. Future research could also seek the opinions of staff about the impact of the environment on them as well as residents.
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http://dx.doi.org/10.1177/1533317513517033DOI Listing
June 2014

[Quantitative CT perfusion measurements in characterization of solitary pulmonary nodules: new insights and limitations].

Recenti Prog Med 2013 Jul-Aug;104(7-8):430-7

Although computed tomography (CT) scans remain the basis of morphologic evaluation in the characterization of solitary pulmonary nodules (SPNs), perfusion CT can represent an additional feasible technique offering reproducible measurements, at least in SPNs with a diameter >10 mm. In particular, CT perfusion could reduce the number of SPNs, diagnosed as undetermined at morphologic CT, avoiding long term follow-up CT, FDG-PET studies, biopsy or unnecessary surgery with a significant reduction in healthcare costs. In order to reduce the radiation dose, an optimization of the CT perfusion protocol could be obtained using axial mode acquisition, using shorter acquisition time and adaptative statistical iterative reconstruction algorithm.
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http://dx.doi.org/10.1701/1315.14591DOI Listing
December 2013

Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).

Abdom Imaging 2013 Dec;38(6):1422-30

Section of Radiological Sciences, Department of Medical, Surgical and Neuro Sciences, University of Siena, Viale Bracci 10, 53100, Siena, Italy,

Purpose: To evaluate the accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent a peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant chemotherapy to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction surgery.

Materials And Methods: Pre-HIPEC CT examinations of 43 patients with advanced ovarian cancer after neoadjuvant chemotherapy were analyzed by two radiologists. The PCI was scored according to the Sugarbaker classification, based on lesion size and distribution. The results were compared with macroscopic and histologic data after peritonectomy and HIPEC. To evaluate the accuracy of MDCT to detect and localize peritoneal carcinomatosis, both patient-level and regional-level analyses were conducted. A correlation between PCI CT and histologic values for each patient was searched according to the PCI grading.

Results: Considering the patient-level analysis, CT shows a sensitivity, specificity, PPV, NPV, and an accuracy in detecting the peritoneal carcinomatosis of 100 %, 40 %, 93 % 100 %, and 93 %, respectively. Considering the regional level analysis, a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 72 %, 80 %, 66 %, 84 %, and 77 %, respectively were obtained for the correlation between CT and histology.

Conclusion: Our results encourage the use of MDCT as the only technique sufficient to select patients with peritoneal carcinomatosis for cytoreductive surgery and HIPEC on the condition that a CT examination will be performed using a dedicated protocol optimized to detect minimal peritoneal disease and CT images will be analyzed by an experienced reader.
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http://dx.doi.org/10.1007/s00261-013-0013-9DOI Listing
December 2013

Differences in perfusion CT parameter values with commercial software upgrades: a preliminary report about algorithm consistency and stability.

Acta Radiol 2013 Sep 30;54(7):805-11. Epub 2013 Apr 30.

Department of Human Pathology and Oncology, Section of Radiological Sciences, University of Siena, Siena.

Background: Computed tomographic perfusion (CTp) imaging is a promising technique that allows functional imaging, as an adjunct to a morphologic CT examination, that can be used as an aid to carefully evaluate the response to therapy in oncologic patients. Considering this statement, it could be desirable that the measurements obtained with the CT perfusion software, and their upgrades, are consistent and reproducible.

Purpose: To determine how commercial software upgrades impact on algorithm consistency and stability among the three version upgrades of the same platform in a preliminary study.

Material And Methods: Blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface area product (PS) were calculated with repeated measurements (n = 1119) while truncating the time density curve at different time values in six CT perfusion studies using CT perfusion software version 4D (CT Perfusion 4D), then repeated with the previous version (CT Perfusion 3.0 and CT Perfusion 4.0), using a fixed ROI both for arterial input and target lesion. The software upgrades were compared in pairs by applying a Kolmogorov-Smirnov test to all the parameters measured. Stability and reliability of the three versions were verified through the variation of the truncated parameters.

Results: The three software versions provided different parent distributions for approximately 80% of the 72 parameters measured. A complete agreement was found only for one patient in version 3.0 vs. 4.0 and 3.0 vs. 4D. Perfusion 4.0 vs. 4D: a complete agreement was found only in two cases. Parameters obtained with Perfusion 4D always showed the lowest standard deviation in all temporal intervals and also for all individual parameters.

Conclusion: The three versions of the same platform tested yield different perfusion measurements. Thus, our preliminary results show that Perfusion 4D version uses a stable deconvolution algorithm to provide more reliable measurements.
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http://dx.doi.org/10.1177/0284185113484643DOI Listing
September 2013

Magnetic resonance imaging: is there a role in clinical management for acute ischemic colitis?

World J Gastroenterol 2013 Feb;19(8):1256-63

Department of Human Pathology and Oncology, Section of Radiological Sciences, University of Siena, 53100 Siena, Italy.

Aim: To validate the utility of magnetic resonance imaging (MRI) for the clinical management of acute ischemic colitis (IC).

Methods: This is a magnetic resonance (MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical, endoscopic and computed tomography (CT) findings and who were imaged in our institution between February 2011 and July 2012. The mean age of the patients was 72.28 years. Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans, in the late arterial phase (start delay 45-50 s) and in the portal venous phase (start delay 70-80 s). The MR examinations were performed using a 1.5T superconducting magnet, using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane. CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings.

Results: Segmental involvement was seen in 6 patients (85.71%), with a mean length of involvement of 412 mm (range 145.5-1000 mm). Wall thickness varied between 6 mm and 17.5 mm (mean 10.52 mm) upon CT examinations and from 5 to 15 mm (mean 8.8 mm) upon MR examinations. The MRI appearance of the colonic wall varied over the time: Type I appearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations (41.66%), patients underwent MR within a mean of 36 h (ranging from 1 to 54 h) after the CT examination. Type II and III appearance with a 2 layer sign, was seen in 4 examinations (33.33%), patients underwent MR within a mean of 420.5 h (ranging from 121 to 720 h) after the CT examination. In the remaining three MRI examinations, performed within a mean of 410 h (ranging from 99.5 to 720 h) the colonic wall appeared normal.

Conclusion: MRI, only using precontrast images, may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC.
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http://dx.doi.org/10.3748/wjg.v19.i8.1256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587482PMC
February 2013

Non-obstructive mesenteric ischemia after cardiovascular surgery: not so uncommon.

Ann Thorac Cardiovasc Surg 2014 28;20(3):253-5. Epub 2013 Feb 28.

Department of Human Pathology and Oncology, Section of Radiological Sciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.5761/atcs.le.12.02154DOI Listing
February 2015

[Accuracy of multislice CT in restaging patients with non-small cell lung carcinoma after neoadjuvant chemotherapy using a multiparametric approach].

Recenti Prog Med 2012 Nov;103(11):465-70

Dipartimento di Patologia, Universita di Siena.

The aim of this study was to assess diagnostic accuracy of multislice CT in restaging patients with N2 non-small cell lung carcinoma after neoadjuvant chemotherapy, using a multiparametric approach as compared with traditional size-based radiological criteria. All patients staged as N2 at histologic examination after neoadjuvant chemotherapy were correctly staged with multislice CT (sensitivity, specificity, positive and negative predictive value, and accuracy were 100%, 80%, 85%, 100% and 93,7% respectively, vs 34%, 60%, 34%, 60% and 50% using size-based criteria), suggesting that a multiparametric approach results in improved diagnostic accuracy.
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http://dx.doi.org/10.1701/1166.12890DOI Listing
November 2012

[Diagnosis of acute mesenteric ischemia/infarction in the era of multislice CT].

Recenti Prog Med 2012 Nov;103(11):435-7

Dipartimento di Patologia Umana e Oncologica, Universita di Siena, Italy.

Acute mesenteric ischemia/infarction is a complex and often misdiagnosed syndrome. The availability of new imaging methods, namely multislice computed tomography, has enabled early recognition of signs and symptoms of acute mesenteric ischemia, resulting in timely therapeutic intervention.
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http://dx.doi.org/10.1701/1166.12884DOI Listing
November 2012