Publications by authors named "Iacopo Carbone"

101 Publications

Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning.

Radiol Med 2021 Aug 27. Epub 2021 Aug 27.

Department of Surgical and Medical Sciences and Translational Medicine, Diagnostic Imaging Unit, "Sapienza" University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035. 00189, Rome, Italy.

Objective: To evaluate the accuracy and reproducibility of hiatal surface area (HSA) measurement on dedicated multidetector computed tomography (MDCT) acquisition, in patients, previously subjected to laparoscopic sleeve gastrectomy (LSG), and affected by gastroesophageal reflux disease (GERD). Intraoperative HSA measurement was considered the reference standard.

Methods: Fifty-two candidates for laparoscopic hiatal hernia repair were prospectively included in the study. MDCT images were acquired during swallowing of oral iodinated contrast media and during strain. Measurements were performed by nine readers divided into three groups according to their experience. Results were compared with intraoperative measurements by means of Spearman correlation coefficient. Reproducibility was evaluated with intra- and interreader agreement by means of weighted Cohen's kappa and intraclass correlation coefficient (ICC).

Results: Significant differences between MDCT and intraoperative HSA measurements were observed for swallowing imaging for less experienced readers (p = 0.037, 0.025, 0.028 and 0.019). No other statistically significant differences were observed (p > 0.05). The correlation between HSA measured intraoperatively and on MDCT was higher for strain imaging compared to swallowing (r = 0.94-0.92 vs 0.94-0.89). The overall reproducibility of MDCT HSA measurement was excellent (ICC of 0.95; 95% CI 0,8993 to 0,9840) independently of reader's experience CONCLUSION: HSA can be accurately measured on MDCT images. This method is reproducible and minimally influenced by reader experience. The preoperative measurement of HSA has potential advantages for surgeons in terms of correct approach to hiatal defects in obese patient.
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http://dx.doi.org/10.1007/s11547-021-01413-0DOI Listing
August 2021

Hepatic pseudolesion as an unusual presentation of Fitz-Hugh-Curtis syndrome.

Radiol Case Rep 2021 Oct 12;16(10):3060-3063. Epub 2021 Aug 12.

Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy.

Fitz-Hugh-Curtis Syndrome is a rare disorder manifesting as a complication associated with Pelvic Inflammatory Disease. The initial presentation generally consists of concomitant right upper quadrant and lower abdominal pain. This syndrome is characterized by inflammation of the peritoneum with the involvement of hepatic capsule and the tissues surrounding the liver. Intrahepatic involvement is rare and not yet well investigated. An accurate interpretation of Computed Tomography and Magnetic Resonance Imaging findings is missing in the literature. This report presents a case of Fitz-Hugh-Curtis Syndrome in which Computed Tomography and Magnetic Resonance Imaging showed a region of heterogeneously decreased enhancement and abnormal signal intensity within the liver mimicking a lesion.
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http://dx.doi.org/10.1016/j.radcr.2021.07.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365459PMC
October 2021

SIRM-SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis.

Radiol Med 2021 Sep 23;126(9):1236-1248. Epub 2021 Jun 23.

Cardiothoracovascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.

In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric "one-stop-shop" approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.
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http://dx.doi.org/10.1007/s11547-021-01378-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370938PMC
September 2021

Low-volume reduced bowel preparation regimen for CT colonography: a randomized noninferiority trial.

Abdom Radiol (NY) 2021 10 18;46(10):4556-4566. Epub 2021 Jun 18.

Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.

Purpose: To determine whether the quality of a low-volume reduced bowel preparation (LV-RBP) for CT Colonography (CTC) is noninferior to full-volume reduced bowel preparation (FV-RBP) regimen.

Methods: In this randomized controlled trial, consecutive participants referred for CTC were randomly assigned to receive LV-RBP (52.5 g of PMF104 in 500 mL of water) or FV-RBP (105 g of PMF104 in 1000 mL of water). Images were independently reviewed by five blinded readers who rated the quality of bowel preparation from 0 (best score) to 3 (worst score). The primary outcome was the noninferiority of LV-RBP to FV-RBP in the proportion of colonic segments scored 0 for cleansing quality, with noninferiority margin of 10%. Volume of residual fluids, colonic distension, lesions and polyps detection rates and patient tolerability were secondary outcomes.

Results: From March 2019 to January 2020, 110 participants (mean age 65 years ± 14 [standard deviation]; 74 women) were allocated to LV-RBP (n = 55) or FV-RBP (n = 55) arms. There were 92% segment scored 0 in colon cleansing quality in LV-RBP and 94% in FV-RBP for prone scans, and 94% vs 92% for supine scans. Risk difference was - 2.1 (95% CI -5.9 to 1.7) and 1.5 (95% CI -2.4 to 5.4) for prone and supine positions, respectively. Residual fluids and colonic distension were also noninferior in LV-RBP. LV-RBP was associated with a lower number of evacuations during preparation (7 ± 5 vs 10 ± 6, p = 0.002).

Conclusion: The LV-RBP for CTC demonstrated noninferior quality of colon cleansing with improved gastrointestinal tolerability compared to FV-RBP regimen.
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http://dx.doi.org/10.1007/s00261-021-03176-8DOI Listing
October 2021

Clinical Implications of Monogenic Versus Polygenic Hypercholesterolemia: Long-Term Response to Treatment, Coronary Atherosclerosis Burden, and Cardiovascular Events.

J Am Heart Assoc 2021 May 23;10(9):e018932. Epub 2021 Apr 23.

Department of Translational and Precision Medicine "Sapienza" University of Rome Rome Italy.

Background Familial hypercholesterolemia (FH) may arise from deleterious monogenic variants in FH-causing genes as well as from a polygenic cause. We evaluated the relationships between monogenic FH and polygenic hypercholesterolemia in influencing the long-term response to therapy and the risk of atherosclerosis. Methods and Results A cohort of 370 patients with clinically diagnosed FH were screened for monogenic mutations and a low-density lipoprotein-rising genetic risk score >0.69 to identify polygenic cause. Medical records were reviewed to estimate the response to lipid-lowering therapies and the occurrence of major atherosclerotic cardiovascular events during a median follow-up of 31.0 months. A subgroup of patients (n=119) also underwent coronary computed tomographic angiography for the evaluation of coronary artery calcium score and severity of coronary stenosis as compared with 135 controls. Two hundred nine (56.5%) patients with hypercholesterolemia were classified as monogenic (FH/M+), 89 (24.1%) as polygenic, and 72 (19.5%) genetically undefined (FH/M-). The response to lipid-lowering therapy was poorest in monogenic, whereas it was comparable in patients with polygenic hypercholesterolemia and genetically undetermined. Mean coronary artery calcium score and the prevalence of coronary artery calcium >100 units were significantly higher in FH/M+ as compared with both FH/M- and controls. Finally, after adjustments for confounders, we observed a 5-fold higher risk of incident major atherosclerotic cardiovascular events in FH/M+ (hazard ratio, 4.8; 95% CI, 1.06-21.36; =0.041). Conclusions Monogenic cause of FH is associated with lower response to conventional cholesterol-lowering therapies as well as with increased burden of coronary atherosclerosis and risk of atherosclerotic-related events. Genetic testing for hypercholesterolemia is helpful in providing important prognostic information.
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http://dx.doi.org/10.1161/JAHA.120.018932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200757PMC
May 2021

Optimization of contrast medium volume for abdominal CT in oncologic patients: prospective comparison between fixed and lean body weight-adapted dosing protocols.

Insights Imaging 2021 Mar 20;12(1):40. Epub 2021 Mar 20.

Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.

Background: Patient body size represents the main determinant of parenchymal enhancement and by adjusting the contrast media (CM) dose to patient weight may be a more appropriate approach to avoid a patient over dosage of CM. To compare the performance of fixed-dose and lean body weight (LBW)-adapted contrast media dosing protocols, in terms of image quality and parenchymal enhancement.

Results: One-hundred cancer patients undergoing multiphasic abdominal CT were prospectively enrolled in this multicentric study and randomly divided in two groups: patients in fixed-dose group (n = 50) received 120 mL of CM while in LBW group (n = 50) the amount of CM was computed according to the patient's LBW. LBW protocol group received a significantly lower amount of CM (103.47 ± 17.65 mL vs. 120.00 ± 0.00 mL, p < 0.001). Arterial kidney signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and pancreatic CNR were significantly higher in LBW group (all p ≤ 0.004). LBW group provided significantly higher arterial liver, kidney, and pancreatic contrast enhancement index (CEI) and portal venous phase kidney CEI (all p ≤ 0.002). Significantly lower portal vein SNR and CNR were observed in LBW-Group (all p ≤ 0.020).

Conclusions: LBW-adapted CM administration for abdominal CT reduces the volume of injected CM and improves both image quality and parenchymal enhancement.
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http://dx.doi.org/10.1186/s13244-021-00980-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981367PMC
March 2021

Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study.

Int J Cardiol 2021 05 31;330:251-258. Epub 2021 Jan 31.

dept. Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.

Background: Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials.

Purpose: To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use.

Methods: MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites.

Results: T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions.

Conclusions: The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials.
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http://dx.doi.org/10.1016/j.ijcard.2021.01.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994017PMC
May 2021

CT texture-based radiomics analysis of carotid arteries identifies vulnerable patients: a preliminary outcome study.

Neuroradiology 2021 Jul 3;63(7):1043-1052. Epub 2021 Jan 3.

Institute of Nuclear Medicine, University College London, London, UK.

Purpose: To assess the potential role of computed tomography (CT) texture analysis (CTTA) in identifying vulnerable patients with carotid artery atherosclerosis.

Methods: In this case-control pilot study, 12 patients with carotid atherosclerosis and a subsequent history of transient ischemic attack or stroke were age and sex matched with 12 control cases with asymptomatic carotid atherosclerosis (follow-up time 103.58 ± 9.2 months). CTTA was performed using a commercially available research software package (TexRAD) by an operator blinded to clinical data. CTTA comprised a filtration-histogram technique to extract features at different scales corresponding to spatial scale filter (fine = 2 mm, medium = 3 mm, coarse = 4 mm), followed by quantification using histogram-based statistical parameters: mean, kurtosis, skewness, entropy, standard deviation, and mean value of positive pixels. A single axial slice was selected to best represent the largest cross-section of the carotid bifurcation or the greatest degree of stenosis, in presence of an atherosclerotic plaque, on each side.

Results: CTTA revealed a statistically significant difference in skewness between symptomatic and asymptomatic patients at the medium (0.22 ± 0.35 vs - 0.18 ± 0.39, p < 0.001) and coarse (0.23 ± 0.22 vs 0.03 ± 0.29, p = 0.003) texture scales. At the fine-texture scale, skewness (0.20 ± 0.59 vs - 0.18 ± 0.58, p = 0.009) and standard deviation (366.11 ± 117.19 vs 300.37 ± 82.51, p = 0.03) were significant before correction.

Conclusion: Our pilot study highlights the potential of CTTA to identify vulnerable patients in stroke and TIA. CT texture may have the potential to act as a novel risk stratification tool in patients with carotid atherosclerosis.
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http://dx.doi.org/10.1007/s00234-020-02628-0DOI Listing
July 2021

Early myocardial damage and microvascular dysfunction in asymptomatic patients with systemic sclerosis: A cardiovascular magnetic resonance study with cold pressor test.

PLoS One 2020 22;15(12):e0244282. Epub 2020 Dec 22.

Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.

Purpose: Cardiac involvement in Systemic Sclerosis (SSc) is increasingly recognized as a mayor cause of morbidity and mortality. The aim of present study is to investigate the early stages of cardiac involvement in SSc by Cardiovascular magnetic resonance (CMR), combining the non-invasive detection of myocardial inflammation and fibrosis using T2 and T1 mapping techniques and the assessment of microcirculatory impairment through perfusion response to cold pressor test (CPT).

Methods: 40 SSc patients (30 females, mean age: 42.1 years) without cardiac symptoms and 10 controls underwent CMR at 1.5 T unit. CMR protocol included: native and contrast-enhanced T1 mapping, T2 mapping, T2-weighted, cineMR and late gadolinium enhancement (LGE) imaging. Microvascular function was evaluated by comparing myocardial blood flow (MBF) on perfusion imaging acquired at rest and after CPT. Native myocardial T1 and T2 relaxation times, extracellular volume fraction (ECV), T2 signal intensity ratio, biventricular volumes and LGE were assessed in each patient.

Results: SSc patients had significantly higher mean myocardial T1 (1029±32ms vs. 985±18ms, p<0.01), ECV (30.1±4.3% vs. 26.7±2.4%, p<0.05) and T2 (50.1±2.8ms vs. 47±1.5ms, p<0.01) values compared with controls. No significant differences were found between absolute MBF values at rest and after CPT; whereas lower MBF variation after CPT was observed in SSc patients (+33 ± 14% vs. +44 ± 12%, p<0.01). MBF variation had inverse correlation with native T1 values (r: -0.32, p<0.05), but not with ECV.

Conclusions: Myocardial involvement in SSc at preclinical stage increases native T1, T2 and ECV values, reflecting inflammation and fibrosis, and reduces vasodilatory response to CPT, as expression of microvascular dysfunction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244282PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755221PMC
March 2021

Diabetic Cardiomiopathy Progression is Triggered by miR122-5p and Involves Extracellular Matrix: A 5-Year Prospective Study.

JACC Cardiovasc Imaging 2021 Jun 18;14(6):1130-1142. Epub 2020 Nov 18.

Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy. Electronic address:

Objectives: The purpose of this study was to follow the long-term progression of diabetic cardiomyopathy by combining cardiac magnetic resonance (CMR) and molecular analysis.

Background: The evolution of diabetic cardiomyopathy to heart failure affects patients'morbidity and mortality. CMR is the gold standard to assess cardiac remodeling, but there is a lack of markers linked to the mechanism of diabetic cardiomyopathy progression.

Methods: Five-year longitudinal study on patients with type 2 diabetes mellitus (T2DM) enrolled in the CECSID (Cardiovascular Effects of Chronic Sildenafil in Men With Type 2 Diabetes) trial compared with nondiabetic age-matched controls. CMR with tagging together with metabolic and molecular assessments were performed at baseline and 5-year follow-up.

Results: A total of 79 men (age 64 ± 8 years) enrolled, comprising 59 men with T2DM compared with 20 nondiabetic age-matched controls. Longitudinal CMR with tagging showed an increase in ventricular mass (ΔLVMi = 13.47 ± 29.66 g/m; p = 0.014) and a borderline increase in end-diastolic volume (ΔEDVi = 5.16 ± 14.71 ml/m; p = 0.056) in men with T2DM. Cardiac strain worsened (Δσ = 1.52 ± 3.85%; p = 0.033) whereas torsion was unchanged (Δθ = 0.24 ± 4.04°; p = 0.737), revealing a loss of the adaptive equilibrium between strain and torsion. Contraction dynamics showed a decrease in the systolic time-to-peak (ΔTtP = -35.18 ± 28.81 ms; p < 0.001) and diastolic early recoil-rate (ΔRR = -20.01 ± 19.07 s; p < 0.001). The ejection fraction and metabolic parameters were unchanged. Circulating miR microarray revealed an up-regulation of miR122-5p. Network analysis predicted the matrix metalloproteinases (MMPs) MMP-16 and MMP-2 and their regulator (tissue inhibitors of metalloproteinases) as targets. In db/db mice we demonstrated that miR122-5p expression is associated with diabetic cardiomyopathy, that in the diabetic heart is overexpressed, and that, in vitro, it regulates MMP-2. Finally, we demonstrated that miR122-5p overexpression affects the extracellular matrix through MMP-2 modulation.

Conclusions: Within 5 years of diabetic cardiomyopathy onset, increasing cardiac hypertrophy is associated with progressive impairment in strain, depletion of the compensatory role of torsion, and changes in viscoelastic contraction dynamics. These changes are independent of glycemic control and paralleled by the up-regulation of specific microRNAs targeting the extracellular matrix. (Cardiovascular Effects of Chronic Sildenafil in Men With Type 2 Diabetes [CECSID]; NCT00692237).
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http://dx.doi.org/10.1016/j.jcmg.2020.10.009DOI Listing
June 2021

Diagnostic Yield of Computed Tomography for the Identification of Coronavirus Disease 2019 Using Repeated Reverse Transcriptase Polymerase Chain Reaction Testing or Confirmed True-Negative State as Reference Standard: Systematic Review and Meta-Analysis.

J Comput Assist Tomogr 2020 Nov/Dec;44(6):812-820

Department of Radiology, University of Washington School of Medicine, Seattle, WA.

Objective: The aim of this study was to perform a meta-analysis assessing the diagnostic yield of computed tomography (CT) for the identification of coronavirus disease 2019 (COVID-19) using repeated reverse transcriptase polymerase chain reaction testing or confirmed true-negative state as reference standard.

Methods: In May 2020, we interrogated the MEDLINE, Embase, and CENTRAL databases. Pooled sensitivity, specificity, and diagnostic odds ratios of CT for COVID-19 identification were computed. Cumulative positive predictive value (PPV) and negative predictive value, stratified by disease prevalence, were calculated.

Results: Ten articles were included (1332 patients). Pooled sensitivity, specificity, and summary diagnostic odds ratio of CT were 82% [95% confidence interval (CI), 79%-84%], 68% (95% CI, 65%-71%), and 18 (95% CI, 9.8-32.8). The PPV and negative predictive value were 54% (95% CI, 30%-77%) and 94% (95% CI, 88%-99%) at a COVID-19 prevalence lower than 40%, and 80% (95% CI, 62%-91%) and 77% (95% CI, 68%-85%) at a prevalence higher than 40%.

Conclusion: CT yields higher specificity and PPV, albeit lower sensitivity, than previously reported for the identification of COVID-19.
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http://dx.doi.org/10.1097/RCT.0000000000001105DOI Listing
November 2020

Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis.

Int J Cardiovasc Imaging 2021 Apr 15;37(4):1395-1404. Epub 2020 Nov 15.

Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.

The purpose of our study was to compare diagnostic performance of old and new Lake Louise Criteria (oLLC and nLLC) among different clinical presentations: infarct-like (IL), cardiomyopathic (CM) and arrhythmic (AR). 102 patients with clinical suspicion of acute myocarditis underwent cardiac magnetic resonance (CMR) on a 1.5 T scanner. Protocol included cine-SSFP, T2-weighted STIR, T2 mapping, early and late gadolinium enhancement and T1 mapping acquired before and after gadolinium administration. The degree of agreement has been calculated with Cohen's K test. 42 patients also underwent endomyocardial biopsy (EMB). IL onset was present in 54/102 patients, CM in 28/102 and AR in 20/102. nLLC were positive in 58.3% of the patients, while oLLC in 37.9%, k = 0.57 (IC: 0.428-0.713). The degree of agreement between nLLC and oLLC was 0.49 (IC: 0.111-0.876) for AR onset (nLLC positive in 35% vs oLLC in 15%), 0.25 (IC: 0.035-0.459) for CM pattern (nLLC positive in 60.7% vs oLLC 17.9%) and 0.73 (IC: 0.543-0.912) for IL presentation (nLLC positive in 66.7% vs oLLC in 57.4%). Diagnostic accuracy was 75% for both nLLC and oLLC among IL onset, and 41.6% for oLLC vs 66.7% for nLLC, as regards CM clinical presentation. nLLC have improved diagnostic performance of CMR for the diagnosis of acute myocarditis, in particular for atypical clinical presentation.
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http://dx.doi.org/10.1007/s10554-020-02097-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026431PMC
April 2021

Myocarditis: imaging up to date.

Radiol Med 2020 Nov 6;125(11):1124-1134. Epub 2020 Oct 6.

Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, I.C.O.T. Hospital, Via Franco Faggiana1668, 04100, Latina, LT, Italy.

Myocarditis is an inflammatory disease of the heart muscle, diagnosed by histological, immunological, and immunohistochemical criteria. Endomyocardial biopsy represents the diagnostic gold standard for its diagnosis but is infrequently used. Due to its noninvasive ability to detect the presence of myocardial edema, hyperemia and necrosis/fibrosis, Cardiac MR imaging is routinely used in the clinical practice for the diagnosis of acute myocarditis. Recently pixel-wise mapping of T1 and T2 relaxation time have been introduced into the clinical Cardiac MR protocol increasing its accuracy. Our paper will review the role of MR imaging in the diagnosis of acute myocarditis.
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http://dx.doi.org/10.1007/s11547-020-01279-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538190PMC
November 2020

Diagnostic accuracy and interobserver variability of CO-RADS in patients with suspected coronavirus disease-2019: a multireader validation study.

Eur Radiol 2021 Apr 23;31(4):1932-1940. Epub 2020 Sep 23.

Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy.

Objective: To conduct a multireader validation study to evaluate the interobserver variability and the diagnostic accuracy for the lung involvement by COVID-19 of COVID-19 Reporting and Data System (CO-RADS) score.

Methods: This retrospective study included consecutive symptomatic patients who underwent chest CT and reverse transcriptase-polymerase chain reaction (RT-PCR) from March 2020 to May 2020 for suspected COVID-19. Twelve readers with different levels of expertise independently scored each CT using the CO-RADS scheme for detecting pulmonary involvement by COVID-19. Receiver operating characteristic (ROC) curves were computed to investigate diagnostic yield. Fleiss' kappa statistics was used to evaluate interreader agreement.

Results: A total of 572 patients (mean age, 63 ± 20 [standard deviation]; 329 men; 142 patients with COVID-19 and 430 patients without COVID-19) were evaluated. There was a moderate agreement for CO-RADS rating among all readers (Fleiss' K = 0.43 [95% CI 0.42-0.44]) with a substantial agreement for CO-RADS 1 category (Fleiss' K = 0.61 [95% CI 0.60-0.62]) and moderate agreement for CO-RADS 5 category (Fleiss' K = 0.60 [95% CI 0.58-0.61]). ROC analysis showed the CO-RADS score ≥ 4 as the optimal threshold, with a cumulative area under the curve of 0.72 (95% CI 66-78%), sensitivity 61% (95% CI 52-69%), and specificity 81% (95% CI 77-84%).

Conclusion: CO-RADS showed high diagnostic accuracy and moderate interrater agreement across readers with different levels of expertise. Specificity is higher than previously thought and that could lead to reconsider the role of CT in this clinical setting.

Key Points: • COVID-19 Reporting and Data System (CO-RADS) demonstrated a good diagnostic accuracy for lung involvement by COVID-19 with an average AUC of 0.72 (95% CI 67-75%). • When a threshold of ≥ 4 was used, sensitivity and specificity were 61% (95% CI 52-69%) and 81% (95% CI 76-84%), respectively. • There was an overall moderate agreement for CO-RADS rating across readers with different levels of expertise (Fleiss' K = 0.43 [95% CI 0.42-0.44]).
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http://dx.doi.org/10.1007/s00330-020-07273-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510765PMC
April 2021

4D flow imaging of the thoracic aorta: is there an added clinical value?

Cardiovasc Diagn Ther 2020 Aug;10(4):1068-1089

Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.

Four-dimensional (4D) flow MRI has emerged as a powerful non-invasive technique in cardiovascular imaging, enabling to analyse in vivo complex flow dynamics models by quantifying flow parameters and derived features. Deep knowledge of aortic flow dynamics is fundamental to better understand how abnormal flow patterns may promote or worsen vascular diseases. In the perspective of an increasingly personalized and preventive medicine, growing interest is focused on identifying those quantitative functional features which are early predictive markers of pathological evolution. The thoracic aorta and its spectrum of diseases, as the first area of application and development of 4D flow MRI and supported by an extensive experimental validation, represents the ideal model to introduce this technique into daily clinical practice. The purpose of this review is to describe the impact of 4D flow MRI in the assessment of the thoracic aorta and its most common affecting diseases, providing an overview of the actual clinical applications and describing the potential role of derived advanced hemodynamic measures in tailoring follow-up and treatment.
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http://dx.doi.org/10.21037/cdt-20-452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487373PMC
August 2020

Spontaneous pneumomediastinum as the only CT finding in an asymptomatic adolescent positive for COVID-19.

BJR Case Rep 2020 Sep 15;6(3):20200051. Epub 2020 May 15.

Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana 34, 04100, Latina, Italy.

The typical findings on CT in patients affected by novel COVID-19 (coronavirus disease 2019) pneumonia are characterized by ground-glass opacities and/or air space consolidation mainly bilateral and peripherical in distribution, including crazy paving pattern and reversed halo sign. We hereby describe a case of an adolescent male tested positive for COVID-19 with mild respiratory symptoms and presenting with pneumomediastinum as the only CT finding.
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http://dx.doi.org/10.1259/bjrcr.20200051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465755PMC
September 2020

Radiological outpatient' visits to avoid inappropriate cardiac CT examinations: an 8-year experience report.

Radiol Med 2021 Feb 10;126(2):214-220. Epub 2020 Jul 10.

Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, V.le Regina Elena, 324 00161, Rome, Italy.

Purpose: The aim of this study was to evaluate the appropriateness of the cardiac computed tomography angiography (CCTA) prescriptions according to the "2010-Appropriate-Use-Criteria-for-Cardiac-Computed-Tomography-Angiography" (AUCCTA) and "Clinical-indication-for-CCTA" (CICCTA) among different specialities (Cardiologist [CA], General Practitioner [GP], Other Specialists [OS]) and prescribers' age.

Materials And Methods: This is a single-centre, single-arm, cohort study. We prospectively enrolled 815 patients (October 2012-May 2019) who underwent a radiological outpatient visit, before CCTA examination. Prescriptions to the examination were categorized as follows: Appropriate (A), Uncertain (U) and Inappropriate (Ina), according to AUCCTA and I, II, III and Inv for CICCTA. This categorization was stratified according to CA, GP and OS and prescribers' age. CCTA was performed in patients whom indications belong to A/U categories.

Results: Eight hundred and fifteen CCTA prescriptions were analysed. An yearly increase in prescriptions was found in the eight-year observational period (2012/2019 projection: 72 vs 223). Considering AUCCTA, indication A was 540/815 (66.3%), indication U was 113/815 (13.9%) and Ina accounted for 162/815 (19.9%; 128/162 [79.0%] indications with stress test listed as criterium of inappropriateness). Only U indications decreased over years (p = 0.003). Regarding CICCTA, 501/815 (61.5%) patients were categorized as I, 144/815 (17.7%) as II, 102/815 (12.5%) as III, 67/815 (8.2%) were INV and 1/815 (0.1%) were non-classified. Clinical referrals were CA in 495/786 (63.0%), GPs in 57/786 (7.3%) GP and OS in 234/786 (29.8%) [p < 0.01]. No statistically significant differences were observed in the appropriateness among different specialty physicians. Younger doctors have a lower chance to not meet A indication (OR 0.98 [CI 95% 0.96-0.99]; p = 0.003).

Conclusion: Our study highlights the importance of a pre-radiological visit prior to CCTA, which prevented execution of 19.9% of inappropriate examinations. Age of prescribers had an impact on appropriateness, with younger doctors having a lower chance to not meet A indication.
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http://dx.doi.org/10.1007/s11547-020-01246-3DOI Listing
February 2021

Assessment of interstitial lung disease in systemic sclerosis using the quantitative CT algorithm CALIPER.

Clin Rheumatol 2020 May 15;39(5):1537-1542. Epub 2020 Jan 15.

Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.

Interstitial lung disease (ILD) remains a major cause of morbidity and mortality in systemic sclerosis (SSc). Study aim is to characterize and quantify SSc-ILD by using Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER). Secondly, our objective is to evaluate which radiological pattern is predictive of lung function decline at 12 months follow-up. In the prospective study (IRB 5435), 66 SSc patients underwent high-resolution computerized tomography (HRCT) at baseline. HRCT was performed according to standard protocol using a CT 64GE light speed VCT power scanner. CALIPER classified lung parenchyma on volume units. Every volume unit was classified into radiological parenchymal patterns (honeycombing, reticular and ground glass). Pulmonary function tests (PFTs) were performed at baseline and after 12 months of follow-up. Cigarette smoking and other lung diseases unrelated to SSc are exclusion criteria. CALIPER analysis showed normal lung parenchyma 87.4 ± 9.8%, ground glass 2.8 ± 5.3%, reticular 4 ± 5.7%, and honeycombing 1 ± 1%. In multiple regression analysis, FEV1 (p < 0.0001), FVC (p = 0.001), and DLCO (p < 0.0001) measurements at baseline showed a negative correlation with the reticular pattern percentage. At follow-up, DLCO reduction showed a positive correlation (p < 0.001) with the percentage of ground glass pattern (r = 0.33, beta coefficient = 0.51). In the ROC curve analysis, ground glass score is a good predictor (0.75, p = 0.009; 95% CI 0.59-0.91) of DLCO worsening, defined as a decrease of more than 10% of DLCO. Using a cutoff ≥ 4.5 for ground glass score, the RR for DLCO worsening is 6.8 (p < 0.01; 95% CI 1.6-29.2). The results of this study show that CALIPER is useful not only for quantifying lung damage but also for assessing worsening PFTs, but larger studies are needed to confirm these preliminary data.Key Points• At baseline reticular pattern showed negative correlation with PFTs• At follow-up ground glass pattern predicts worsening of DLCO• CALIPER is a useful to quantify lung damage.
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http://dx.doi.org/10.1007/s10067-020-04938-3DOI Listing
May 2020

Layered enhancement at magnetic resonance enterography in inflammatory bowel disease: A meta-analysis.

World J Gastroenterol 2019 Aug;25(31):4555-4566

Department of Surgical and Medical Sciences and Translational Medicine, "Sapienza"-University of Rome, Sant'Andrea University Hospital, AOU Sant'Andrea, Rome 00189, Italy,

Background: Documentation of disease activity in patients affected by Crohn's disease (CD) is mandatory in order to manage patients properly. Magnetic resonance imaging (MRI) is considered the reference cross-sectional technique for the assessment of CD activity. Among MRI findings, layered pattern (LP) of contrast enhancement seems to be one of the most significant signs of severe disease activity; however, it has also been associated with chronic disease and mural fibrosis.

Aim: To systematically evaluate the accuracy of LP of contrast enhancement in the diagnosis of active inflammation in patients with CD.

Methods: In February 2019, we searched the MEDLINE and Cochrane Central Register of Controlled Trials databases for studies evaluating the diagnostic accuracy of LP of contrast enhancement on MRI for the detection of active inflammation in patients with CD. To be included, studies had to use histopathologic analysis (endoscopy or surgery) as the reference standard. Risk of bias and applicability concerns of the included studies were evaluated by using items from the Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Pooled sensitivity and specificity were determined using a bivariate random-effect model. Heterogeneity was quantified by using the statistic. Our meta-analysis received no funding, and the review protocol was not published or registered in advance.

Results: Of the 1383 studies identified, five articles were finally selected for quantitative and qualitative synthesis (245 patients, 238 of whom had histopathologically confirmed CD, 144 with active inflammation and 94 with inactive disease). The meta-analysis showed a pooled sensitivity of 49.3% (95%CI: 41%-57.8%; : 90.7%) and specificity of 89.1% (95%CI: 81.3%- 94.4%; : 48.6%). Pooled PLR and NLR were 3.3 (95%CI: 1.9-5.7; : 6.1%) and 0.6 (95%CI: 0.5-0.9; 70.5%), respectively. SDOR was 6.8 (95%CI: 2.6-17.6; : 27.1%). The summary ROC curve showed an area under the curve (AUC) of 0.82 (SE 0.06; Q* 0.76). High risk of bias and applicability concerns were observed in the domains of patient selection for one included study.

Conclusion: LP on contrast-enhanced MRI is a specific finding to rule out active inflammation in patients with CD. Further studies using a prespecified definition of LP on contrast-enhanced MRI are needed to support our findings.
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http://dx.doi.org/10.3748/wjg.v25.i31.4555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710183PMC
August 2019

Myocardial fibrosis in systemic sclerosis assessed by cardiac magnetic resonance is associated with vascular endothelial growth factor expression.

Clin Exp Rheumatol 2019 Jul-Aug;37 Suppl 119(4):158. Epub 2019 Jul 22.

Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.

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October 2019

Early or deferred cardiovascular magnetic resonance after ST-segment-elevation myocardial infarction for effective risk stratification.

Eur Heart J Cardiovasc Imaging 2020 06;21(6):632-639

Radiology Department, Gasthuisberg University Hospitals, Herestraat 49, 3000 Leuven, Belgium.

Aims: In ST-segment-elevation myocardial infarction (STEMI), cardiovascular magnetic resonance (CMR) holds the potentiality to improve risk stratification in addition to Thrombolysis in Myocardial Infarction (TIMI) risk score. Nevertheless, the optimal timing for CMR after STEMI remains poorly defined. We aim at comparing the prognostic performance of three stratification strategies according to the timing of CMR after STEMI.

Methods And Results: The population of this prospective registry-based study included 492 reperfused STEMI patients. All patients underwent post-reperfusion (median: 4 days post-STEMI) and follow-up (median: 4.8 months post-STEMI) CMR. Left ventricular (LV) volumes, function, infarct size, and microvascular obstruction extent were quantified. Primary endpoint was a composite of all-death and heart failure (HF) hospitalization. Baseline-to-follow-up percentage increase of LV end-diastolic (EDV; ΔLV-EDV) ≥20% or end-systolic volumes (ESV; ΔLV-ESV) ≥15% were tested against outcome. Three multivariate models were developed including TIMI risk score plus early post-STEMI (early-CMR) or follow-up CMR (deferred-CMR) or both CMRs parameters along with adverse LV remodelling (paired-CMRs). During a median follow-up of 8.3 years, the primary endpoint occurred in 84 patients (47 deaths; 37 HF hospitalizations). Early-CMR, deferred-CMR, and paired-CMR demonstrated similar predictive value for the primary endpoint (C-statistic: 0.726, 0.728, and 0.738, respectively; P = 0.663). ΔLV-EDV ≥20% or ΔLV-ESV ≥15% were unadjusted outcome predictors (hazard ratio: 2.020 and 2.032, respectively; P = 0.002 for both) but lost their predictive value when corrected for other covariates in paired-CMR model.

Conclusion: In STEMI patients, early-, deferred-, or paired-CMR were equivalent stratification strategies for outcome prediction. Adverse LV remodelling parameters were not independent prognosticators.
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http://dx.doi.org/10.1093/ehjci/jez179DOI Listing
June 2020

Splenic Blood Flow Increases after Hypothermic Stimulus (Cold Pressor Test): A Perfusion Magnetic Resonance Study.

Biomed Res Int 2019 23;2019:8437927. Epub 2019 May 23.

Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome 00161, Italy.

The Cold Pressor Test (CPT) is a novel diagnostic strategy to noninvasively assess the myocardial microvascular endothelial-dependent function using perfusion magnetic resonance imaging (MRI). Spleen perfusion is modulated by a complex combination of several mechanisms involving the autonomic nervous system and vasoactive mediators release. In this context, the effects of cold temperature on splenic blood flow (SBF) still need to be clarified. Ten healthy subjects were studied by MRI. MRI protocol included the acquisition of GRE T1-weighted sequence ("first pass perfusion") during gadolinium administration (0.1mmol/kg of Gd-DOTA at flow of 3.0 ml/s), at rest and after CPT. Myocardial blood flow (MBF) and SBF were measured by applying Fermi function deconvolution, using the blood pool input function sampled from the left ventricle cavity. MBF and SBF values after performing CPT were significantly higher than rest values (SBF at rest: 0.65 ± 0.15 ml/min/g Vs. SBF after CPT: 0.90 ± 0.14 ml/min/g, p: <0.001; MBF at rest: 0.90 ± 0.068 ml/min/g Vs. MBF after CPT: 1.22 ± 0.098 ml/min/g, p<0.005). Both SBF and MBF increased in all patients during the CPT. In particular, the CPT-induced increase was 43% ± 29% for SBF and 36.5% ± 17% for MBF. CPT increases SBF in normal subjects. The characterization of a standard perfusion response to cold might allow the use of the spleen as reference marker for the adequacy of cold stimulation during myocardial perfusion MRI.
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http://dx.doi.org/10.1155/2019/8437927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556242PMC
December 2019

Role of autonomic dysfunction in the regulation of myocardial blood flow in systemic sclerosis evaluated by cardiac magnetic resonance.

Int J Rheum Dis 2019 Jun 15;22(6):1029-1035. Epub 2019 Apr 15.

Department of Clinical Medicine, Clinical Immunology Unit-Scleroderma Center, Sapienza University of Rome, Rome, Italy.

Aim: Autonomic dysfunction (AD) is an early feature of systemic sclerosis (SSc). A regular endothelial function is a prerequisite for normal response of the myocardial blood flow (MBF) to cold pressure test (CPT). The aim of the study was to evaluate the relation between MBF and AD at rest and after CPT in asymptomatic SSc patients.

Methods: Twenty SSc patients and 10 age-, sex- and body mass index-matched healthy controls underwent cardiac magnetic resonance at rest and after CPT. All subjects underwent 24 hours ambulatory 3-channel electrocardiogram Holter to evaluate AD by heart rate variability.

Results: We did not observe any significant difference in MBF (mL/g/min) at rest and after CPT between SSc patients and healthy controls. Delta of MBF (difference between MBF after CPT and rest MBF) was lower (P = 0.039) in SSc patients than healthy controls (0.28 [0.04-0.40] vs 0.33 [0.24-0.54]). The low frequency/high frequency (LF/HF) was higher (P = 0.002) in SSc patients than healthy controls (3 [1.7-6] vs 1.8 [1.1-2.8]). The high frequencies (HF), modulated mainly by paraympathetic system, was lower (P = 0.003) in SSc patients than healthy controls (30 [16-42] vs 36.5 [24-44]). Sympathetic hyperactivity, due to reduction of parasympathetic activity (HF), is present in SSc patients. A negative correlation was observed between Delta of MBF and LF/HF (r = -0.572, P = 0.0031).

Conclusion: AD, characterized by sympathovagal imbalance due to a reduced parasympathetic tone with high LF/HF ratio, could be responsible for the reduced myocardial vasodilatory response after CPT.
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http://dx.doi.org/10.1111/1756-185X.13569DOI Listing
June 2019

Systematic Review and Meta-Analysis Investigating the Diagnostic Yield of Dual-Energy CT for Renal Mass Assessment.

AJR Am J Roentgenol 2019 Mar 5:1-10. Epub 2019 Mar 5.

5 Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA 98195.

Objective: The objective of our study was to perform a systematic review and meta-analysis to evaluate the diagnostic accuracy of dual-energy CT (DECT) for renal mass evaluation.

Materials And Methods: In March 2018, we searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Web of Science databases. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled estimates for sensitivity, specificity, and diagnostic odds ratios were calculated for DECT-based virtual monochromatic imaging (VMI) and iodine quantification techniques as well as for conventional attenuation measurements from renal mass CT protocols. I was used to evaluate heterogeneity. The methodologic quality of the included studies and potential bias were assessed using items from the Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2).

Results: Of the 1043 articles initially identified, 13 were selected for inclusion (969 patients, 1193 renal masses). Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for VMI were 87% (95% CI, 80-92%; I, 92.0%), 93% (95% CI, 90-96%; I, 18.0%), and 183.4 (95% CI, 30.7-1093.4; I, 61.6%), respectively. Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for iodine quantification were 99% (95% CI, 97-100%; I, 17.6%), 91% (95% CI, 89-94%; I, 84.2%), and 511.5 (95% CI, 217-1201; I, 0%). No significant differences in AUCs were found when comparing iodine quantification to conventional attenuation measurements (p = 0.79).

Conclusion: DECT yields high accuracy for renal mass evaluation. Determination of iodine content with the iodine quantification technique shows diagnostic accuracy similar to conventional attenuation measurements from renal mass CT protocols. The iodine quantification technique may be used to characterize incidental renal masses when a dedicated renal mass protocol is not available.
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http://dx.doi.org/10.2214/AJR.18.20625DOI Listing
March 2019

T1 and extracellular volume fraction mapping in cardiac magnetic resonance: estimation of accuracy and precision of a novel algorithm.

Phys Med Biol 2019 02 11;64(4):04NT06. Epub 2019 Feb 11.

Department of Public Health and Infectious Disease, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. Department of Medical Physics, Azienda Ospedaliera Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy. Author to whom any correspondence should be addressed.

Magnetic resonance imaging is effective for non-invasive detection of myocardial diseases by extracellular volume fraction (ECV) estimation. A new methodology for T1 and ECV mapping is tested in this work, comparing results with other well-consolidated methods. The associated level of uncertainty for data was also estimated, to assess the reliability of the technique. A phantom with known T1 values was used for reference, and 60 subjects (40 controls, 20 diseased patients) were examined, using the modified look-locker inversion-recovery (MOLLI) method. Obtained T1 data were studied in terms of accuracy (difference with reference T1), paired comparisons with other methods, and Gamma-tool analysis with tolerances criteria of 4.21 mm for distance-to-agreement, and between 2%-5% for T1 difference. Accuracy and precision of the T1 mapping was analysed by phantom measurements, and the uncertainty of the ECV was estimated by T1 error propagation. Differences (in paired comparisons) of T1 datasets were not significant neither for statistical tests, nor for Bland-Altman analysis. T1 accuracy was between  -12% and  -1% across methods, slightly better for the tested method (mean accuracy in the T1 range of interest better than 2%). The Gamma analysis confirm slightly better results for the tested method than other methodologies. The new method improves the computational efficiency by a factor of 25 (at least), revealing to be also more suitable for Big Data-related applications.
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http://dx.doi.org/10.1088/1361-6560/aafccaDOI Listing
February 2019

Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction.

Eur Radiol 2019 May 14;29(5):2369-2377. Epub 2018 Dec 14.

Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome "Sapienza", Viale Regina Elena 324, 00161, Rome, Italy.

Objectives: To investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).

Methods: Seventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF > 50% at CMR were included. The median time between STEMI and CMR was 5 days (IQR 2-8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.

Results: During median follow-up of 4 years (range 3 to 5 years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p = 0.044) and its extent (2.30 ± 1.64 g vs. 0.18 ± 0.12 g, respectively; p = 0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75-1.0; p = 0.000), late MVO extent > 0.385 g was a strong independent predictor of MACE at long-term follow-up (sensitivity = 87%, specificity = 90%; hazard ratio = 2.24; 95% confidence interval, 1.51-3.33; p = 0.000).

Conclusions: Late MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF > 50%. Noticeably, late MVO extent > 0.385 g provided relevant prognostic insights leading to improved long-term risk stratification.

Key Points: • Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction • The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up. • The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.
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http://dx.doi.org/10.1007/s00330-018-5895-zDOI Listing
May 2019

Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations.

J Am Coll Cardiol 2018 12;72(24):3158-3176

Heidelberg University Hospital, Heidelberg, Germany; Department of Cardiology, McGill University Health Centre, Montreal, Canada; Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada. Electronic address:

This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.
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http://dx.doi.org/10.1016/j.jacc.2018.09.072DOI Listing
December 2018

Immune-Mediated Myocarditis in Fabry Disease Cardiomyopathy.

J Am Heart Assoc 2018 09;7(17):e009052

1 Department of Cardiovascular Nephrologic, Anesthetic and Geriatric Sciences La Sapienza University of Rome Italy.

Background Glycosphingolipid accumulation in Fabry cells generates a proinflammatory response that may influence disease evolution and responsiveness to enzyme replacement therapy. This study evaluated incidence, mechanism, and impact of myocarditis in Fabry disease cardiomyopathy ( FDCM ). Methods and Results Myocarditis, defined as CD 3 T lymphocytes >7/mm associated with necrosis of glycolipid-laden myocardiocytes, was retrospectively evaluated in endomyocardial biopsies from 78 patients with FDCM : 13 with maximal wall thickness (MWT) <11 mm (group 1), 17 with MWT 11 to 15 mm (group 2), 30 with MWT 16 to 20 mm (group 3), and 18 with MWT >20 mm (group 4). Myocarditis was investigated by polymerase chain reaction for cardiotropic viruses, by serum antiheart and antimyosin antibodies, and by cardiac magnetic resonance. Myocarditis was recognized at histology in 48 of 78 patients with FDCM (38% of group 1, 41% of group 2, 66% of group 3, and 72% of group 4). Myocarditis was characterized by positive antiheart and antimyosin antibodies and negative polymerase chain reaction for viral genomes. CD 3 cells/mm correlated with myocyte necrosis, antimyosin autoantibody titer, and MWT ( P<0.001, r=0.79; P<0.001, r=0.84; P<0.001, r=0.61, respectively). Cardiac magnetic resonance showed myocardial edema in 24 of 78 patients (31%): 0% of group 1, 23% of group 2, 37% of group 3, and 50% of group 4. Conclusions Myocarditis is detectable at histology in up to 56% of patients with FDCM . It is immune mediated and correlates with disease severity. It can be disclosed by antiheart/antimyosin autoantibodies and in the advanced phase by cardiac magnetic resonance. It may contribute to progression of FDCM and resistance to enzyme replacement therapy.
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http://dx.doi.org/10.1161/JAHA.118.009052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201436PMC
September 2018

Aortic valvular imaging with cardiovascular magnetic resonance: seeking for comprehensiveness.

Br J Radiol 2019 Sep 18;92(1101):20170868. Epub 2019 Jul 18.

1Department of Radiological, Oncological and Pathological Sciences,"Sapienza" University of Rome, Rome, Italy.

Cardiovascular magnetic resonance (CMR) has an emerging role in aortic valve disease evaluation, becoming an all-in-one technique. CMR evaluation of the anatomy and flow through the aortic valve has a higher reproducibility than echocardiography. Its unique ability of myocardial tissue characterization, significantly improves the risk stratification and management of patients. In addition, CMR is equivalent to cardiac CT angiography for trans-aortic valvular implantation and surgical aortic valve replacement planning; on the other hand, its role in the evaluation of ventricular function improving and post-treatment complications is undisputed. This review encompasses the existing literature regarding the role of CMR in aortic valve disease, exploring all the aspects of the disease, from diagnosis to prognosis.
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http://dx.doi.org/10.1259/bjr.20170868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732913PMC
September 2019

4D flow characterization of aortic blood flow after valve sparing root reimplantation procedure.

J Vis Surg 2018 9;4:95. Epub 2018 May 9.

Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA.

Valve-sparing aortic root replacement (VSRR) with reimplantation technique is an effective alternative for young patients with dilated roots and preserved cusps, which avoids the risks of lifelong anticoagulation or valve degeneration. New grafts with anatomically-shaped sinuses have been developed in order to preserve aortic root physiology, which could decrease complication rates and improve durability. However, controversy remains regarding the effect of recreation of the sinuses of Valsalva during VSRR on long-term outcomes. The novel 4D flow technique, exploiting its unique ability to combine anatomical evaluation of the root with fluid-dynamic assessment of aortic flow, enables integrated analysis of the close interaction between graft design, valvular morphology and three-dimensional (3D) flow characteristics. Early experimental studies have shown how graft shape affects the aortic root flow pattern, formation of vortexes and helicity of downstream flow; however, the clinical significance of these findings is yet to be clarified. Various and still unexplored knowledge can be obtained from the qualitative and quantitative analysis of these complex datasets, that could shed more light on which is the best among myriad surgical techniques and grafts adopted in VSRR. The extraordinary potential 4D flow imaging opens new boundless horizons in the perspective of an increasingly patient-tailored surgical planning.
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http://dx.doi.org/10.21037/jovs.2018.03.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994458PMC
May 2018
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