Publications by authors named "Mariano Scaglione"

100 Publications

Role of MRI in early follow-up of patients with solid organ injuries: How and why we do it?

Radiol Med 2021 Jul 20. Epub 2021 Jul 20.

Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.

Trauma represents one of the most common causes of death or permanent disability in the population below 50 years. At present, non-operative treatment is the commonly adopted strategy in hemodynamically stable patients with solid organ injuries, when there are not concomitant bowel and mesenteric injuries requiring a prompt surgical approach, but it may require multiple imaging follow-up examinations, especially in the case of major injuries. No data are available about magnetic resonance imaging utilization in the early follow-up of trauma patients with solid organ injuries, particularly in liver and spleen trauma. We report our preliminary experience in this field.
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http://dx.doi.org/10.1007/s11547-021-01394-0DOI Listing
July 2021

Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review.

Diagnostics (Basel) 2021 May 30;11(6). Epub 2021 May 30.

Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy.

Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.
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http://dx.doi.org/10.3390/diagnostics11060998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230100PMC
May 2021

MRI to assess deep myometrial invasion in patients with endometrial cancer:A multi-reader study to evaluate the diagnostic role of different sequences.

Eur J Radiol 2021 May 4;138:109629. Epub 2021 Mar 4.

Institute of Biostructures and Bioimaging of the National Research Council, Naples, Italy.

Objective: The identification of deep myometrial invasion (DMI) represents a fundamental aspect in patients with endometrial cancer (EC) for accurate disease staging. It can be detected on MRI using T2-weighted (T2-w), diffusion weighted (DWI) and dynamic contrast enhanced sequences (DCE). Aim of the study was to perform a multi-reader evaluation of such sequences to identify the most accurate and its reliability for the best protocol.

Methods: In this multicenter retrospective study, MRI were independently evaluated by 4 radiologists (2 senior and 2 novice) with a sequence-based approach to identify DMI. The performance of the entire protocol was also evaluated. A comparison between the different sequences assessed by the same reader was performed using receiver operating curve and post-hoc analysis. Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-observer variability.

Results: A total of 92 patients were included. The performance of the readers did not show significant differences among DWI, DCE and the entire protocol. For only one senior radiologist, who reached the highest diagnostic accuracy with the entire protocol (82,6 %), both DWI (p = 0,0197) and entire protocol (p = 0,0039) were found significantly superior to T2-w. The highest inter-observer agreement was obtained with the entire protocol by expert readers (ICC = 0,77).

Conclusions: For the detection of DMI, the performances of DWI and DCE alone and that of a complete protocol do not significantly differ, even though the latter ensures the highest reliability particularly for expert readers. In cases in which T2-w and DWI are consistent, an unenhanced protocol could be proposed.
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http://dx.doi.org/10.1016/j.ejrad.2021.109629DOI Listing
May 2021

Late Diagnosis of Interrupted Aortic Arch With Massive Collateral Circulation in a Former Competitive Athlete With Early-Onset Hypertension.

Circ Cardiovasc Imaging 2021 02 28;14(2):e010818. Epub 2021 Jan 28.

Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy (M.A., M.S.).

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http://dx.doi.org/10.1161/CIRCIMAGING.120.010818DOI Listing
February 2021

Dual energy computed tomography evaluation of skeletal traumas.

Eur J Radiol 2021 Jan 1;134:109456. Epub 2020 Dec 1.

Department of Radiology, S. Maria delle Grazie Hospital, Pozzuoli, Italy. Electronic address:

Skeletal traumas are among the most common routine challenges faced by Emergency Radiologists, in particular in case of radiographically occult nondisplaced fractures or in case of soft tissue injuries. With the development of Dual Energy Computed Tomography (DECT) technology, new post-processing applications have gained a useful diagnostic role in many fields of musculoskeletal imaging including acute skeletal trauma imaging. In addition to conventional CT images, DECT allows for the generation of virtual calcium-suppressed images subtracting calcium from unenhanced CT images based on the fact that material attenuation varies at different energy levels. In this way, virtual-non-calcium (VNC) images can precisely characterize traumatic bone marrow edema in both axial and appendicular skeleton, facilitating prompt clinical decision, especially when magnetic resonance method is contraindicated or unavailable. Other DECT emerging applications in the trauma setting include metal artifact reduction and collagen mapping for the evaluation of injuries affecting ligament, tendon, and intervertebral disk. This review focuses on the basic principles of DECT and related post-processing algorithms, highlighting the current advantages and limitations of these new imaging advances in the Emergency Department related to skeletal traumas.
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http://dx.doi.org/10.1016/j.ejrad.2020.109456DOI Listing
January 2021

European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version).

Insights Imaging 2020 Dec 10;11(1):135. Epub 2020 Dec 10.

European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria.

Background: Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines.

Results: Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org ) and a short version also covering all recommendations (this article).

Conclusions: Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
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http://dx.doi.org/10.1186/s13244-020-00947-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726597PMC
December 2020

The practice of emergency radiology throughout Europe: a survey from the European Society of Emergency Radiology on volume, staffing, equipment, and scheduling.

Eur Radiol 2021 May 5;31(5):2994-3001. Epub 2020 Nov 5.

Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy.

Objectives: To obtain information from radiology departments throughout Europe regarding the practice of emergency radiology METHODS: A survey which comprised of 24 questions was developed and made available online. The questionnaire was sent to 1097 chairs of radiology departments throughout Europe using the ESR database. All data were collected and analyzed using IBM SPSS Statistics software, version 20 (IBM).

Results: A total of 1097 radiologists were asked to participate, 109 responded to our survey. The response rate was 10%. From our survey, 71.6% of the hospitals had more than 500 beds. Ninety-eight percent of hospitals have an active teaching affiliation. In large trauma centers, emergency radiology was considered a dedicated section. Fifty-three percent of institutions have dedicated emergency radiology sections. Less than 30% had all imaging modalities available. Seventy-nine percent of institutions have 24/7 coverage by staff radiologists. Emergency radiologists interpret cross-sectional body imaging, US scans, and basic CT/MRI neuroimaging in more than 50% of responding institutions. Cardiac imaging examinations/procedures are usually performed by cardiologist in 53% of institutions, while non-cardiac vascular procedures are largely performed and interpreted by interventional radiologists. Most people consider the European Diploma in Emergency Radiology an essential tool to advance the education and the dissemination of information within the specialty of emergency radiology.

Conclusion: Emergency radiologists have an active role in the emergency medical team. Indeed, based upon our survey, they have to interact with emergency physicians and surgeons in the management of critically ill patients. A broad skillset from ultrasonography and basic neuroimaging is required.

Key Points: • At most major trauma centers in Europe, emergency imaging is currently performed by all radiologists in specific units who are designated in the emergency department. • Radiologists in the emergency section at present have a broad skillset, which includes cross-sectional body imaging, ultrasonography, and basic neuroimaging of the brain and spine. • A dedicated curriculum that certifies a subspecialty in emergency radiology with a diploma offered by the European Society of Emergency Radiology demonstrates a great interest by the vast majority of the respondents.
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http://dx.doi.org/10.1007/s00330-020-07436-xDOI Listing
May 2021

Hemopericardium in the acute clinical setting: Are we ready for a tailored management approach on the basis of MDCT findings?

Radiol Med 2021 Apr 2;126(4):527-543. Epub 2020 Nov 2.

Department of Diagnostic Imaging, Pineta Grande Hospital, Castelvolturno, Italy.

The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach.
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http://dx.doi.org/10.1007/s11547-020-01303-xDOI Listing
April 2021

Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process.

Abdom Radiol (NY) 2020 Oct 14. Epub 2020 Oct 14.

Department of Radiology, University of Rome "Campus Bio-medico", Via Alvaro del Portillo, 21, 00128, Rome, Italy.

The objective of this article is to assess the computed tomography (CT) findings of small bowel obstruction (SBO) complicated by ischemia. SBO is a frequent clinical entity characterized by high morbidity and mortality. The radiologic aim is not just to diagnose the obstruction itself but to rule out the presence of complications related to SBO. This is crucial for differentiating which patients can be safely treated non-operatively from the ones who may need an urgent surgical approach. The main complication of SBO is intestinal ischemia. In the emergency setting, CT imaging is the modality of choice for SBO because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one. On the other hand, the radiologist who documents an intestinal ischemia should think about SBO as possible cause. In this case, the main finding which helps the radiologist in the identification of SBO is the presence of multiple and packed valvulae conniventes in the dilated bowel wall and the "transition zone" that indicates the passage between compressed and decompressed small bowel, otherwise the localization of the obstruction cause. Once the site of obstruction has been recognized, the other issue is to assess the cause of obstruction, considering that the most common cause of SBO remains "unidentified" and related to intra-abdominal adhesions. After that, the following most important point is to rule out the presence of an ischemic bowel and mesenteric changes associated to SBO. CT signs of bowel ischemia include reduced or increased bowel wall enhancement, mesenteric edema or engorgement, fluid or free air in the peritoneal cavity. This condition usually leads to an urgent laparotomy and, in some cases, to a surgical resection.
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http://dx.doi.org/10.1007/s00261-020-02800-3DOI Listing
October 2020

Pelvic floor dysfunctions: how to image patients?

Jpn J Radiol 2020 Jan 16;38(1):47-63. Epub 2019 Dec 16.

Department of Radiology, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.

Pelvic floor dysfunctions embrace a large series of different conditions in which functional abnormalities of the pelvic floor lead to impairment in urinary and sexual functions and in rectal voiding. A multidisciplinary approach is needed in the evaluation of these patients, as well as the adoption of imaging studies adequate to explore the complex anatomy of the region and its dynamic functionality. Available imaging studies include: endoanal and transperineal ultrasound, X-ray defecography and MR defecography. The purpose of this review article is to illustrate the technique, indications, the current role, and diagnostic value of each one of these. The recent availability of new imaging techniques and related advantages will also be discussed.
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http://dx.doi.org/10.1007/s11604-019-00903-6DOI Listing
January 2020

The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma.

Emerg Radiol 2019 Dec 23;26(6):647-654. Epub 2019 Aug 23.

Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli, 9, 80131, Naples, Italy.

Purpose: In the literature, no consensus exists about which CT protocol is to be adopted in patients who underwent high-energy blunt trauma. The aim of the study is to evaluate the additional value of the arterial phase in the CT assessment of vascular injuries of the liver.

Methods: Admission CT examinations for patients with traumatic injury of the liver due to high-energy blunt trauma, performed between 2011 and 2017 in two major trauma centres, were retrospectively reviewed. Images were analysed for presence or absence of liver parenchymal injury, intrahepatic contained vascular injuries and active bleeding in the arterial and portal venous phase of the CT study.

Results: Two hundred twelve patients have been identified. Parenchymal injuries were detected as isolated in 90.6% of cases, whereas they were associated with vascular injuries in 9.4% of cases: contained vascular injuries in 3.3% and active bleeding in 6.1%. Out of all parenchymal injuries detected on the CT portal venous phase, 90.5% were also detectable in the arterial phases (p < 0.0001). All of the contained vascular injuries were visible in the CT arterial phase, whereas they were detectable in 28.5% of cases also during the venous phase (p = 0.02). All 13 cases of active bleeding were detected on the CT venous phase, and 76.9% of these cases were also revealed in the arterial phase, thus confirming their arterial origin (p = 0.22).

Conclusion: The addiction of the arterial phase to the venous phase in the CT assessment of patients who underwent high-energy blunt trauma allows an accurate identification and characterization of traumatic vascular injuries, so distinguishing between patients suitable for conservative management and those requiring interventional or surgical treatment.
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http://dx.doi.org/10.1007/s10140-019-01714-yDOI Listing
December 2019

MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report.

Br J Radiol 2019 Sep 20;92(1101):20170980. Epub 2019 Jun 20.

2Sunderland Royal Hospital, Kayll Road, Sunderland, UK.

Resternotomy (RS) is a common occurrence in cardiac surgical practice. It is associated with an increased risk of injury to old conduits, cardiac structures, catastrophic hemorrhage and subsequent high morbidity and mortality rate in the operating room or during the recovery period. To mitigate this risk, we evaluated the role of multidetector CT (MDCT) in planning repeat cardiac surgery. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings. Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications.
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http://dx.doi.org/10.1259/bjr.20170980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732917PMC
September 2019

Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience.

Gland Surg 2019 Apr;8(2):184-196

Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy.

Pancreatic injuries can occur from either penetrating or blunt abdominal trauma. While there are rare, especially in the setting of blunt abdominal trauma, they are associated with a mortality of up to 30%, and a morbidity of 60%. Multidetector computed tomography (MDCT) is the preferred imaging modality in patients with acute blunt abdominal trauma and for the detection of acute pancreatic injury. Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) plays an important role in the follow-up of pancreatic injury. In this brief review, we discuss the main MDCT acute imaging findings as well as the complications. Finally, we discuss the role of MR and MRCP in follow up of patients with pancreatic injuries.
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http://dx.doi.org/10.21037/gs.2019.02.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534762PMC
April 2019

MRI and CT findings of a primary malignant fibrous hystiocitoma presenting as a huge glissonian mass; imaging findings with surgical and histological correlations.

BJR Case Rep 2019 Feb 2;5(1):20180055. Epub 2018 Aug 2.

Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy.

The present case report describes imaging findings (CT and MRI features) of a primary malignant fibrous hystiocitoma, presenting as a dual stage lesion, completely exophytic along liver surface with surgical and histological correlations. Imaging characteristics suggested the nature of the lesion (mesenchymal) and the behavior (expansile growth pattern) which addressed surgeons to a conservative excision.
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http://dx.doi.org/10.1259/bjrcr.20180055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519500PMC
February 2019

Occupational exposure to furry animals and asthma: The complex interconnection between work and everyday life.

Ann Allergy Asthma Immunol 2018 10;121(4):512-513

Postgraduate School of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy; Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.

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http://dx.doi.org/10.1016/j.anai.2018.07.039DOI Listing
October 2018

Long-term follow-up of unresectable medium-large hepatocellular carcinoma nodules treated with radiofrequency ablation using a multiple-electrode switching system.

Br J Radiol 2019 Jan 11;92(1093):20180625. Epub 2018 Oct 11.

Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy.

Objective: The purpose of this study was to prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat unresectable medium-large (3.1-6.0 cm) HCC nodules.

Methods: RFA using a multiple-electrode switching system was performed for HCC nodules with size > 3.0 < 6.0 cm in nonsurgical candidates. Two electrodes were consecutively placed for 3.1-4.0 cm tumours, and three electrodes for 4.1-5.9 cm tumours, with a 2.0-2.5 cm spacing. The power was switched from one electrode to the next automatically when the impedance reached 30 Ω above the baseline level. 25 patients (M/F = 9/16; median age 76 years, range 61-84) with liver cirrhosis (20 HCV-positive) in Child's Class A (22 cases) and B (3 cases) and 26 HCC nodules (median diameter 4.0 cm; range 3.2-5.5 cm) underwent treatment in 25 sessions from 2013 and 2018. Therapeutic effectiveness was assessed through CT or MRI exam at 30-40 days post-ablation.

Results: No procedure-related death or major complications occurred. Complete ablation was obtained in all nodules (100%). At a median follow up of 30 months, local tumor progression occurred in five out of 26 nodules (19.2%). Overall survival at 4 years was 49%.

Conclusion: RFA with a multiple-electrode switching system may be a safe, quick and effective therapeutic option for treatment of 3.1-6.0 cm unresectable HCC tumours.

Advances In Knowledge: RFA with multiple electrodes provides favourable clinical results in patients with medium-large HCC nodules who are not suitable for surgery.
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http://dx.doi.org/10.1259/bjr.20180625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435052PMC
January 2019

Ablation treatment of primary and secondary liver tumors under contrast-enhanced ultrasound guidance in field practice of interventional ultrasound centers. A multicenter study.

Eur J Radiol 2018 Aug 31;105:96-101. Epub 2018 May 31.

Department of Internal Medicine and Gastroenterology, Catholic University of Sacred Heart, Rome, Italy.

The present retrospective study was aimed at characterizing the clinical impact of contrast-enhanced ultrasound (CEUS) as a guidance technique for ablation of primary and secondary liver tumors at six interventional ultrasound centers. 148 patients (103M/45F, median age 74 yrs.) with 151 liver target lesions (median size 15 mm, 86.7% Hepatocellular Carcinomas) in whom CEUS guidance was used for Percutaneous Ethanol Injection (35.2%), Radiofrequency (46.3%) and Microwave (18.5%) were selected during the period 2008-2016. CEUS-guided ablations represented 7.3% (range 2.5%-13.8%) of 2015 ablative sessions performed at the participating centers. Indications to CEUS-guided ablation were: improvement of conspicuity of the target (28.5%), a target lesion undetectable on B-mode ultrasound (29.8%), detection of viable areas in nodules with either incomplete ablation or local tumor progression (41.7%). Overall, complete radiological ablation was obtained in 113/151 tumors (74.8%), with heat-based techniques (RF and MW) achieving higher rate of successful ablation (86.7%) than PEI (51%). Neither deaths nor major complications occurred after ablations. CEUS guidance demonstrates improved visibility and effectiveness in aiding ablation procedures that are otherwise technically difficult using only B-Mode US guidance.
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http://dx.doi.org/10.1016/j.ejrad.2018.05.030DOI Listing
August 2018

Imaging of Oncologic Emergencies.

Semin Ultrasound CT MR 2018 Apr 15;39(2):151-166. Epub 2017 Dec 15.

Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland, UK. Electronic address:

Oncologic emergencies can be either the result of the primary tumor, its metastasis, a paraneoplastic syndrome or reaction to the chemotherapy. Imaging plays a crucial role in ensuring a prompt diagnosis as well as assisting in the therapeutic management. In this article, we discuss the common thoracic and abdominal oncological emergencies that may be encountered in an emergency department.
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http://dx.doi.org/10.1053/j.sult.2017.12.001DOI Listing
April 2018

Biopsy of Liver Target Lesions under Contrast-Enhanced Ultrasound Guidance - A Multi-Center Study.

Ultraschall Med 2018 Aug 12;39(4):448-453. Epub 2017 Dec 12.

Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Roma, Italy.

Purpose:  To retrospectively characterize the prevalence and impact of contrast-enhanced ultrasound (CEUS) as a guidance technique for the biopsy of liver target lesions (LTLs) at six interventional ultrasound centers.

Materials And Methods:  The six participating centers retrospectively selected all patients in whom biopsy needles were positioned in LTLs during CEUS. The prevalence of CEUS-guided biopsies at each center between 2005 and 2016, contrast agent consumption, procedure indications, diagnostic yield and complications were assessed. Informed consent was obtained for all patients.

Results:  CEUS-guided biopsy of LTLs was carried out in 103 patients (68 M/35 F, median age: 69 yrs) with 103 liver target lesions (median size: 20 mm) using cutting needles (18 - 20 g) in 94 cases (91.2 %). CEUS-guided biopsy represented 2.6 % (range: 0.8 - 7.7 %) of 3818 biopsies on LTLs carried out at the participating centers. Indications to CEUS-guided biopsy were: a target lesion not visible on non-enhanced US (27.2 %), improvement of conspicuity of the target (33 %), choice of non-necrotic area inside the target (39.8 %). 26 patients (25.2 %) had a previously non-diagnostic cyto-histological exam. The diagnostic accuracy of the technique was 99 %. No major complications followed infusion of contrast agent or biopsy performance.

Conclusion:  The indications for CEUS-guided biopsy for LTLs are limited, but CEUS can be useful in challenging clinical scenarios, e. g. poorly visualized or invisible lesions or sampling of non-necrotic areas in the target lesions. There is also a potential advantage in using CEUS to guide repeat biopsies after unsuccessful sampling performed using the standard ultrasound technique.
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http://dx.doi.org/10.1055/s-0043-122496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405338PMC
August 2018

Imaging Assessment of Thoracic Cage Injuries.

Semin Musculoskelet Radiol 2017 Jul 1;21(3):303-314. Epub 2017 Jun 1.

Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno CE, Italy.

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http://dx.doi.org/10.1055/s-0037-1602413DOI Listing
July 2017

MDCT evaluation of acute aortic syndrome (AAS).

Br J Radiol 2016 1;89(1061):20150825. Epub 2016 Apr 1.

3 Department of Diagnostic Imaging, Presidio Ospedaliero "Pineta Grande", Caserta, Italy.

Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes.
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http://dx.doi.org/10.1259/bjr.20150825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985458PMC
September 2016

Radiofrequency and microwave ablation of subcapsular hepatocellular carcinoma accessed by direct puncture: Safety and efficacy.

Eur J Radiol 2016 Apr 1;85(4):739-43. Epub 2016 Feb 1.

Department of Radiology and Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Medison, United States.

Objectives: Direct puncture of subcapsular hepatocellular carcinoma (HCC) for tumor ablation has been considered high risk due to a perceived increased incidence of hemorrhage or tumor seeding. The purpose of this retrospective multicenter study was to identify the rate of tumor seeding, hemorrhage and local tumor progression (LTP) associated with direct puncture radiofrequency (RF) and microwave (MW) ablation of subcapsular HCC.

Methods: A multicenter, retrospective review of direct-puncture RF and MW performed on subcapsular HCC was conducted. Complications and local tumor progression were documented. Data was analyzed using Kaplan-Meier and log-rank tests.

Results: The study group consisted of 60 cirrhotic patients (M/F=43/17; mean age 69.6 years) with 67 subcapsular HCC (mean diameter 2.3 cm ± 1.0 cm) that were directly punctured for RF (n=40) or MW (n=27) under ultrasound (US) guidance. The mean follow-up period was 30.8 months. There were no hemorrhagic complications. The overall LTP rate was 13.4%. There was one case of tumor tract seeding in a patient who had undergone a percutaneous biopsy two weeks prior to RF.

Conclusions: Thermal ablation of HCC by direct puncture appears safe and effective. There were no cases of intraperitoneal hemorrhage, and tumor seeding was seen in a single case in which a preceding percutaneous biopsy had been performed.
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http://dx.doi.org/10.1016/j.ejrad.2016.01.020DOI Listing
April 2016

Emergency radiology special feature: editorial.

Br J Radiol 2016 4;89(1061):20160203. Epub 2016 Mar 4.

1 Department of Radiology, Pineta Grande Medical Center, Castel Volturno, Italy.

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http://dx.doi.org/10.1259/bjr.20160203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985485PMC
September 2016

Fat Embolism Syndrome: Lung Computed Tomography Findings in 18 Patients.

J Comput Assist Tomogr 2016 May-Jun;40(3):335-42

From the *UOC Radiologia Ospedale Maggiore Area Nord Ovest; †Radiologia Ospedale Bellaria, AUSL Bologna, Bologna; and ‡Department of Imaging, Pineta Grande Medical Center, Castel Volturno, Italy; §Dartford & Gravesham NHS Trust, Dartford, UK; ∥Rianimazione e 118 and ¶Dipartimento di Ortopedia, Ospedale Maggiore, AUSL Bologna; and #Struttura Complessa di Pneumologia Interventistica, Dipartimento Cardio-Toraco-Vascolare, AOSP Bologna, Bologna, Italy.

Objective: The purpose of this study was to evaluate the lung computed tomography (CT) findings in fat embolism (FE) syndrome.

Methods: We retrospectively evaluated 19 CT examinations of 18 patients with FE syndrome, diagnosed clinically using the Gurd and Wilson criteria.

Result: Fat embolism syndrome showed 3 patterns: negative examination, bilateral interstitial-alveolar involvement, and adult respiratory distress syndrome like. Frequent findings included consolidations (17 patients), mostly with gravity dependent distribution, and ground-glass opacities (17 patients), mostly with patchy distribution. Fifteen patients showed an overlapping random nodular pattern. Less common findings included lobular ground-glass opacities and lobular consolidations, smooth septal thickening, thickening of the bronchial wall, and areas of crazy paving. The extension of the consolidations correlates with the duration of assisted ventilation.

Conclusions: In FE syndrome, pulmonary CT findings are ground-glass opacities and dependent consolidations, associated with other variably overlapping signs, such as lobular opacities, random nodules, septal thickening, and bronchial wall thickening.
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http://dx.doi.org/10.1097/RCT.0000000000000376DOI Listing
January 2017

Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications.

Br J Radiol 2016 17;89(1061):20150952. Epub 2016 Feb 17.

1 Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Italy.

Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.
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http://dx.doi.org/10.1259/bjr.20150952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985472PMC
September 2016

Perforated Appendicitis: Assessment With Multidetector Computed Tomography.

Semin Ultrasound CT MR 2016 Feb 9;37(1):31-6. Epub 2015 Oct 9.

Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Italy; Department of Radiology, Darent Valley Hospital, Dartford & Gravesham NHS Trust, Dartford, UK.

Appendicitis is one of the most common abdominal surgical emergencies. In some cases, the correct diagnosis may be challenging, owing to different conditions that can mimic this pathology. In this context, abdominal computed tomography (CT) is the imaging modality of choice, leading to an accurate diagnosis and to a reduction in unnecessary laparotomies. The diagnosis of perforated appendix is crucial, but the detection of the perforation signs by CT may not be so simple in the early process. The aim of this article is to review the multiple detector CT signs of perforated appendicitis.
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http://dx.doi.org/10.1053/j.sult.2015.10.002DOI Listing
February 2016

Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia.

Gastroenterol Res Pract 2016 27;2016:2657876. Epub 2015 Dec 27.

Radiology Department, University of Foggia, Foggia, Italy.

Purpose. Aim of the study is to evaluate the efficacy of the endoscopic (pneumatic dilation) versus surgical (Heller myotomy) treatment in patients affected by esophageal achalasia using barium X-ray examination of the digestive tract performed before and after the treatment. Materials and Methods. 19 patients (10 males and 9 females) were enrolled in this study; each patient underwent a barium X-ray examination to evaluate the esophageal diameter and the height of the barium column before and after endoscopic or surgical treatment. Results. The mean variation of oesophageal diameter before and after treatment is -2.1 mm for surgery and 1.74 mm for pneumatic dilation (OR 0.167, CI 95% 0.02-1.419, and P: 0.10). The variations of all variables, with the exception of the oesophageal diameter variation, are strongly related to the treatment performed. Conclusions. The barium X-ray study of the digestive tract, performed before and after different treatment approaches, demonstrates that the surgical treatment has to be considered as the treatment of choice of achalasia, reserving endoscopic treatment to patients with high operative risk and refusing surgery.
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http://dx.doi.org/10.1155/2016/2657876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706911PMC
January 2016

Errors in imaging of traumatic injuries.

Abdom Imaging 2015 Oct;40(7):2091-8

Division of Emergency Imaging, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, 14642, USA.

The advent of multi-detector computed tomography (MDCT) has drastically improved the outcomes of patients with multiple traumatic injuries. However, there are still diagnostic challenges to be considered. A missed or the delay of a diagnosis in trauma patients can sometimes be related to perception or other non-visual cues, while other errors are due to poor technique or poor image quality. In order to avoid any serious complications, it is important for the practicing radiologist to be cognizant of some of the most common types of errors. The objective of this article is to review the various types of errors in the evaluation of patients with multiple trauma injuries or polytrauma with MDCT.
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http://dx.doi.org/10.1007/s00261-015-0494-9DOI Listing
October 2015
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