Publications by authors named "Nicholas Landini"

13 Publications

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Pulmonary magnetic resonance imaging in systemic sclerosis: a jump in the future to unravel inflammation in interstitial lung disease.

Clin Rheumatol 2021 Sep 30;40(9):3461-3464. Epub 2021 Jul 30.

Department of Experimental and Clinical Biomedical Sciences, and Radiodiagnostic Unit N. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.

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http://dx.doi.org/10.1007/s10067-021-05869-3DOI Listing
September 2021

THE ROLE OF CHEST CT IN DECIPHERING INTERSTITIAL LUNG INVOLVEMENT: SYSTEMIC SCLEROSIS VERSUS COVID-19.

Rheumatology (Oxford) 2021 Jul 28. Epub 2021 Jul 28.

Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy.

Objective: To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia.

Methods: This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.

Results: Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity).

Conclusion: The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.
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http://dx.doi.org/10.1093/rheumatology/keab615DOI Listing
July 2021

A three-dimensional measurement method on MR arthrography of the hip to classify femoro-acetabular impingement.

Jpn J Radiol 2021 Jun 28. Epub 2021 Jun 28.

Department of Radiology, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.

Purpose: (1) To investigate correlations between different types of FAI and the ratio of acetabular volume (AV) to femoral head volume (FV) on MR arthrography. (2) To assess 2D/3D measurements in identifying different types of FAI by means of cut-off values of AV/FV ratio (AFR).

Materials And Methods: Alpha angle, cranial acetabular version, acetabular depth, lateral center edge angle, AV, and FV of 52 hip MR arthrography were measured. ANOVA test correlated different types of FAI with AFR. ROC curves classified FAI by cut-off values of AFR. Accuracy of 2D/3D measurements was calculated.

Results: ANOVA test showed a significant difference of AFR (p value < 0.001) among the three types of FAI. The mean values of AFR were 0.64, 0.74, and 0.89 in cam, mixed, and pincer types, respectively. Cut-off values of AFR were 0.70 to distinguish cam types from mixed and pincer types, and 0.79 to distinguish pincer types from cam and mixed types. Cut-off values identified 100%, 73.9%, and 55.6% of pincer, cam, and mixed types. 2D and 3D classifications of FAI showed accuracy of 40.4% and 73.0%.

Conclusions: 3D measurements were clearly more accurate than 2D measurements. Distinct cut-off values of AFR discriminated cam types from pincer types and identified pincer types in all cases. Cam and mixed types were not accurately recognized.
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http://dx.doi.org/10.1007/s11604-021-01162-0DOI Listing
June 2021

Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in Common Variable Immunodeficiency (CVID): A Multicenter Retrospective Study of Patients From Italian PID Referral Centers.

Front Immunol 2021 10;12:627423. Epub 2021 Mar 10.

Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.

Granulomatous and Lymphocytic Interstitial Lung Diseases (GLILD) is a severe non-infectious complication of Common Variable Immunodeficiency (CVID), often associated with extrapulmonary involvement. Due to a poorly understood pathogenesis, GLILD diagnosis and management criteria still lack consensus. Accordingly, it is a relevant cause of long-term loss of respiratory function and is closely associated with a markedly reduced survival. The aim of this study was to describe clinical, immunological, laboratory and functional features of GLILD, whose combination in a predictive model might allow a timely diagnosis. In a multicenter retrospective cross-sectional study we enrolled 73 CVID patients with radiologic features of interstitial lung disease (ILD) associated to CVID (CVID-ILD) and 125 CVID patients without ILD (controls). Of the 73 CVID-ILD patients, 47 received a definite GLILD diagnosis while 26 received a clinical-radiologic diagnosis of CVID related ILD defined as uILD. In GLILD group we found a higher prevalence of splenomegaly (84.8 vs. 39.2%), autoimmune cytopenia (59.6 vs. 6.4%) and bronchiectasis (72.3 vs. 28%), and lower IgA and IgG serum levels at CVID diagnosis. GLILD patients presented lower percentage of switched-memory B cells and marginal zone B cells, and a marked increase in the percentage of circulating CD21lo B cells (14.2 vs. 2.9%). GLILD patients also showed lower total lung capacity (TLC 87.5 vs. 5.0%) and gas transfer (DLCO 61.5 vs. 5.0%) percent of predicted. By univariate logistic regression analysis, we found IgG and IgA levels at CVID diagnosis, presence of splenomegaly and autoimmune cytopenia, CD21lo B cells percentage, TLC and DCLO percent of predicted to be associated to GLILD. The joint analysis of four variables (CD21lo B cells percentage, autoimmune cytopenia, splenomegaly and DLCO percent of predicted), together in a multiple logistic regression model, yielded an area under the ROC curve (AUC) of 0.98 (95% CI: 0.95-1.0). The AUC was only slightly modified when pooling together GLILD and uILD patients (0.92, 95% CI: 0.87-0.97). we propose the combination of two clinical parameters (splenomegaly and autoimmune cytopenia), one lung function index (DLCO%) and one immunologic variable (CD21lo%) as a promising tool for early identification of CVID patients with interstitial lung disease, limiting the use of aggressive diagnostic procedures.
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http://dx.doi.org/10.3389/fimmu.2021.627423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987811PMC
March 2021

The Role of Imaging in COVID-19 Pneumonia Diagnosis and Management: Main Positions of the Experts, Key Imaging Features and Open Answers.

J Cardiovasc Echogr 2020 Oct 27;30(Suppl 2):S25-S30. Epub 2020 Oct 27.

Department of Radiology, Ca' Foncello General Hospital, Treviso, Italy.

Lung imaging is widely involved in facing the coronavirus disease (COVID-19) pandemic. In fact, the COVID-19 infection may lead to a rapidly evolving and potentially fatal pneumonia. Moreover, computed tomography (CT) can be more sensitive than the COVID-19 reverse transcriptase-polymerase chain reaction test, especially at the beginning of the disease. Only patients with mild features consistent with COVID-19 infection, negative COVID-19 test, or positive COVID-19 test but at low risk for disease progression should avoid imaging. However, imaging becomes mandatory if respiratory symptoms worsen. A CT pattern classification has been designed to help both radiologists and clinicians. The typical pattern of COVID-19 is depicted by multifocal, bilateral, and peripheral ground-glass opacities (with or without consolidations or crazy paving) or findings of organizing pneumonia. Moreover, CT has demonstrated a prognostic role in patients with a diagnosis of COVID-19 pneumonia. Lung ultrasounds (LUS) are an emergent tool in the diagnosis of the disease. The adoption of LUS combined to chest X-rays in COVID-19 in pneumonia diagnosis is an interesting prospect that needs to be confirmed.
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http://dx.doi.org/10.4103/jcecho.jcecho_59_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811702PMC
October 2020

Texture analysis in the characterization of parotid salivary gland lesions: A study on MR diffusion weighted imaging.

Eur J Radiol 2021 Mar 7;136:109529. Epub 2021 Jan 7.

Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy. Electronic address:

Background And Purpose: Parotid lesions show overlaps of morphological findings, apparent diffusion coefficient (ADC) values and types of time/intensity curve. This research aimed to evaluate the role of diffusion weighted imaging texture analysis in differentiating between benign and malignant parotid lesions and in characterizing pleomorphic adenoma (PA), Warthin tumor (WT), epithelial malignancy (EM), and lymphoma (LY).

Methods: Texture analysis of 54 parotid lesions (19 PA, 14 WT, 14 EM, and 7 LY) was performed on ADC map images. An ANOVA test was used to estimate both the difference between benign and malignant lesions and the texture feature differences among PA, WT, EM, and LY. A P-value≤0.01 was considered to be statistically significant. A cut-off value defined by ROC curve analysis was found for each statistically significant texture parameter. The diagnostic accuracy was obtained for each texture parameter with AUC ≥ 0.5. The agreement between each texture parameter and histology was calculated using the Cohen's kappa coefficient.

Results: The mean kappa values were 0.61, 0.34, 0.26, 0.17, and 0.48 for LY, EM, WT, PA, and benign vs. malignant lesions respectively. Long zone emphasis cut-off values >1.870 indicated EM with an accuracy of 81 % and values >2.630 revealed LY with an accuracy of 93 %. Long run emphasis values >1.050 and >1.070 indicated EM and LY with a diagnostic accuracy of 79% and 93% respectively.

Conclusions: Long zone emphasis and long run emphasis texture parameters allowed the identification of LY and the differentiation between benign and malignant lesions. WT and PA were not accurately recognized.
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http://dx.doi.org/10.1016/j.ejrad.2021.109529DOI Listing
March 2021

Pleuroparenchymal fibroelastosis in rheumatic autoimmune diseases: a systematic literature review.

Rheumatology (Oxford) 2020 Dec;59(12):3645-3656

Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence.

Objectives: Pleuroparenchymal fibroelastosis (PPFE) is characterized by predominantly upper lobe pleural and subjacent parenchymal fibrosis; PPFE features were described in patients with rheumatic autoimmune diseases (RAID). A systematic literature review was performed to investigate the prevalence, prognosis and potential association of PPFE with previous immunosuppression in RAID.

Methods: EMBASE, Web of Science and PubMed databases were questioned from inception to 1 September 2019. Articles published in English and addressing PPFE in patients with RAID were selected.

Results: Twenty out of 794 papers were selected with a total of 76 cases of RAID-PPFE patients (20 SSc, 9 RA, 6 IIM6 primary SS, 5 overlap syndromes, 3 ANCA-associated vasculitides, 2 granulomatosis with polyangiitis, 1 microscopic polyangiitis, 1 UCTD, 1 SLE, 1 GCA and 21 patients with non-specified RAID). Dyspnoea was the most frequently reported symptom (37/48 patients, 77%). Patients frequently presented with a restrictive pattern and decline in diffusing lung capacity for carbon monoxide. During the follow-up, 7/12 patients had progression at imaging, 22/39 presented a generic clinical worsening, 19/38 had a functional deterioration and 15/43 remained stable.

Conclusion: The present systematic literature review confirms that PPFE features are present in RAID. Rheumatologists should be aware of this new radiological pattern that holds a bad prognosis.
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http://dx.doi.org/10.1093/rheumatology/keaa451DOI Listing
December 2020

Infection or Autoimmunity? The Clinical Challenge of Interstitial Lung Disease in Systemic Sclerosis During the COVID-19 Pandemic.

J Rheumatol 2021 05 1;48(5):790-792. Epub 2020 Dec 1.

Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.

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http://dx.doi.org/10.3899/jrheum.200832DOI Listing
May 2021

Progressive lung fibrosis and mortality can occur in early systemic sclerosis patients without pulmonary abnormalities at baseline assessment.

Clin Rheumatol 2020 Nov 8;39(11):3393-3400. Epub 2020 May 8.

Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.

Objectives: In systemic sclerosis, baseline extent of radiological involvement is an important outcome predictor and baseline absence of radiological involvement suggests a more favourable prognosis. As current predictive models are based on cohorts with variable disease duration, we aim to assess disease dynamics in early disease.

Methods: Patients were included from the prospective longitudinal Belgian Systemic Sclerosis Cohort. We included patients with a disease duration < = 36 months at baseline with available baseline thoracic high-resolution computed tomography (HRCT) images and longitudinal pulmonary function test (PFT) results until 42 months of follow-up.

Results: Fifty-two patients were included; 50% were male and 44% suffered from diffuse cutaneous systemic sclerosis. A total of 46% carried anti-topoisomerase 1 antibodies. The mean disease duration at baseline visit was 11 months. At baseline visit, 40.4% (21/52) patients had HRCT abnormalities. Patients with abnormal HRCT findings more frequently suffered from diffuse cutaneous systemic sclerosis (p < 0.05) and less frequently carried anti-centromere antibodies (p < 0.05). Patients without CT abnormalities at baseline had a shorter disease duration (9 ± 7 months versus 14 ± 12 months). After 42 months, 8/52 patients, including 3 patients with normal HRCT findings at baseline, died due to SSc-related manifestations. Progression of lung fibrosis occurred in 16 patients at month 42, including 7 patients with normal CT at baseline. No clear predictors of progression could be identified.

Conclusion: In early SSc patients, the disease dynamics differ from the large published cohorts. Progressive lung fibrosis and mortality can also occur in patients without radiological abnormalities at baseline. Key Points • Disease dynamics in early SSc differ from more established SSc. • In early SSc, progressive pulmonary fibrosis can occur in patients without CT abnormalities at baseline. • In early SSc, more stringent pulmonary follow-up is warranted both in lcSSc and dcSSc.
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http://dx.doi.org/10.1007/s10067-020-05105-4DOI Listing
November 2020

Glottis Closure Influences Tracheal Size Changes in Inspiratory and Expiratory CT in Patients with COPD.

Acad Radiol 2017 07 22;24(7):901-907. Epub 2017 Mar 22.

Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, Florence 50134, Italy.

Rationale And Objectives: The opened or closed status of the glottis might influence tracheal size changes in inspiratory and expiratory computed tomography (CT) scans. We investigated if the glottis status makes the tracheal collapse differently correlate with lung volume difference between inspiratory and expiratory CT scans.

Materials And Methods: Forty patients with chronic obstructive pulmonary disease whose glottis was included in the acquired scanned volume for lung CT were divided into two groups: 16 patients with the glottis closed in both inspiratory and expiratory CT, and 24 patients with the glottis open in at least one CT acquisition. Lung inspiratory (Vinsp) and expiratory (Vexp) volumes were automatically computed and lung ΔV was calculated using the following formula: (Vinsp - Vexp)/Vinsp × 100. Two radiologists manually measured the anteroposterior diameter and cross-sectional area of the trachea 1 cm above the aortic arch and 1 cm above the carina. Tracheal collapse was then calculated and correlated with lung ΔV.

Results: In the 40 patients, the correlations between tracheal Δanteroposterior diameter and Δcross-sectional area at each level and lung ΔV ranged between 0.68 and 0.74 (ρ) at Spearman rank correlation test. However, in the closed glottis group, the correlations were higher for all measures at the two levels (ρ range: 0.84-0.90), whereas in the open glottis group, correlations were low and not statistically significant (ρ range: 0.29-0.34) at the upper level, and moderate at the lower level (ρ range: 0.51-0.55).

Conclusions: A closed or open glottis influences the tracheal size change in inspiratory and expiratory CT scans. With closed glottis, the tracheal collapse shows a stronger correlation with the lung volume difference between inspiratory and expiratory CT scans.
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http://dx.doi.org/10.1016/j.acra.2017.01.018DOI Listing
July 2017

Development of digital phantoms based on a finite element model to simulate low-attenuation areas in CT imaging for pulmonary emphysema quantification.

Int J Comput Assist Radiol Surg 2017 Sep 12;12(9):1561-1570. Epub 2016 Nov 12.

BEAMS Department, École polytechnique de Bruxelles, ULB - Université Libre de Bruxelles, Bruxelles, Belgium.

Purpose: To develop an innovative finite element (FE) model of lung parenchyma which simulates pulmonary emphysema on CT imaging. The model is aimed to generate a set of digital phantoms of low-attenuation areas (LAA) images with different grades of emphysema severity.

Methods: Four individual parameter configurations simulating different grades of emphysema severity were utilized to generate 40 FE models using ten randomizations for each setting. We compared two measures of emphysema severity (relative area (RA) and the exponent D of the cumulative distribution function of LAA clusters size) between the simulated LAA images and those computed directly on the models output (considered as reference).

Results: The LAA images obtained from our model output can simulate CT-LAA images in subjects with different grades of emphysema severity. Both RA and D computed on simulated LAA images were underestimated as compared to those calculated on the models output, suggesting that measurements in CT imaging may not be accurate in the assessment of real emphysema extent.

Conclusions: Our model is able to mimic the cluster size distribution of LAA on CT imaging of subjects with pulmonary emphysema. The model could be useful to generate standard test images and to design physical phantoms of LAA images for the assessment of the accuracy of indexes for the radiologic quantitation of emphysema.
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http://dx.doi.org/10.1007/s11548-016-1500-6DOI Listing
September 2017

Development and analysis of a finite element model to simulate pulmonary emphysema in CT imaging.

Annu Int Conf IEEE Eng Med Biol Soc 2015 ;2015:6370-3

In CT imaging, pulmonary emphysema appears as lung regions with Low-Attenuation Areas (LAA). In this study we propose a finite element (FE) model of lung parenchyma, based on a 2-D grid of beam elements, which simulates pulmonary emphysema related to smoking in CT imaging. Simulated LAA images were generated through space sampling of the model output. We employed two measurements of emphysema extent: Relative Area (RA) and the exponent D of the cumulative distribution function of LAA clusters size. The model has been used to compare RA and D computed on the simulated LAA images with those computed on the models output. Different mesh element sizes and various model parameters, simulating different physiological/pathological conditions, have been considered and analyzed. A proper mesh element size has been determined as the best trade-off between reliable results and reasonable computational cost. Both RA and D computed on simulated LAA images were underestimated with respect to those calculated on the models output. Such underestimations were larger for RA (≈ -44 ÷ -26%) as compared to those for D (≈ -16 ÷ -2%). Our FE model could be useful to generate standard test images and to design realistic physical phantoms of LAA images for the assessment of the accuracy of descriptors for quantifying emphysema in CT imaging.
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http://dx.doi.org/10.1109/EMBC.2015.7319850DOI Listing
September 2016

Myocardial T1 and T2 mapping in diastolic and systolic phase.

Int J Cardiovasc Imaging 2015 Jun 13;31(5):1001-10. Epub 2015 Mar 13.

Department of Radiology, Versilia Hospital, Lido di Camaiore, Italy,

The aim of this study was to evaluate the regional (i.e. myocardial segments) variability as well as the overall image quality of cardiac T1 and T2 maps obtained in diastole and in systole. In 22 healthy subjects (group-1), diastolic T1 and T2 maps were obtained at 1.5 T in short-axis view at basal, mid-ventricular and apical level, as well as in 4-chamber (4 ch) and in 2-chamber (2 ch) views. In another group of 25 patients (group-2), the maps were obtained in both diastole and systole. In the group-1, 15.4% of myocardial segments in T1 maps and 0.8% of myocardial segments in T2 maps, mainly located at apical level, showed relevant artifacts and/or partial-volume effect and had to be discarded. We found no significant difference in T1 values among basal, mid-ventricular and apical segments. T2 values at apical level were significantly higher than at basal and mid-ventricular level (short-axis, p < 0.0001; 4 ch, p < 0.009; 2 ch, p = 0.0002 at ANOVA tests). In the group-2, 21.1%/5.3% and 4.0%/0.8% of segments showed relevant artifacts in diastolic/systolic T1 and T2 maps, respectively. Apical T2 values were significantly lower in systole than in diastole. In systole, there were no significant differences in T1/T2 among basal, mid-ventricular and apical segments. The overall quality of T1 and T2 maps drops in apical segments. This could be problematic when evaluating focal myocardial changes. The acquisition in systole increases the number of evaluable segments.
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http://dx.doi.org/10.1007/s10554-015-0639-5DOI Listing
June 2015
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