Publications by authors named "Roberto Miraglia"

119 Publications

Percutaneous embolization of hepatic artery pseudoaneurysm after pediatric liver transplantation.

Diagn Interv Imaging 2021 Oct 19. Epub 2021 Oct 19.

Department of Pediatrics, IRCCS ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), Palermo 90127, Italy.

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http://dx.doi.org/10.1016/j.diii.2021.10.002DOI Listing
October 2021

Portal vein puncture-related complications during transjugular intrahepatic portosystemic shunt creation: Colapinto needle set vs Rösch-Uchida needle set.

Radiol Med 2021 Aug 18. Epub 2021 Aug 18.

Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), via Tricomi 5, 90127, Palermo, Italy.

Transjugular portal vein puncture is considered the riskiest step in TIPS creation with possible incidence of portal vein puncture-related complications (PVPC). The Colapinto and the Rösch-Uchida needle sets are two different needle sets currently available. To date, there have been no randomized control trials or systematic reviews which compare the incidence of PVPC when using the two different needle sets. The aim of this literature review is to assess the rate of PVPC associated with the different needle sets used in the creation of TIPS. From the described search, 1500 articles were identified and 34 met the inclusion criteria. Outcome measured was the prevalence of PVPC using the different needle sets. Overall 212 (3.6%) PVPC were reported in 5865 patients; 142 (3.5%) reported in 4000 cases using the Rösch-Uchida set and 70 (3.7%) in 1865 patients using the Colapinto set (p = 0.69). PVPC in TIPS creation are not related to the choice of needle set used in the procedure. To our knowledge, this is the first review of its kind, the results of which support the theory that while the rate of PVPC is influenced by many factors, choice of needle set does not seem to be one of them.
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http://dx.doi.org/10.1007/s11547-021-01404-1DOI Listing
August 2021

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology.

J Hepatol 2021 Jul 30. Epub 2021 Jul 30.

Gastroenterology Unit, ASL Latina, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Italy.

Background & Aims: Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model.

Methods: In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses.

Results: In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD.

Conclusions: In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed.

Lay Summary: While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
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http://dx.doi.org/10.1016/j.jhep.2021.07.018DOI Listing
July 2021

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair.

Vasc Endovascular Surg 2021 Jun 7:15385744211022591. Epub 2021 Jun 7.

Department of Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy.

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.
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http://dx.doi.org/10.1177/15385744211022591DOI Listing
June 2021

Bile duct anatomical variations: Relevance for liver division and preparing left split liver grafts for pediatric transplantation: Cohort study.

Int J Surg 2021 Jun 30;90:105979. Epub 2021 May 30.

Department of Pediatrics, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Ernesto Tricomi 5, 90127, Palermo, Italy. Electronic address:

Background: liver lateral section graft is the most common graft type used for transplantation in children worldwide. Compared to whole liver grafts, a higher rate of biliary complications has been described. Historically, 2 techniques have been described for transection of liver - trans-hilar or trans-umbilical parenchymal transection. Though these techniques allow dividing the biliary system at two distinct positions, the usual surgical strategies do not take advantage of this advantage.

Material And Methods: A retrospective study was conducted on 40 candidates who volunteered for donation of their left lateral liver section for transplantation, between October 2017 and April 2019. Preoperative imaging was analyzed to depict the arterial and biliary anatomy of the liver and their variations, with a dedicated attention to the left liver (segments 2, 3 and 4). Anatomy of the biliary system was taken into account for defining the optimal surgical strategy - either through a trans-hilar or a trans-umbilical parenchymal transection.

Results: In 26/40 patients, arterial or biliary variations were much relevant for decision-making on the optimal plane of liver division (trans-umbilical (N = 14) and trans-hilar (N = 26)). This resulted in 23 grafts with a single artery and bile duct, 6 grafts with double arteries and a single bile duct, and 9 grafts with double bile ducts and a single artery; only two grafts had complex anatomy. There was no arterial complication and the overall incidence of biliary problems was 14.7%. All grafts are functioning well at a mean follow-up of 19.6 ± 8.5 months.

Conclusions: Anatomical variations are frequent and their knowledge is relevant for procurement of lateral section liver graft. Knowledge of these variation, or -better- preoperative biliary imaging is helpful in guiding parenchymal transection at procurement and preparing optimal liver grafts.
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http://dx.doi.org/10.1016/j.ijsu.2021.105979DOI Listing
June 2021

Transjugular Intrahepatic Portosystemic Shunt: A Single-Centre Mid-term Experience Using the Viatorr Controlled-Expansion Stent.

Dig Dis Sci 2021 Feb 27. Epub 2021 Feb 27.

Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via E. Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s10620-021-06867-wDOI Listing
February 2021

Clinical and Molecular-Based Approach in the Evaluation of Hepatocellular Carcinoma Recurrence after Radical Liver Resection.

Cancers (Basel) 2021 Jan 29;13(3). Epub 2021 Jan 29.

Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), 90127 Palermo, Italy.

Background: Hepatic resection remains the treatment of choice for patients with early-stage HCC with preserved liver function. Unfortunately, however, the majority of patients develop tumor recurrence. While several clinical factors were found to be associated with tumor recurrence, HCC pathogenesis is a complex process of accumulation of somatic genomic alterations, which leads to a huge molecular heterogeneity that has not been completely understood. The aim of this study is to complement potentially predictive clinical and pathological factors with next-generation sequencing genomic profiling and loss of heterozygosity analysis.

Methods: 124 HCC patients, who underwent a primary hepatic resection from January 2016 to December 2019, were recruited for this study. Next-generation sequencing (NGS) analysis and allelic imbalance assessment in a case-control subgroup analysis were performed. A time-to-recurrence analysis was performed as well by means of Kaplan-Meier estimators.

Results: Cumulative number of HCC recurrences were 26 (21%) and 32 (26%), respectively, one and two years after surgery. Kaplan-Meier estimates for the probability of recurrence amounted to 37% (95% C.I.: 24-47) and to 51% (95% C.I.: 35-62), after one and two years, respectively. Multivariable analysis identified as independent predictors of HCC recurrence: hepatitis C virus (HCV) infection (HR: 1.96, 95%C.I.: 0.91-4.24, = 0.085), serum bilirubin levels (HR: 5.32, 95%C.I.: 2.07-13.69, = 0.001), number of nodules (HR: 1.63, 95%C.I.: 1.12-2.38, = 0.011) and size of the larger nodule (HR: 1.11, 95%C.I.: 1.03-1.18, = 0.004). Time-to-recurrence analysis showed that loss of heterozygosity in the loci (involved in the PI3K/AKT/mTOR signaling pathway) was significantly associated with a lower risk of HCC recurrence (HR: 0.35, 95%C.I.: 0.13-0.93, = 0.036).

Conclusions: multiple alterations of cancer genes are associated with HCC progression. In particular, the evidence of a specific AI mutation presented in 20 patients seemed to have a protective effect on the risk of HCC recurrence.
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http://dx.doi.org/10.3390/cancers13030518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866287PMC
January 2021

Imaging of calcified hepatic lesions: spectrum of diseases.

Abdom Radiol (NY) 2021 06 16;46(6):2540-2555. Epub 2021 Jan 16.

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.

Hepatic calcifications have been increasingly identified over the past decade due to the widespread use of high-resolution Computed Tomography (CT) imaging. Calcifications can be seen in a vast spectrum of common and uncommon diseases, from benign to malignant, including cystic lesions, solid neoplastic masses, and inflammatory focal lesions. The purpose of this paper is to present an updated review of CT imaging findings of a wide range of calcified hepatic focal lesions, which can help radiologists to narrow the differential diagnosis.
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http://dx.doi.org/10.1007/s00261-020-02924-6DOI Listing
June 2021

Feasibility of combined ECG-Gated and Helical acquisition mode in a pre-TAVI computed tomography angiography protocol using a fixed low-volume contrast medium injection.

Eur J Radiol 2020 Oct 28;131:109239. Epub 2020 Aug 28.

Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy. Electronic address:

Background: To investigate the feasibility, image quality, and clinical implications of a combined ECG-gated and helical acquisition mode in a computed tomography angiography (CTA) protocol in patients scheduled for transcatheter aortic valve implantation (TAVI) using a fixed, low-volume, contrast medium injection.

Methods: Between July and October 2019, 43 TAVI candidates underwent investigation with CTA using a 64-slice CT scanner. Images obtained were prospectively evaluated. 65 mL of low iodine dose contrast medium (CM), followed by 25 mL of saline, were administered using a fixed multiphasic injection protocol in all patients. Patients were divided into three groups based on BMI: Group 1 (n = 9) with BMI < 22 kg/m; Group 2 (n = 22) with BMI 22-29 kg/m; Group 3 (n = 12) with BMI > 29 kg/m. Images were evaluated for image quality, vessel attenuation (HU), Signal-to-Noise Ratio (SNR), Contrast-to-Noise Ratio (CNR) and estimated radiation dose. Image quality of the aortic root and iliac-femoral vessels was diagnostic in all patients.

Results: Vascular attenuation was > 200 HU and CNR > 3 at all vessel levels.

Conclusion: Data from our study suggest that it is possible to image the aortic annulus and aorto-iliac anatomy and obtain high image quality in all patients by using a combined ECG-gated and helical acquisition mode in a computed tomography angiography (CTA) protocol with a fixed low-volume contrast medium injection (65 mL). This allows for accurate CT measurements of the aortic annulus, recruitment of patients for TAVI and facilitates pre-procedural planning in these high surgical risk patients.
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http://dx.doi.org/10.1016/j.ejrad.2020.109239DOI Listing
October 2020

MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis.

Updates Surg 2020 Sep 27;72(3):617-637. Epub 2020 May 27.

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.

Pancreatic cystic lesions (PCLs) have been increasingly identified over the past 2 decades due to the widespread use of high-resolution non-invasive abdominal imaging. They cover a vast spectrum, from benign to malignant and invasive lesions, thus they constitute a significant clinical entity. Among PCLs, mucin-producing lesions are those at risk of progression to malignancy. They include mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN). The diagnosis and management of these cystic lesions are a dilemma since there is a significant overlap in the morphology of benign and premalignant lesions. At the moment, there is no single test that will allow a correct diagnosis in all cases. Magnetic resonance (MR) and endoscopic ultrasound (EUS) morphology, with cyst fluid analysis and cytohistology done with EUS-guided procedure are the best techniques that can narrow the differential diagnosis and identify potentially malignant lesions requiring resection from those requiring follow-up only. The purpose of this paper is to present an updated review of MR imaging findings of mucinous PCLs and to provide a new morphological approach that can serve as a practical guide for the diagnosis of these lesions, allowing a more confident characterization and avoiding relevant misdiagnosis. Furthermore, we provide some information about EUS and cystic fluid analysis and cytohistology, since they are diagnostic modalities that radiologists and surgeons should be familiar with.
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http://dx.doi.org/10.1007/s13304-020-00800-yDOI Listing
September 2020

Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma.

Radiol Med 2020 Jul 18;125(7):609-617. Epub 2020 Feb 18.

Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi, 5, 90127, Palermo, PA, Italy.

Background: This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting.

Materials And Methods: This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed.

Results: In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites (n =  25), variceal bleeding (n = 16) and other (n = 8). TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone (n = 40), a transjugular/transhepatic approach (n = 5) and a transjugular/transsplenic approach (n = 1). Median DAP was 261 Gy * cm (range 29-950), median AK was 0.2 Gy (range 0.05-0.5), and median FT was 28.2 min (range 7.7-93.7). Mean portosystemic pressure gradient decreased from 16.8  ±  5.1 mmHg to 7.5  ±  3.3 mmHg (P <  0.01). There were no major procedural complications. Overall clinical success was achieved in 77% of patients (mean follow-up of 21.1 months). Encephalopathy was observed in 16 patients (34%), grade II-III encephalopathy in 7 patients (15%). TIPS revision was performed in 15 patients (32%). Overall survival rate was 75%.

Conclusion: In our experience, the use of real-time ultrasound guidance allowed the majority of the TIPS to be performed via a transjugular approach alone with a reasonably low radiation exposure considering the high technical difficulties of the selected cohort of patients with CVPT or PC.
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http://dx.doi.org/10.1007/s11547-020-01155-5DOI Listing
July 2020

OCCUPATIONAL RADIATION DOSE PERFORMING HEPATOBILIARY MINIMALLY INVASIVE PROCEDURES IN CHILDREN WEIGHING LESS THAN 20 kg.

Radiat Prot Dosimetry 2020 Jun;188(1):56-64

Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy.

Our objective is to retrospectively evaluate the effective dose (E) of operators performing pediatric Hepatobiliary Minimally Invasive Procedures (HMIP). Between October 2015 and December 2017, 58 consecutive HMIP were performed on 26 children weighing less than 20 kg (mean 12.3 kg, median 13 kg, range 2.4-20 kg). About 31 vascular procedures (n = 9 hepatic venograms with/without stenting; n = 9 retrograde wedge portography; n = 8 transhepatic portography with angioplasty and/or stenting and n = 5 hepatic arteriography/embolization) and 27 non-vascular procedures (n = 6 percutaneous transhepatic biliary drainage (PTBD); n = 3 bilioplasty; n = 15 biliary catheter change and n = 3 cholangiogram) were performed. Electronic personal dosimeters were used to measure radiation doses to the interventional radiologist, radiographer and anesthesia nurse. The results shows the highest mean effective dose: interventional radiologist's in PTBD (1.18 μSv); radiographer's in hepatic veins phlebography with/without stenting (0.25 μSv) and nurse's in hepatic arteriography/embolization (0.26 μSv). Operators' E can vary depending on the complexity of procedure performed and the position of the operators within the angiosuite.
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http://dx.doi.org/10.1093/rpd/ncz260DOI Listing
June 2020

Imaging of hepatic hemangioma: from A to Z.

Abdom Radiol (NY) 2020 03;45(3):672-691

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.

The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.
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http://dx.doi.org/10.1007/s00261-019-02294-8DOI Listing
March 2020

Resting-State Functional Magnetic Resonance Imaging for Brain Tumor Surgical Planning: Feasibility in Clinical Setting.

World Neurosurg 2019 Nov;131:356-363

Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy.

The aim of this study was to introduce resting-state functional magnetic resonance imaging (rest-fMRI) capability for brain tumor surgical planning. rest-fMRI is an emerging functional neuroimaging technique potentially able to provide new insights into brain physiology and to provide useful information regarding brain tumors in preoperative and postoperative settings. rest-fMRI evaluates low-frequency fluctuations in the blood oxygen level-dependent signal while the subject is at rest during magnetic resonance imaging examination. Multiple resting-state networks have been identified, including the somatosensory, language, and visual networks, which are of primary importance for surgical planning. We discuss the feasibility of rest-fMRI examination before and after surgical resection of brain tumors in routine clinical practice and the usefulness of the information obtained for surgical planning in brain tumor resection. rest-fMRI is particularly useful for patients who are unable to cooperate with the task-based paradigm, such as children or patients who are sedated, paretic, or aphasic. Although standardization and validation of rest-fMRI are still ongoing, this technique is feasible and valuable and can be implemented for routine clinical surgical planning.
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http://dx.doi.org/10.1016/j.wneu.2019.07.022DOI Listing
November 2019

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke.

Neuroradiol J 2019 Dec 30;32(6):431-437. Epub 2019 Sep 30.

Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Italy.

Purpose: The aim of this study was to assess the novel advanced magnetic resonance imaging findings of acute stage cortical laminar necrosis developing after complicated cardiovascular or abdominal surgery.

Materials And Methods: This institutional review board-approved study included patients with postoperative stroke due to cortical laminar necrosis imaged with magnetic resonance in the acute stage. Brain magnetic resonance imaging examinations were obtained on a 3T magnetic resonance scanner within 48 hours of the neurological symptoms, including diffusion-weighted images (b value, 1000 s/mm) and arterial spin labelling using a pseudo-continuous arterial spin labelling method in four patients. Conventional and advanced magnetic resonance images were analysed to assess the imaging features in acute stage cortical laminar necrosis.

Results: The final population consisted of 14 patients (seven men and seven women, mean age 61 years, range 32-79 years) diagnosed with stroke and acute phase cortical laminar necrosis. All the patients presented with cortical lesions showing restricted diffusion on diffusion-weighted images and hypointensity on the apparent diffusion coefficient map. Cortical hyperintensity on T2-weighted or fluid-attenuated inversion recovery images was found in three (21%) and six (43%) patients, respectively. Reduced perfusion was noted in three out of four patients imaged with arterial spin labelling, while in one case no corresponding perfusion abnormality was noted on the arterial spin labelling maps. Arterial spin labelling abnormalities were much more extensive than diffusion restriction in two patients, and they were associated with a poor outcome.

Conclusion: Cortical hyperintense abnormalities on diffusion-weighted imaging may be the only sign of developing cortical laminar necrosis injury. The acquisition of arterial spin labelling helps to identify perfusion alterations and the extension of the ischaemic injury.
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http://dx.doi.org/10.1177/1971400919876621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856996PMC
December 2019

Multidisciplinary approach in the management of uterine intravenous leiomyomatosis with intracardiac extension: case report and review of literature.

J Radiol Case Rep 2019 Jul 31;13(7):1-13. Epub 2019 Jul 31.

Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.

Uterine intravenous leiomyomatosis is an uncommon tumor, usually arising from the uterus, with nodular masses which extend intravascularly over variable distances and may reach the inferior vena cava, right atrium, and pulmonary arteries. Early diagnosis and surgical intervention are crucial as intracardiac leiomyomatosis not only causes cardiac symptoms but may result in pulmonary embolism and sudden death. Complete tumor resection is key in disease management, thus rendering cardiac-extending uterine intravenous leiomyomatosis one of the most challenging conditions for surgical treatment. The use of interventional radiology procedures can facilitate the surgical approach. We report the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and pulmonary embolism, analyzing management and surgical outcomes, highlighting the role of interventional radiology during the therapeutic pathway. Nonetheless, there are currently very few data available concerning the use of interventional radiology procedures in the therapeutic strategy of uterine intravenous leiomyomatosis with intracardiac extension.
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http://dx.doi.org/10.3941/jrcr.v13i7.3607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738492PMC
July 2019

Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications.

Pediatr Transplant 2019 09 22;23(6):e13539. Epub 2019 Jul 22.

Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.

PVT is the most frequent vascular complication after LT in small children, and a higher incidence has been observed in those transplanted for biliary atresia or with a LLSG. Thrombosis of the PV causes extrahepatic portal hypertension and is associated with splenomegaly and the development of venous neo-collaterals, including gastro-oesophageal varices and splenorenal shunts. It has also been incidentally suggested in the literature that patients who have had a Roux-en-Y loop for a biliary reconstruction may present with a cavernomatous transformation of the distal portion of the loop. In this study, 13 children with CEPH caused by thrombosis of the PV after LT were analysed. The study evidenced the development of two types of hepatopetal venous networks: (a) a large cavernoma along the Roux loop and around the biliary anastomosis, and (b) a network of neo-collaterals in the gastro-duodeno-pancreatic area that connected to the intrahepatic portal branches directly through the liver capsule. These hepatopetal venous networks between the venous system of the surrounding organs or the omentum and the intrahepatic portal branches can be identified by radiologists. The relevance for the transplanting physician and the transplant surgeon is discussed.
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http://dx.doi.org/10.1111/petr.13539DOI Listing
September 2019

Budd-Chiari Syndrome and hepatic regenerative nodules: Magnetic resonance findings with emphasis of hepatobiliary phase.

Eur J Radiol 2019 Aug 20;117:15-25. Epub 2019 May 20.

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127 Palermo, Italy.

Budd-Chiari syndrome (BCS) is a disorder with numerous causes that is a result of hepatic outflow obstruction, in the absence of right heart failure or constrictive pericarditis. Acute Budd-Chiari syndrome is uncommon and clinically characterized by ascites, hepatomegaly, and hepatic insufficiency. In the majority of cases, patients present with chronic BCS, showing a dysmorphic liver disease with variable fibrosis deposition. In chronic Budd-Chiari syndrome, hepatocellular carcinoma (HCC) and benign regenerative nodules (called large regenerative nodules or FNH-like lesions) have been described in the literature. Very few studies have reported magnetic resonance imaging (MRI) findings about these nodules, using hepatobiliary contrast medium. The aim of our review is to describe the magnetic resonance imaging findings of hepatic regenerative nodules in BCS, with emphasis on the hepatobiliary phase, and to compare the imaging features of benign nodules with those of HCC.
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http://dx.doi.org/10.1016/j.ejrad.2019.05.015DOI Listing
August 2019

Acute rejection after lung transplantation: association between histopathological and CT findings.

Radiol Med 2019 Oct 5;124(10):1000-1005. Epub 2019 Jul 5.

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.

Purpose: To evaluate the predictive role of computed tomography (CT) on acute rejection in patients who underwent lung transplantation (LT).

Materials And Methods: Seventy-eight patients who underwent LT were evaluated in our study. The CT scans were reviewed by three different radiologists, who evaluated the findings potentially associated with acute rejection such as air trapping, tree-in-bud, consolidations, crazy paving, ground-glass opacity, bronchiectasis, thickening of intralobular or interlobular septa and presence of pleural effusion. The association between a tissue diagnosis of acute rejection and the above-mentioned CT findings was assessed using a multivariate model of logistic regression.

Results: Based on our results, none of the CT findings included in the study, alone or in combination, showed significant statistical association with the diagnosis of acute rejection.

Conclusion: CT is a very useful technique for the assessment of lung transplant recipients although it has limited accuracy for the assessment of acute rejection. None of the radiological findings considered in our study was significantly associated with histologically proven acute rejection.
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http://dx.doi.org/10.1007/s11547-019-01059-zDOI Listing
October 2019

The "hepatic subcapsular flow sign" in early diagnosis of biliary atresia.

Abdom Radiol (NY) 2019 09;44(9):3200-3202

Department of Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s00261-019-02115-yDOI Listing
September 2019

The "mosaic pattern" in hepatic sinusoidal dilatation.

Abdom Radiol (NY) 2019 08;44(8):2949-2950

Department of Diagnostic and Therapeutic Services, Radiology Unit. IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s00261-019-02057-5DOI Listing
August 2019

The "peripheral wash-out sign" in hepatic malignant lesions.

Abdom Radiol (NY) 2019 08;44(8):2937-2938

Department of Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s00261-019-02034-yDOI Listing
August 2019

The "light bulb sign" in liver hemangioma.

Abdom Radiol (NY) 2019 06;44(6):2327-2328

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s00261-019-01964-xDOI Listing
June 2019

Erratum: Endoscopist's occupational dose evaluation related to correct wearing of dosimeter during X-ray-guided procedures.

Endosc Int Open 2019 03 20;7(3):C1. Epub 2019 Mar 20.

IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy - Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.

[This corrects the article DOI: 10.1055/a-0841-3350.].
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http://dx.doi.org/10.1055/a-0876-6448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426725PMC
March 2019

Percutaneous recanalization of a segmental inferior vena cava occlusion in a patient with situs viscerum inversus and symptomatic Budd-Chiari syndrome.

Dig Liver Dis 2019 06 22;51(6):909. Epub 2019 Feb 22.

Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy.

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http://dx.doi.org/10.1016/j.dld.2019.02.007DOI Listing
June 2019

Magnetic resonance imaging of fibropolycystic liver disease: the spectrum of ductal plate malformations.

Abdom Radiol (NY) 2019 06;44(6):2156-2171

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

Fibropolycystic liver diseases, also known as ductal plate malformations, are a group of associated congenital disorders resulting from abnormal development of the biliary ductal system. These disorders include congenital hepatic fibrosis, biliary hamartomas, polycystic liver disease, choledochal cysts and Caroli disease. Recently, it has been thought to include biliary atresia in this group of diseases, because ductal plate malformations could be implicated in the pathogenesis of this disease. Concomitant associated renal anomalies can also be present, such as autosomal recessive polycystic kidney disease (ARPKD), medullary sponge kidney and nephronophthisis. These disorders can be clinically silent or can cause abnormalities such as cholangitis, portal hypertension, gastrointestinal bleeding and infections. The different types of ductal plate malformations show typical findings at magnetic resonance (MR) imaging. A clear knowledge of the embryology and pathogenesis of the ductal plate plays a pivotal role to understand the characteristic imaging appearances of these complex diseases. Awareness of these MR imaging findings is central to the detecting and differentiating between various fibropolycystic liver diseases and is important to direct appropriate clinical management and prevent misdiagnosis.
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http://dx.doi.org/10.1007/s00261-019-01966-9DOI Listing
June 2019

Endoscopist's occupational dose evaluation related to correct wearing of dosimeter during X-ray-guided procedures.

Endosc Int Open 2019 Mar 28;7(3):E367-E371. Epub 2019 Feb 28.

RCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy - Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.

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http://dx.doi.org/10.1055/a-0841-3350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395086PMC
March 2019

Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome.

J Cardiothorac Surg 2019 Jan 25;14(1):23. Epub 2019 Jan 25.

Diagnostic and Therapeutic Services, Radiology Unit, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy.

Background: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery.

Methods: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits.

Results: A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications.

Conclusions: Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.
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http://dx.doi.org/10.1186/s13019-019-0844-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347812PMC
January 2019

The "expanded gallbladder fossa sign" in liver cirrhosis.

Abdom Radiol (NY) 2019 03;44(3):1199-1200

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s00261-018-1878-4DOI Listing
March 2019

The "enlarged hilar periportal space sign" in liver cirrhosis.

Abdom Radiol (NY) 2019 05;44(5):1936-1937

Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s00261-018-1876-6DOI Listing
May 2019
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