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1. Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

Author

Ippolito, D, Capodaglio, C, Maino, C, Corso, R, Leni, D, Fior, D, Giandola, T, Ragusi, M, Talei Franzesi, C, Gandola, D, Rovere, A, Sironi, S, Ippolito D., Capodaglio C., Maino C., Corso R., Leni D., Fior D., Giandola T., Ragusi M., Talei Franzesi C., Gandola D., Rovere A., Sironi S., Ippolito, D, Capodaglio, C, Maino, C, Corso, R, Leni, D, Fior, D, Giandola, T, Ragusi, M, Talei Franzesi, C, Gandola, D, Rovere, A, Sironi, S, Ippolito D., Capodaglio C., Maino C., Corso R., Leni D., Fior D., Giandola T., Ragusi M., Talei Franzesi C., Gandola D., Rovere A., and Sironi S.

Abstract

Purpose: To evaluate the usefulness of compressive ultrasound (CUS) for the diagnosis of deep vein thrombosis (DVT) in patients with SARS-CoV-2-related infection. Methods: 112 hospitalized patients with confirmed SARS-CoV-2 infection were retrospectively enrolled. CUS was performed within 2 days of admission and consisted in the assessment of the proximal and distal deep venous systems. Lack of compressibility, or direct identification of an endoluminal thrombus, were the criteria used for the diagnosis of DVT. Pulmonary embolism (PE) events were investigated at computed tomography pulmonary angiography (CTPA) within 5 days of follow-up. Logistic binary regression was computed to determine which clinical and radiological parameters were independently associated with PE onset. Results: Overall, the incidence of DVT in our cohort was about 43%. The most common district involved was the left lower limb (68.7%) in comparison with the right one (58.3%) while the upper limbs were less frequently involved (4.2% the right one and 2.1% the left one, respectively). On both sides, the distal tract of the popliteal vein was the most common involved (50% right side and 45.8% left side). The presence of DVT in the distal tract of the right popliteal vein (OR = 2.444 95%CIs 1.084–16.624, p = 0.038), in the distal tract of the left popliteal vein (OR = 4.201 95%CIs 1.484–11.885, p = 0.007), and D-dimer values (OR = 2.122 95%CIs 1.030–5.495, p = 0.003) were independently associated with the onset on PE within 5 days. Conclusions: CUS should be considered a useful tool to discriminate which category of patients can develop PE within 5 days from admission.

Published
2022

2. Use of diagnostic criteria from acr and eu-tirads systems to improve the performance of cytology in thyroid nodule triage

Author

Seminati, D, Capitoli, G, Leni, D, Fior, D, Vacirca, F, Di Bella, C, Galimberti, S, L'Imperio, V, Pagni, F, Seminati D., Capitoli G., Leni D., Fior D., Vacirca F., Di Bella C., Galimberti S., L'imperio V., Pagni F., Seminati, D, Capitoli, G, Leni, D, Fior, D, Vacirca, F, Di Bella, C, Galimberti, S, L'Imperio, V, Pagni, F, Seminati D., Capitoli G., Leni D., Fior D., Vacirca F., Di Bella C., Galimberti S., L'imperio V., and Pagni F.

Abstract

Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting >TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive values (77.5% vs. 50.7%, p < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EUTIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.

Published
2021

3. Diagnostic performances of the acr-tirads system in thyroid nodules triage: A prospective single center study

Author

Leni, D, Seminati, D, Fior, D, Vacirca, F, Capitoli, G, Cazzaniga, L, Di Bella, C, L'Imperio, V, Galimberti, S, Pagni, F, Leni D., Seminati D., Fior D., Vacirca F., Capitoli G., Cazzaniga L., Di Bella C., L'imperio V., Galimberti S., Pagni F., Leni, D, Seminati, D, Fior, D, Vacirca, F, Capitoli, G, Cazzaniga, L, Di Bella, C, L'Imperio, V, Galimberti, S, Pagni, F, Leni D., Seminati D., Fior D., Vacirca F., Capitoli G., Cazzaniga L., Di Bella C., L'imperio V., Galimberti S., and Pagni F.

Abstract

Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system.

Published
2021

4. Surgical strategies to push up resection limits in liver disease and liver failure after surgery

Author

Romano, F, Fumularo, S, Pellegrino, R, Gianotti, L, Uggeri, F, Pinotti, E, Corso, R, Ippolito, D, Talei, C, Fior, D, ROMANO, FABRIZIO, Pellegrino, RA, GIANOTTI, LUCA VITTORIO, UGGERI, FABIO, IPPOLITO, DAVIDE, Fior, D., Romano, F, Fumularo, S, Pellegrino, R, Gianotti, L, Uggeri, F, Pinotti, E, Corso, R, Ippolito, D, Talei, C, Fior, D, ROMANO, FABRIZIO, Pellegrino, RA, GIANOTTI, LUCA VITTORIO, UGGERI, FABIO, IPPOLITO, DAVIDE, and Fior, D.

Abstract

In oncological surgery, the liver still remain a challenge for surgeons. From the seventies, when liver surgery spread, techniques and strategies to approach parenchymal resection are very changed: from a radical surgery, to the finding of liver regeneration capacity and the concept of minimum remnant size, until now, where new liver regeneration theories and new physiological data are changing our approach. In case of HCC, or in case of metastatic disease, when resection is indicated, there are several diagnostic feature to perform before candidate a patient to surgery. How could be safe a liver resection? Which is the phatophysiological etiology of post-hepatectomy liver failure? How could we expand the safe limits for surgery? All these questions are key-points to better understand liver disease, and, moreover, their treatments. From the first meeting with patient affected by liver cancer, we would like to describe how to manage patients, which kinds of imaging we should prefer, how to assess safe limits for resections, and, in case, how to expand this limit. Then, we will focus on interventional radiologic and surgical strategies to approach liver cancer, and how and why posthepatectomy liver failure could be prevented and diagnosed correctly. Particularly, we would focus on portal vein embolization, two-staged hepatectomy, and ALPPS, always with physiological explanation, from the most up-to-date clinical evidence. Particular attention will be made for liver surgery’s sequel and risks. Comparing the newest data available in literature, we will focus on diagnosing, staging and surgical planning to approach liver resections correctly., In oncological surgery, the liver still remain a challenge for surgeons. From the seventies, when liver surgery spread, techniques and strategies to approach parenchymal resection are very changed: from a radical surgery, to the finding of liver regeneration capacity and the concept of minimum remnant size, until now, where new liver regeneration theories and new physiological data are changing our approach. In case of HCC, or in case of metastatic disease, when resection is indicated, there are several diagnostic feature to perform before candidate a patient to surgery. How could be safe a liver resection? Which is the phatophysiological etiology of post-hepatectomy liver failure? How could we expand the safe limits for surgery? All these questions are key-points to better understand liver disease, and, moreover, their treatments. From the first meeting with patient affected by liver cancer, we would like to describe how to manage patients, which kinds of imaging we should prefer, how to assess safe limits for resections, and, in case, how to expand this limit. Then, we will focus on interventional radiologic and surgical strategies to approach liver cancer, and how and why posthepatectomy liver failure could be prevented and diagnosed correctly. Particularly, we would focus on portal vein embolization, two-staged hepatectomy, and ALPPS, always with physiological explanation, from the most up-to-date clinical evidence. Particular attention will be made for liver surgery’s sequel and risks. Comparing the newest data available in literature, we will focus on diagnosing, staging and surgical planning to approach liver resections correctly

Published
2016

5. Diagnostic value of iterative reconstruction algorithm in low kV CT angiography (CTA) with low contrast medium volume for transcatheter aortic valve implantation (TAVI) planning: Image quality and radiation dose exposure

Author

Talei Franzesi, C, Ippolito, D, Riva, L, Fior, D, Cangiotti, C, Sironi, S, Talei Franzesi, CR, CANGIOTTI, CECILIA, Talei Franzesi, C, Ippolito, D, Riva, L, Fior, D, Cangiotti, C, Sironi, S, Talei Franzesi, CR, and CANGIOTTI, CECILIA

Abstract

Objective: To evaluate image quality and radiation dose exposure of low-kV (100 kV) and low contrast medium (CM) volume CT angiography (CTA) in patients candidate to Transcatheter Aortic Valve Implantation (TAVI), in comparison with standard CTA protocol. Methods: 79 patients candidate for TAVI were prospectively enrolled in this study and examined with 256-MDCT. 42 patients were evaluated using study-group protocol (100 kV; whole-body retrospective ECG-gating; with 50 ml of CM; iterative reconstruction algorithm) while 37 patients underwent a standard CTA study (120 kV; ECG-gating for chest; 100 ml of CM; FBP reconstruction). Overall image quality was evaluated using a 4-point scale. Vascular enhancement (HU) was then assessed in each patient by manually drawing multiple ROIs in lumen of 7 segments of the whole aorta. The radiation dose exposure of both groups was calculated and all data were compared and statistically analyzed. Results: On low-kV protocol, higher mean attenuation values were achieved in all the measurements as compared to standard protocol. There were no significant differences in the image quality evaluation in both groups. Mean radiation dose value of study group was significantly lower than in control group (reduction of 20%). Conclusion: Low kV and low CM volume CTA protocols allow TAVI planning to be carried out with high quality images and a significant reduction in the radiation dose as compared to the standard CTA protocol. Advances in knowledge: Low-kV CTA for pre-operative assessment of patients candidates for TAVI, permits to achieve a significant reduction of radiation dose exposure and contrast medium volume, reducing the risk of contrast induced nephropathy.

Published
2018

6. Low-dose computed tomography with 4th-generation iterative reconstruction algorithm in assessment of oncologic patients

Author

Ippolito, D, Casiraghi, A, TALEI FRANZESI, C, Fior, D, Meloni, F, Sironi, S, IPPOLITO, DAVIDE, CASIRAGHI, ALESSANDRA SILVIA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, SIRONI, SANDRO, Ippolito, D, Casiraghi, A, TALEI FRANZESI, C, Fior, D, Meloni, F, Sironi, S, IPPOLITO, DAVIDE, CASIRAGHI, ALESSANDRA SILVIA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, and SIRONI, SANDRO

Abstract

AIM To compare radiation dose and image quality of lowdose computed tomography (CT) protocol combined with hybrid-iterative reconstruction algorithm with standarddose CT examinations for follow-up of oncologic patients. METHODS Fifty-one patients with known malignant diseases which underwent, during clinical follow-up, both standarddose and low-dose whole-body CT scans were enrolled. Low-dose CT was performed on 256-row scanner, with 120 kV and automated mA modulation, and iterative reconstruction algorithm. Standard-dose CT was performed on 16-rows scanner, with 120 kV, 200-400 mAs (depending on patient weight). We evaluated density values and signal-to-noise ratio, along with image noise (SD), sharpness and diagnostic quality with 4-point scale. RESULTS Density values in liver, spleen and aorta were higher in lowdose images (liver 112.55 HU vs 103.90 HU, P < 0.001), as SD values in liver and spleen (liver 16.81 vs 14.41). Volumetric-Computed-Tomographic-Dose-Index (CTDIvol) and Dose-Length-Product (DLP) were significantly lower in low-dose CT as compared to standard-dose (DLP 1025.6 mGy*cm vs 1429.2 mGy*cm, P < 0.001) with overall dose reduction of 28.9%. Qualitative analysis did not reveal significant differences in image noise and diagnostic quality. CONCLUSION Automatic tube-current modulation combined with hybriditerative algorithm allows radiation dose reduction of 28.9% without loss of diagnostic quality, being useful in reducing dose exposure in oncologic patients.

Published
2017

7. Diagnostic accuracy of 256-row multidetector CT coronary angiography with prospective ECG-gating combined with fourth-generation iterative reconstruction algorithm in the assessment of coronary artery bypass: evaluation of dose reduction and image quality

Author

Ippolito, D, Fior, D, Franzesi, C, Riva, L, Casiraghi, A, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, RIVA, LUCA, CASIRAGHI, ALESSANDRA SILVIA, SIRONI, SANDRO, Ippolito, D, Fior, D, Franzesi, C, Riva, L, Casiraghi, A, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, RIVA, LUCA, CASIRAGHI, ALESSANDRA SILVIA, and SIRONI, SANDRO

Abstract

Background: Effective radiation dose in coronary CT angiography (CTCA) for coronary artery bypass graft (CABG) evaluation is remarkably high because of long scan lengths. Prospective electrocardiographic gating with iterative reconstruction can reduce effective radiation dose. Objectives: To evaluate the diagnostic performance of low-kV CT angiography protocol with prospective ecg-gating technique and iterative reconstruction (IR) algorithm in follow-up of CABG patients compared with standard retrospective protocol. Methods: Seventy-four non-obese patients with known coronary disease treated with artery bypass grafting were prospectively enrolled. All the patients underwent 256 MDCT (Brilliance iCT, Philips) CTCA using low-dose protocol (100 kV; 800 mAs; rotation time: 0.275 s) combined with prospective ECG-triggering acquisition and fourth-generation IR technique (iDose4; Philips); all the lengths of the bypass graft were included in the evaluation. A control group of 42 similar patients was evaluated with a standard retrospective ECG-gated CTCA (100 kV; 800 mAs).On both CT examinations, ROIs were placed to calculate standard deviation of pixel values and intra-vessel density. Diagnostic quality was also evaluated using a 4-point quality scale. Results: Despite the statistically significant reduction of radiation dose evaluated with DLP (study group mean DLP: 274 mGy cm; control group mean DLP: 1224 mGy cm; P value < 0.001). No statistical differences were found between PGA group and RGH group regarding intra-vessel density absolute values and SNR. Qualitative analysis, evaluated by two radiologists in “double blind”, did not reveal any significant difference in diagnostic quality of the two groups. Conclusions: The development of high-speed MDCT scans combined with modern IR allows an accurate evaluation of CABG with prospective ECG-gating protocols in a single breath hold, obtaining a significant reduction in radiation dose.

Published
2017

8. Sarcopenic obesity as an independent determinant of major complications after pancreatoduodenectomy for cancer

Author

Sandini, M, Bernasconi, D, Fior, D, Molinelli, M, Ippolito, D, Nespoli, L, Caccialanza, R, Gianotti, L, Sandini, Marta, Bernasconi, Davide, Fior, Davide, Molinelli, Matilde, Ippolito, Davide, Nespoli, Luca, Caccialanza, Riccardo, Gianotti, Luca, Sandini, M, Bernasconi, D, Fior, D, Molinelli, M, Ippolito, D, Nespoli, L, Caccialanza, R, Gianotti, L, Sandini, Marta, Bernasconi, Davide, Fior, Davide, Molinelli, Matilde, Ippolito, Davide, Nespoli, Luca, Caccialanza, Riccardo, and Gianotti, Luca

Published
2016

9. Intraobserver and interobserver agreement in the evaluation of tumor vascularization with computed tomography perfusion in cirrhotic patients with hepatocellular carcinoma

Author

Ippolito, D, Casiraghi, A, TALEI FRANZESI, C, Bonaffini, P, Fior, D, Sironi, S, IPPOLITO, DAVIDE, CASIRAGHI, ALESSANDRA SILVIA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, BONAFFINI, PIETRO ANDREA, FIOR, DAVIDE, SIRONI, SANDRO, Ippolito, D, Casiraghi, A, TALEI FRANZESI, C, Bonaffini, P, Fior, D, Sironi, S, IPPOLITO, DAVIDE, CASIRAGHI, ALESSANDRA SILVIA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, BONAFFINI, PIETRO ANDREA, FIOR, DAVIDE, and SIRONI, SANDRO

Abstract

Objectives To evaluate intrareader and inter-reader agreement in CT perfusion (Perf) measurements in cirrhotic patients with hepatocellular carcinoma (HCC) lesions. Methods Sixteen patients with HCC (9 untreated, 5 recurrence/residual disease after transarterial chemoembolization, and 2 after radiofrequency ablation treatment) underwent standard CT examination and a Perf study; a quantitative map of arterial and portal Perf by means of a color scale was generated. With dedicated Perf software, the following parameters were calculated on untreated and treated HCC lesions and on cirrhotic parenchyma: hepatic Perf, tissue blood volume, hepatic perfusion index, arterial perfusion, and time to peak. Intraobserver and interobserver agreements were assessed for 2 readers with Bland-Altman plots, intraclass correlation coefficients (ICCs), coefficients of variation, and repeatability. Results In HCC lesions, agreement analysis demonstrated higher intra-agreement values in comparison with interagreement (range of ICC values, 0.26-0.59 between readers and 0.67-0.94 between readings). Lower interagreement was found for treated HCC lesions in comparison with untreated lesions (range of ICC values, respectively, 0.12-0.54 and 0.31-0.89). Conclusions For all Perf parameters intra-agreement was higher than interagreement, even though a relatively wide range of 95% limits of agreement was found in both cases.

Published
2016

10. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer

Author

Sandini, M, Bernasconi, D, Fior, D, Molinelli, M, Ippolito, D, Nespoli, L, Caccialanza, R, Gianotti, L, SANDINI, MARTA, BERNASCONI, DAVIDE PAOLO, FIOR, DAVIDE, IPPOLITO, DAVIDE, NESPOLI, LUCA CARLO, GIANOTTI, LUCA VITTORIO, Sandini, M, Bernasconi, D, Fior, D, Molinelli, M, Ippolito, D, Nespoli, L, Caccialanza, R, Gianotti, L, SANDINI, MARTA, BERNASCONI, DAVIDE PAOLO, FIOR, DAVIDE, IPPOLITO, DAVIDE, NESPOLI, LUCA CARLO, and GIANOTTI, LUCA VITTORIO

Abstract

Objective Complication rates after pancreatic resections remain high despite improvement in perioperative management. The effects of body composition and the relationship among different body compartments on surgical morbidity are not comprehensively investigated. The aim of this study was to assess whether the evaluation of different body compartments and their relationship was associated with the development of major postoperative complications after pancreatoduodenectomy (PD) for cancer. Methods We retrospectively analyzed 124 patients who underwent PD and had a staging computed tomography (CT) scan at our center. CT scan was used to measure abdominal skeletal muscle area and volume, as well as visceral fat area (VFA) and volume. The total abdominal muscle area (TAMA) was then normalized for height. The severity of complications was assessed. Univariate and multivariate analyses were performed to investigate correlations between the above variables and postoperative complications. The receiver operating characteristic curve methodology was used to investigate the predictive ability of each parameter. Results Major complications occurred in 42 patients (33.9%). The prevalence of sarcopenia was 24.2%. Regression analyses revealed no correlation between abdominal muscular and adipose tissue areas. Univariate analysis showed that the depletion of muscle area normalized for height was not per se predictive of complications (P = 0.318). Multivariate logistic regression showed that the VFA/TAMA was the only determinant of major complications (odds ratio, 3.20; 95% confidence interval, 1.35–7.60; P = 0.008). The model predictive performance was 0.735 (area under the curve) with a sensitivity of 64.3% and a specificity of 74.4%. Conclusion Sarcopenic obesity is a strong predictor of major complications after PD for cancer.

Published
2016

11. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

Author

Ippolito, D, Drago, S, TALEI FRANZESI, C, Fior, D, Sironi, S, IPPOLITO, DAVIDE, DRAGO, SILVIA GIROLAMA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, SIRONI, SANDRO, Ippolito, D, Drago, S, TALEI FRANZESI, C, Fior, D, Sironi, S, IPPOLITO, DAVIDE, DRAGO, SILVIA GIROLAMA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, and SIRONI, SANDRO

Abstract

AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients. METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed. RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images

Published
2016

15. Diagnostic Value of Semiquantitative Analysis of Dynamic Susceptibility Contrast Magnetic Resonance Imaging with GD-EOB-DTPA in Focal Liver Lesions Characterization: A Feasibility Study

Author

Ippolito, D, Colombo, M, Trattenero, C, Bonaffini, P, TALEI FRANZESI, C, Fior, D, Sironi, S, IPPOLITO, DAVIDE, COLOMBO, MADDALENA, TRATTENERO, CHIARA, BONAFFINI, PIETRO ANDREA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, SIRONI, SANDRO, Ippolito, D, Colombo, M, Trattenero, C, Bonaffini, P, TALEI FRANZESI, C, Fior, D, Sironi, S, IPPOLITO, DAVIDE, COLOMBO, MADDALENA, TRATTENERO, CHIARA, BONAFFINI, PIETRO ANDREA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, and SIRONI, SANDRO

Abstract

Purpose. To assess the diagnostic accuracy of dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSCE-MRI) in differentiation between benign and malignant liver lesions by assessment of tumoral perfusion parameters. Methods Materials. Seventy-three patients with known focal liver lesions, including 45 benign (16 FNH, 27 angiomas, and 2 abscesses) and 28 malignant ones (17 metastases, 9 HCCs, and 2 cholangiocarcinoma) underwent 1.5 T MRI upper abdominal study, with standard protocol that included dynamic contrast-enhanced sequences. On dedicated workstation, time-intensity curves were determined and the following perfusion parameters were calculated: relative arterial, venous and late enhancement (RAE, RVE, RLE), maximum enhancement (ME), relative enhancement (RE), and time to peak (TTP). Results. All diagnoses were established either by histopathology or imaging follow-up. Perfusion mean values calculated in benign lesions were RAE 33.8%, RVE 66.03%, RLE 80.63%, ME 776.00%, MRE 86.27%, and TTP 146.95 sec. Corresponding perfusion values calculated in malignant lesions were RAE 22.47%, RVE 40.54%, RLE 47.52%, ME 448.78%, MRE 49.85%, and TTP 183.79 sec. Statistical difference (p<0.05) was achieved in all the perfusion parameters calculated, obtaining different cluster of perfusion kinetics between benign and malignant lesions. Conclusions. DSCE-MRI depicts kinetic differences in perfusion parameters among the different common liver lesions, related to tumour supply and microvascular characteristics.

Published
2015

16. Low kV settings CT angiography (CTA) with low dose contrast medium volume protocol in the assessment of thoracic and abdominal aorta disease: A feasibility study

Author

Ippolito, D, TALEI FRANZESI, C, Fior, D, Bonaffini, P, Minutolo, O, Sironi, S, IPPOLITO, DAVIDE, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, BONAFFINI, PIETRO ANDREA, MINUTOLO, ORAZIO, SIRONI, SANDRO, Ippolito, D, TALEI FRANZESI, C, Fior, D, Bonaffini, P, Minutolo, O, Sironi, S, IPPOLITO, DAVIDE, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, FIOR, DAVIDE, BONAFFINI, PIETRO ANDREA, MINUTOLO, ORAZIO, and SIRONI, SANDRO

Abstract

Objective: To assess the diagnostic quality of low dose (100kV) CT angiography (CTA), by using ultra-low contrast medium volume (30ml), for thoracic and abdominal aorta evaluation. Methods: 67 patients with thoracic or abdominal vascular disease underwent multidetector CT study using a 256 slice scanner, with low dose radiation protocol (automated tube current modulation, 100kV) and low contrast medium volume (30 ml; 4ml s-1). Density measurements were performed on ascending, arch, descending thoracic aorta, anonymous branch, abdominal aorta, and renal and common iliac arteries. Radiation dose exposure [dose-length product (DLP)] was calculated. A control group of 35 patients with thoracic or abdominal vascular disease were evaluated with standard CTA protocol (automated tube current modulation, 120 kV; contrast medium, 80ml). Results: In all patients, we correctly visualized and evaluated main branches of the thoracic and abdominal aorta. No difference in density measurements was achieved between low tube voltage protocol (mean attenuation value of thoracic aorta, 304HU; abdominal, 343 HU; renal arteries, 331HU) and control group (mean attenuation value of thoracic aorta, 320HU; abdominal, 339; renal arteries, 303 HU). Radiation dose exposure in low tube voltage protocol was significantly different between thoracic and abdominal low tube voltage studies (490 and 324DLP, respectively) and the control group (thoracic DLP, 1032; abdomen, DLP 1078). Conclusion: Low-tube-voltage protocol may provide a diagnostic performance comparable with that of the standard protocol, decreasing radiation dose exposure and contrast material volume amount. Advances in knowledge: Low-tube-voltage-setting protocol combined with ultra-low contrast agent volume (30 ml), by using new multidetector-row CT scanners, represents a feasible diagnostic tool to significantly reduce the radiation dose delivered to patients and to preserve renal function, while also maintaining adequate d

Published
2015

17. Combined value of apparent diffusion coefficient-standardized uptake value max in evaluation of post-treated locally advanced rectal cancer

Author

Ippolito, D, Fior, D, Trattenero, C, DE PONTI, E, Drago, S, Guerra, L, TALEI FRANZESI, C, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, TRATTENERO, CHIARA, DE PONTI, ELENA, DRAGO, SILVIA GIROLAMA, GUERRA, LUCA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, SIRONI, SANDRO, Ippolito, D, Fior, D, Trattenero, C, DE PONTI, E, Drago, S, Guerra, L, TALEI FRANZESI, C, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, TRATTENERO, CHIARA, DE PONTI, ELENA, DRAGO, SILVIA GIROLAMA, GUERRA, LUCA, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, and SIRONI, SANDRO

Abstract

AIM: To assess the clinical diagnostic value of functional imaging, combining quantitative parameters of apparent diffusion coefficient (ADC) and standardized uptake value (SUV) max, before and after chemo-radiation therapy, in prediction of tumor response of patients with rectal cancer, related to tumor regression grade at histology. METHODS: A total of 31 patients with biopsy proven diagnosis of rectal carcinoma were enrolled in our study. All patients underwent a whole body (18)FDG positron emission tomography (PET)/computed tomography (CT) scan and a pelvic magnetic resonance (MR) examination including diffusion weighted (DW) imaging for staging (PET1, RM1) and after completion (6.6 wk) of neoadjuvant treatment (PET2, RM2). Subsequently all patients underwent total mesorectal excision and the histological results were compared with imaging findings. The MR scanning, performed on 1.5 T magnet (Philips, Achieva), included T2-weighted multiplanar imaging and in addition DW images with b-value of 0 and 1000 mm(2) /s. On PET/CT the SUVmax of the rectal lesion were calculated in PET1 and PET2. The percentage decrease of SUVmax (.SUV) and ADC (.ADC) values from baseline to presurgical scan were assessed and correlated with pathologic response classified as tumor regression grade (Mandard's criteria; TRG1 = complete regression, TRG5 = no regression). RESULTS: After completion of therapy, all the patients were submitted to surgery. According to the Mandard's criteria, 22 tumors showed complete (TRG1) or subtotal regression (TRG2) and were classified as responders; 9 tumors were classified as non responders (TRG3, 4 and 5). Considering all patients the mean values of SUVmax in PET 1 was higher than the mean value of SUVmax in PET 2 (P < 0.001), whereas the mean ADC values was lower in RM1 than RM2 (P < 0.001), with a.SUV and.ADC respectively of 60.2% and 66.8%. The best predictors for TRG response were SUV2 (threshold of 4.4) and ADC2 (1.29 x 10-3 mm(2)/s) with high sensi

Published
2015

18. Preoperative computed tomography to predict and stratify the risk of severe pancreatic fistula after pancreatoduodenectomy

Author

Sandini, M, Bernasconi, D, Ippolito, D, Nespoli, L, Baini, M, Barbaro, S, Fior, D, Gianotti, L, SANDINI, MARTA, BERNASCONI, DAVIDE PAOLO, IPPOLITO, DAVIDE, NESPOLI, LUCA CARLO, BARBARO, SALVATORE, FIOR, DAVIDE, GIANOTTI, LUCA VITTORIO, Sandini, M, Bernasconi, D, Ippolito, D, Nespoli, L, Baini, M, Barbaro, S, Fior, D, Gianotti, L, SANDINI, MARTA, BERNASCONI, DAVIDE PAOLO, IPPOLITO, DAVIDE, NESPOLI, LUCA CARLO, BARBARO, SALVATORE, FIOR, DAVIDE, and GIANOTTI, LUCA VITTORIO

Abstract

The aim of this article is to assess whether measures of abdominal fat distribution, visceral density, and antropometric parameters obtained from computed tomography (CT) may predict postoperative pancreatic fistula (POPF) occurrence. We analyzed 117 patients who underwent pancreatoduodenectomy (PD) and had a preoperative CT scan as staging in our center. CT images were processed to obtain measures of total fat volume (TFV), visceral fat volume (VFV), density of spleen, and pancreas, and diameter of pancreatic duct. The predictive ability of each parameter was investigated by receiver-operating characteristic (ROC) curves methodology and assessing optimal cutoff thresholds. A stepwise selection method was used to determine the best predictive model. Clinically relevant (grades B and C) POPF occurred in 24 patients (20.5%). Areas under ROC-curves showed that none of the parameters was per se significantly predictive. The multivariate analysis revealed that a VFV >2334 cm3, TFV >4408 cm3, pancreas/spleen density ratio <0.707, and pancreatic duct diameter <5mm were predictive of POPF. The risk of POPF progressively increased with the number of factors involved and age. It is possible to deduce objective information on the risk of POPF from a simple and routine preoperative radiologic workup.

Published
2015

20. Tumour-related neoangiogenesis: Functional dynamic perfusion computed tomography for diagnosis and treatment efficacy assessment in hepatocellular carcinoma

Author

Ippolito, D, Fior, D, TALEI FRANZESI, C, Capraro, C, Casiraghi, A, Leni, D, Vacirca, F, Corso, R, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, CAPRARO, CRISTINA, CASIRAGHI, ALESSANDRA SILVIA, VACIRCA, FRANCESCO, SIRONI, SANDRO, Ippolito, D, Fior, D, TALEI FRANZESI, C, Capraro, C, Casiraghi, A, Leni, D, Vacirca, F, Corso, R, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, TALEI FRANZESI, CAMMILLO ROBERTO GIOVANNI LEOPOLDO, CAPRARO, CRISTINA, CASIRAGHI, ALESSANDRA SILVIA, VACIRCA, FRANCESCO, and SIRONI, SANDRO

Abstract

Background: Aim of the study was to determine the value of perfusion computed tomography in the quantitative assessment of tumour-related neoangiogenesis for the diagnosis and treatment of hepatocellular carcinoma lesions. Methods: Overall, 47 consecutive patients with cirrhotic liver disease, with a high risk of hepatocellular carcinoma, and undergoing standard surveillance (six-month intervals) were eligible for inclusion in this prospective study; based on Barcelona Clinic Liver Cancer guidelines, 27 patients were enrolled. Perfusion computed tomography was performed in 29 biopsy-proven hepatocellular carcinoma lesions before and after treatment with transarterial chemoembolization or radiofrequency ablation. The dynamic study was performed with a 256-slice multidetector-computed tomography scanner; the following parameters were measured: hepatic perfusion, arterial perfusion, blood volume, hepatic perfusion index, and time-to-peak in all patients. Results: Hepatocellular carcinoma lesions had the following median perfusion values: perfusion 46.3. mL/min/100. g; blood volume 20.4. mL/100. mg; arterial perfusion 42.9. mL/min; hepatic perfusion index 92.5%; time to peak 18.7. s. Significantly lower perfusion values were obtained in correctly treated lesions or surrounding parenchyma than in viable hepatocellular carcinoma tissue. Conclusions: In hepatocellular carcinoma, perfusion computed tomography could contribute to a non-invasive quantification of tumour blood supply related to the formation of new arterial structures, and enable the assessment of therapeutic response

Published
2014

21. Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients

Author

Ippolito, D, Fior, D, Bonaffini, P, Capraro, C, Leni, D, Corso, R, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, BONAFFINI, PIETRO ANDREA, CAPRARO, CRISTINA, SIRONI, SANDRO, Ippolito, D, Fior, D, Bonaffini, P, Capraro, C, Leni, D, Corso, R, Sironi, S, IPPOLITO, DAVIDE, FIOR, DAVIDE, BONAFFINI, PIETRO ANDREA, CAPRARO, CRISTINA, and SIRONI, SANDRO

Abstract

Purpose To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. Materials and methods Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50 mL of non ionic contrast agent (350 mg I/mL) at a flow rate of 6 mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). Results A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2 ± 6.3; AP 10.4 ± 7; BV 4.05 ± 4.8; TTP 38.9 ± 4.2; HPI 9.9 ± 9.2, whereas in partially treated lesions were: HP 43.2 ± 15.1 mL/s/100 g; AP 38.7 ± 8.8 mL/min; BV 20.7 ± 9.5 mL/100 mg; TTP 24 ± 3.7 s; HPI 61.7 ± 7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2 ± 4; AP 12.3 ± 3.4; BV 11.8 ± 2.8; TTP 43.9 ± 2.9; and HPI 17.1 ± 9.8. A significant difference (P < 0.001) was found for all parameters between residual viable tumor tissue (P < 0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC. Conclusion According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients. © 2014 Elsevier Ireland Lt

Published
2014

23. Underdiagnosed systemic mastocytosis: The role of flow cytometry

Author

Perbellini, Omar, Zanotti, Roberta, Bonadonna, Patrizia, Vincenzi, C., Colarossi, S., Caruso, Beatrice, Frattini, F., Randon, F., Dal Fior, D., Zampieri, F., Scupoli, Maria, Chilosi, Marco, Martinelli, G., and Pizzolo, Giovanni

Subjects
mastocytosis, diagnosis, Flow cytometry
Published
2007

26. Surgical strategies to push up resection limits in liver disease and liver failure after surgery

Author

Romano, F., Simone Famularo, Pellegrino, R. A., Gianotti, L. V., Uggeri, F., Pinotti, E., Corso, R., Ippolito, D., Talei, C., Fior, D., Romano, F, Fumularo, S, Pellegrino, R, Gianotti, L, Uggeri, F, Pinotti, E, Corso, R, Ippolito, D, Talei, C, and Fior, D

Subjects
MED/18 - CHIRURGIA GENERALE, Herpatic resection ,liver failure, surgical limits
Abstract

In oncological surgery, the liver still remain a challenge for surgeons. From the seventies, when liver surgery spread, techniques and strategies to approach parenchymal resection are very changed: from a radical surgery, to the finding of liver regeneration capacity and the concept of minimum remnant size, until now, where new liver regeneration theories and new physiological data are changing our approach. In case of HCC, or in case of metastatic disease, when resection is indicated, there are several diagnostic feature to perform before candidate a patient to surgery. How could be safe a liver resection? Which is the phatophysiological etiology of post-hepatectomy liver failure? How could we expand the safe limits for surgery? All these questions are key-points to better understand liver disease, and, moreover, their treatments. From the first meeting with patient affected by liver cancer, we would like to describe how to manage patients, which kinds of imaging we should prefer, how to assess safe limits for resections, and, in case, how to expand this limit. Then, we will focus on interventional radiologic and surgical strategies to approach liver cancer, and how and why posthepatectomy liver failure could be prevented and diagnosed correctly. Particularly, we would focus on portal vein embolization, two-staged hepatectomy, and ALPPS, always with physiological explanation, from the most up-to-date clinical evidence. Particular attention will be made for liver surgery’s sequel and risks. Comparing the newest data available in literature, we will focus on diagnosing, staging and surgical planning to approach liver resections correctly. In oncological surgery, the liver still remain a challenge for surgeons. From the seventies, when liver surgery spread, techniques and strategies to approach parenchymal resection are very changed: from a radical surgery, to the finding of liver regeneration capacity and the concept of minimum remnant size, until now, where new liver regeneration theories and new physiological data are changing our approach. In case of HCC, or in case of metastatic disease, when resection is indicated, there are several diagnostic feature to perform before candidate a patient to surgery. How could be safe a liver resection? Which is the phatophysiological etiology of post-hepatectomy liver failure? How could we expand the safe limits for surgery? All these questions are key-points to better understand liver disease, and, moreover, their treatments. From the first meeting with patient affected by liver cancer, we would like to describe how to manage patients, which kinds of imaging we should prefer, how to assess safe limits for resections, and, in case, how to expand this limit. Then, we will focus on interventional radiologic and surgical strategies to approach liver cancer, and how and why posthepatectomy liver failure could be prevented and diagnosed correctly. Particularly, we would focus on portal vein embolization, two-staged hepatectomy, and ALPPS, always with physiological explanation, from the most up-to-date clinical evidence. Particular attention will be made for liver surgery’s sequel and risks. Comparing the newest data available in literature, we will focus on diagnosing, staging and surgical planning to approach liver resections correctly

32. Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

Author

Vincenzo L'Imperio, Davide Leni, Fabio Pagni, Camillo Di Bella, Stefania Galimberti, Davide Seminati, Giulia Capitoli, Davide Fior, Francesco Vacirca, Seminati, D, Capitoli, G, Leni, D, Fior, D, Vacirca, F, Di Bella, C, Galimberti, S, L'Imperio, V, and Pagni, F

Subjects
Thyroid nodules, Cancer Research, medicine.medical_specialty, Article, Thyroid carcinoma, ultrasound imaging, Cytology, medicine, fine-needle aspiration, skin and connective tissue diseases, RC254-282, medicine.diagnostic_test, business.industry, Thyroid, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Nodule (medicine), medicine.disease, Predictive value, Triage, thyroid carcinoma, medicine.anatomical_structure, Fine-needle aspiration, Oncology, thyroid nodule, Radiology, medicine.symptom, business
Abstract

Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting &gt, TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p &lt, 0.0001) and positive predictive values (77.5% vs. 50.7%, p &lt, 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.

Published
2021
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33. Virtual Guidance of Percutaneous Transthoracic Needle Biopsy with C-Arm Cone-Beam CT: Diagnostic Accuracy, Risk Factors and Effective Radiation Dose

Author

Davide Leni, Davide Fior, Rocco Corso, Luca Riva, Francesco Vacirca, Fabio Pagni, Sandro Sironi, Davide Ippolito, Fior, D, Vacirca, F, Leni, D, Pagni, F, Ippolito, D, Riva, L, Sironi, S, and Corso, R

Subjects
Adult, Image-Guided Biopsy, Male, medicine.medical_specialty, Lung Neoplasms, Percutaneous, Radiography, Radiation Dosage, Radiography, Interventional, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, Core biopsy, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Biopsy, medicine, Humans, Fluoroscopy, Radiology, Nuclear Medicine and imaging, Lung, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Biopsy, Needle, Ultrasound, Reproducibility of Results, Retrospective cohort study, Cone-Beam Computed Tomography, Middle Aged, medicine.disease, Pneumothorax, Multiple Pulmonary Nodules, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Complication
Abstract

Purpose: C-arm cone-beam computed tomography-guided transthoracic lung core needle biopsy (CBCT-CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. The purpose of our study was to evaluate the diagnostic performance, complication rates and effective radiation dose of CBCT-CNB with virtual guidance. Materials and Methods: We retrospectively collected data regarding 375 CBCT-CNBs performed with virtual guidance (XperGuide—Philips Healthcare, Best, The Netherlands) from January 2010 to June 2015 on 355 patients (mean age, 68.1 years ± 11.8; age range, 31–88 years). Patients were divided into groups and compared based on the diagnostic failure and lesion size (15 mm cutoff). Diagnostic performance, complication rate and effective radiation dose were investigated. Variables influencing diagnostic performance and complications were assessed using Student’s T test and Pearson’s χ 2 test. Results: The sensitivity, specificity, positive and negative predictive value and accuracy for patients subjected to CNBs were 96.8%, 100%, 100%, 100% and 97.2%, respectively. Considering risk factors for pneumothorax, no significant differences were found regarding patient and lesion characteristics. Perilesional hemorrhage occurred more frequently in older patients (p = 0.046) and in smaller lesions (p = 0.001). Hemoptysis was significantly more frequent in patients with perilesional hemorrhage (p = 0.01). Mean effective radiation dose in CBCT-CNB was 7.12 ± 8.78 mSv. Conclusions: CBCT-CNB combined with virtual guidance is a reliable and accurate technique that allows exact localization of pulmonary lesions, effective preprocedural planning and real-time fluoroscopy altogether.

Published
2019
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34. Low-dose computed tomography with 4th-generation iterative reconstruction algorithm in assessment of oncologic patients

Author

Alessandra Casiraghi, Sandro Sironi, Franca Meloni, Cammillo Talei Franzesi, Davide Ippolito, Davide Fior, Ippolito, D, Casiraghi, A, TALEI FRANZESI, C, Fior, D, Meloni, F, and Sironi, S

Subjects
Evidence-Based Medicine, medicine.diagnostic_test, business.industry, Radiation dose, Low dose, Gastroenterology, Computed tomography, Iterative reconstruction, Oncologic imaging, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, Tube current modulation, medicine, business, Algorithm, Low-dose computed tomography
Abstract

AIM To compare radiation dose and image quality of low-dose computed tomography (CT) protocol combined with hybrid-iterative reconstruction algorithm with standard-dose CT examinations for follow-up of oncologic patients. METHODS Fifty-one patients with known malignant diseases which underwent, during clinical follow-up, both standard-dose and low-dose whole-body CT scans were enrolled. Low-dose CT was performed on 256-row scanner, with 120 kV and automated mA modulation, and iterative reconstruction algorithm. Standard-dose CT was performed on 16-rows scanner, with 120 kV, 200-400 mAs (depending on patient weight). We evaluated density values and signal-to-noise ratio, along with image noise (SD), sharpness and diagnostic quality with 4-point scale. RESULTS Density values in liver, spleen and aorta were higher in low-dose images (liver 112.55 HU vs 103.90 HU, P < 0.001), as SD values in liver and spleen (liver 16.81 vs 14.41). Volumetric-Computed-Tomographic-Dose-Index (CTDIvol) and Dose-Length-Product (DLP) were significantly lower in low-dose CT as compared to standard-dose (DLP 1025.6 mGy*cm vs 1429.2 mGy*cm, P < 0.001) with overall dose reduction of 28.9%. Qualitative analysis did not reveal significant differences in image noise and diagnostic quality. CONCLUSION Automatic tube-current modulation combined with hybrid-iterative algorithm allows radiation dose reduction of 28.9% without loss of diagnostic quality, being useful in reducing dose exposure in oncologic patients.

Published
2017

35. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer

Author

Matilde Molinelli, Marta Sandini, Davide Ippolito, Riccardo Caccialanza, Davide Fior, Davide Paolo Bernasconi, Luca Gianotti, Luca Nespoli, Sandini, M, Bernasconi, D, Fior, D, Molinelli, M, Ippolito, D, Nespoli, L, Caccialanza, R, and Gianotti, L

Subjects
Male, Sarcopenia, medicine.medical_specialty, Intra-Abdominal Fat, Endocrinology, Diabetes and Metabolism, Gastroenterology, Body Mass Index, Pancreaticoduodenectomy, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Internal medicine, Multidetector Computed Tomography, medicine, Pancrea, Humans, Sarcopenic obesity, Obesity, Muscle, Skeletal, Aged, Retrospective Studies, Univariate analysis, Nutrition and Dietetics, Receiver operating characteristic, business.industry, Area under the curve, Odds ratio, Middle Aged, medicine.disease, Surgery, Pancreatic Neoplasms, 030220 oncology & carcinogenesis, Body Composition, Female, 030211 gastroenterology & hepatology, Morbidity, business, Body mass index
Abstract

Objective Complication rates after pancreatic resections remain high despite improvement in perioperative management. The effects of body composition and the relationship among different body compartments on surgical morbidity are not comprehensively investigated. The aim of this study was to assess whether the evaluation of different body compartments and their relationship was associated with the development of major postoperative complications after pancreatoduodenectomy (PD) for cancer. Methods We retrospectively analyzed 124 patients who underwent PD and had a staging computed tomography (CT) scan at our center. CT scan was used to measure abdominal skeletal muscle area and volume, as well as visceral fat area (VFA) and volume. The total abdominal muscle area (TAMA) was then normalized for height. The severity of complications was assessed. Univariate and multivariate analyses were performed to investigate correlations between the above variables and postoperative complications. The receiver operating characteristic curve methodology was used to investigate the predictive ability of each parameter. Results Major complications occurred in 42 patients (33.9%). The prevalence of sarcopenia was 24.2%. Regression analyses revealed no correlation between abdominal muscular and adipose tissue areas. Univariate analysis showed that the depletion of muscle area normalized for height was not per se predictive of complications (P = 0.318). Multivariate logistic regression showed that the VFA/TAMA was the only determinant of major complications (odds ratio, 3.20; 95% confidence interval, 1.35–7.60; P = 0.008). The model predictive performance was 0.735 (area under the curve) with a sensitivity of 64.3% and a specificity of 74.4%. Conclusion Sarcopenic obesity is a strong predictor of major complications after PD for cancer.

Published
2016
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36. Intraobserver and Interobserver Agreement in the Evaluation of Tumor Vascularization With Computed Tomography Perfusion in Cirrhotic Patients With Hepatocellular Carcinoma

Author

Davide Fior, Pietro Andrea Bonaffini, Alessandra Casiraghi, Davide Ippolito, Cammillo Talei Franzesi, Sandro Sironi, Ippolito, D, Casiraghi, A, TALEI FRANZESI, C, Bonaffini, P, Fior, D, and Sironi, S

Subjects
Liver Cirrhosis, Male, observer agreement, medicine.medical_specialty, Carcinoma, Hepatocellular, Computed tomography perfusion, Intraclass correlation, Radiofrequency ablation, Liver Cirrhosi, Reproducibility of Result, Blood volume, Perfusion scanning, Tumor vascularization, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Multidetector Computed Tomography, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Aged, Aged, 80 and over, Observer Variation, Neovascularization, Pathologic, business.industry, Medicine (all), Liver Neoplasms, Reproducibility of Results, Arterial perfusion, computed tomography, hepatocellular carcinoma, Middle Aged, medicine.disease, Liver, Liver Neoplasm, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, CT perfusion, Female, Radiology, business, Human
Abstract

Objectives To evaluate intrareader and inter-reader agreement in CT perfusion (Perf) measurements in cirrhotic patients with hepatocellular carcinoma (HCC) lesions. Methods Sixteen patients with HCC (9 untreated, 5 recurrence/residual disease after transarterial chemoembolization, and 2 after radiofrequency ablation treatment) underwent standard CT examination and a Perf study; a quantitative map of arterial and portal Perf by means of a color scale was generated. With dedicated Perf software, the following parameters were calculated on untreated and treated HCC lesions and on cirrhotic parenchyma: hepatic Perf, tissue blood volume, hepatic perfusion index, arterial perfusion, and time to peak. Intraobserver and interobserver agreements were assessed for 2 readers with Bland-Altman plots, intraclass correlation coefficients (ICCs), coefficients of variation, and repeatability. Results In HCC lesions, agreement analysis demonstrated higher intra-agreement values in comparison with interagreement (range of ICC values, 0.26-0.59 between readers and 0.67-0.94 between readings). Lower interagreement was found for treated HCC lesions in comparison with untreated lesions (range of ICC values, respectively, 0.12-0.54 and 0.31-0.89). Conclusions For all Perf parameters intra-agreement was higher than interagreement, even though a relatively wide range of 95% limits of agreement was found in both cases.

Published
2016
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37. Diagnostic value of iterative reconstruction algorithm in low kV CT angiography (CTA) with low contrast medium volume for transcatheter aortic valve implantation (TAVI) planning: Image quality and radiation dose exposure

Author

Cammillo Talei Franzesi, Luca Riva, Sandro Sironi, Cecilia Cangiotti, Davide Fior, Davide Ippolito, Talei Franzesi, C, Ippolito, D, Riva, L, Fior, D, Cangiotti, C, and Sironi, S

Subjects
Male, Transcatheter aortic, Image quality, Computed Tomography Angiography, Iterative reconstruction, 030204 cardiovascular system & hematology, Radiation Dosage, 030218 nuclear medicine & medical imaging, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Low contrast, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Computed tomography, Aorta, Aged, Aged, 80 and over, medicine.diagnostic_test, Full Paper, business.industry, Radiation dose, General Medicine, Aortic Valve Stenosis, Angiography, Female, Nuclear medicine, business, Algorithms, Volume (compression)
Abstract

OBJECTIVE: To evaluate image quality and radiation dose exposure of low-kV (100 kV) and low contrast medium (CM) volume CT angiography (CTA) in patients candidate to Transcatheter Aortic Valve Implantation (TAVI), in comparison with standard CTA protocol. METHODS: 79 patients candidate for TAVI were prospectively enrolled in this study and examined with 256-MDCT. 42 patients were evaluated using study-group protocol (100 kV; whole-body retrospective ECG-gating; with 50 ml of CM; iterative reconstruction algorithm) while 37 patients underwent a standard CTA study (120 kV; ECG-gating for chest; 100 ml of CM; FBP reconstruction). Overall image quality was evaluated using a 4-point scale. Vascular enhancement (HU) was then assessed in each patient by manually drawing multiple ROIs in lumen of 7 segments of the whole aorta. The radiation dose exposure of both groups was calculated and all data were compared and statistically analyzed. RESULTS: On low-kV protocol, higher mean attenuation values were achieved in all the measurements as compared to standard protocol. There were no significant differences in the image quality evaluation in both groups. Mean radiation dose value of study group was significantly lower than in control group (reduction of 20%). CONCLUSION: Low kV and low CM volume CTA protocols allow TAVI planning to be carried out with high quality images and a significant reduction in the radiation dose as compared to the standard CTA protocol. ADVANCES IN KNOWLEDGE: Low-kV CTA for pre-operative assessment of patients candidates for TAVI, permits to achieve a significant reduction of radiation dose exposure and contrast medium volume, reducing the risk of contrast induced nephropathy.

Published
2018

38. Diagnostic accuracy of 256-row multidetector CT coronary angiography with prospective ECG-gating combined with fourth-generation iterative reconstruction algorithm in the assessment of coronary artery bypass: evaluation of dose reduction and image quality

Author

Sandro Sironi, Cammillo Talei Franzesi, Davide Fior, Alessandra Casiraghi, Davide Ippolito, Luca Riva, Ippolito, D, Fior, D, Franzesi, C, Riva, L, Casiraghi, A, and Sironi, S

Subjects
Adult, Male, medicine.medical_specialty, Image quality, Prospective ecg gating, Computed Tomography Angiography, Cardiac-Gated Imaging Techniques, Coronary Disease, Iterative reconstruction, 030204 cardiovascular system & hematology, Coronary Angiography, Radiation Dosage, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Radiation Protection, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Coronary Artery Bypass, CABG, Neuroradiology, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Ultrasound, Interventional radiology, General Medicine, Middle Aged, MDCT CCTA, medicine.anatomical_structure, Low dose, Angiography, Radiographic Image Interpretation, Computer-Assisted, Female, Radiology, business, Algorithm, Algorithms, Artery
Abstract

Background: Effective radiation dose in coronary CT angiography (CTCA) for coronary artery bypass graft (CABG) evaluation is remarkably high because of long scan lengths. Prospective electrocardiographic gating with iterative reconstruction can reduce effective radiation dose. Objectives: To evaluate the diagnostic performance of low-kV CT angiography protocol with prospective ecg-gating technique and iterative reconstruction (IR) algorithm in follow-up of CABG patients compared with standard retrospective protocol. Methods: Seventy-four non-obese patients with known coronary disease treated with artery bypass grafting were prospectively enrolled. All the patients underwent 256 MDCT (Brilliance iCT, Philips) CTCA using low-dose protocol (100 kV; 800 mAs; rotation time: 0.275 s) combined with prospective ECG-triggering acquisition and fourth-generation IR technique (iDose4; Philips); all the lengths of the bypass graft were included in the evaluation. A control group of 42 similar patients was evaluated with a standard retrospective ECG-gated CTCA (100 kV; 800 mAs).On both CT examinations, ROIs were placed to calculate standard deviation of pixel values and intra-vessel density. Diagnostic quality was also evaluated using a 4-point quality scale. Results: Despite the statistically significant reduction of radiation dose evaluated with DLP (study group mean DLP: 274 mGy cm; control group mean DLP: 1224 mGy cm; P value

Published
2017

39. Sarcopenic obesity as an independent determinant of major complications after pancreatoduodenectomy for cancer

Author

Matilde Molinelli, Davide Fior, Davide Ippolito, Davide Paolo Bernasconi, Marta Sandini, Riccardo Caccialanza, Luca Nespoli, Luca Gianotti, Sandini, M, Bernasconi, D, Fior, D, Molinelli, M, Ippolito, D, Nespoli, L, Caccialanza, R, and Gianotti, L

Subjects
medicine.medical_specialty, Hepatology, business.industry, Endocrinology, Diabetes and Metabolism, Gastroenterology, Cancer, medicine.disease, Surgery, medicine.anatomical_structure, Internal medicine, medicine, Sarcopenic obesity, Major complication, pancreas, Pancreas, business
Published
2016

40. Low kV settings CT angiography (CTA) with low dose contrast medium volume protocol in the assessment of thoracic and abdominal aorta disease: A feasibility study

Author

Orazio Minutolo, Davide Ippolito, Sandro Sironi, C. Talei Franzesi, Pietro Andrea Bonaffini, Davide Fior, Ippolito, D, TALEI FRANZESI, C, Fior, D, Bonaffini, P, Minutolo, O, and Sironi, S

Subjects
Adult, Male, medicine.medical_specialty, Radiology, Nuclear Medicine and Imaging, Iohexol, Aortic Diseases, Cardiac-Gated Imaging Techniques, Contrast Media, Cardiac-Gated Imaging Technique, Radiation Dosage, Thoracic Diseases, medicine.artery, Thoracic Disease, Vascular Disease, medicine, Humans, Thoracic aorta, Prospective Studies, Vascular Diseases, Prospective cohort study, Aged, Aged, 80 and over, Full Paper, medicine.diagnostic_test, business.industry, Vascular disease, Medicine (all), Abdominal aorta, Angiography, General Medicine, Middle Aged, medicine.disease, Aortic Disease, Feasibility Studie, Contrast medium, Prospective Studie, Feasibility Studies, Radiographic Image Interpretation, Computer-Assisted, Female, Tomography, Radiology, business, Tomography, X-Ray Computed, medicine.drug, Human
Abstract

Objective: To assess the diagnostic quality of low dose (100kV) CT angiography (CTA), by using ultra-low contrast medium volume (30ml), for thoracic and abdominal aorta evaluation. Methods: 67 patients with thoracic or abdominal vascular disease underwent multidetector CT study using a 256 slice scanner, with low dose radiation protocol (automated tube current modulation, 100kV) and low contrast medium volume (30 ml; 4ml s-1). Density measurements were performed on ascending, arch, descending thoracic aorta, anonymous branch, abdominal aorta, and renal and common iliac arteries. Radiation dose exposure [dose-length product (DLP)] was calculated. A control group of 35 patients with thoracic or abdominal vascular disease were evaluated with standard CTA protocol (automated tube current modulation, 120 kV; contrast medium, 80ml). Results: In all patients, we correctly visualized and evaluated main branches of the thoracic and abdominal aorta. No difference in density measurements was achieved between low tube voltage protocol (mean attenuation value of thoracic aorta, 304HU; abdominal, 343 HU; renal arteries, 331HU) and control group (mean attenuation value of thoracic aorta, 320HU; abdominal, 339; renal arteries, 303 HU). Radiation dose exposure in low tube voltage protocol was significantly different between thoracic and abdominal low tube voltage studies (490 and 324DLP, respectively) and the control group (thoracic DLP, 1032; abdomen, DLP 1078). Conclusion: Low-tube-voltage protocol may provide a diagnostic performance comparable with that of the standard protocol, decreasing radiation dose exposure and contrast material volume amount. Advances in knowledge: Low-tube-voltage-setting protocol combined with ultra-low contrast agent volume (30 ml), by using new multidetector-row CT scanners, represents a feasible diagnostic tool to significantly reduce the radiation dose delivered to patients and to preserve renal function, while also maintaining adequate diagnostic quality images in assessment of aorta.

Published
2015

41. Diagnostic Value of Semiquantitative Analysis of Dynamic Susceptibility Contrast Magnetic Resonance Imaging with GD-EOB-DTPA in Focal Liver Lesions Characterization: A Feasibility Study

Author

Chiara Trattenero, Cammillo Talei Franzesi, Davide Fior, Maddalena Colombo, Davide Ippolito, Sandro Sironi, Pietro Andrea Bonaffini, Ippolito, D, Colombo, M, Trattenero, C, Bonaffini, P, TALEI FRANZESI, C, Fior, D, and Sironi, S

Subjects
medicine.medical_specialty, Hepatology, medicine.diagnostic_test, Article Subject, business.industry, media_common.quotation_subject, Gastroenterology, Gd-EOB-DTPA, Magnetic resonance imaging, Text mining, Internal medicine, medicine, Contrast (vision), Histopathology, lcsh:Diseases of the digestive system. Gastroenterology, lcsh:RC799-869, Nuclear medicine, business, Perfusion, media_common, Dynamic susceptibility, Research Article
Abstract

Purpose.To assess the diagnostic accuracy of dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSCE-MRI) in differentiation between benign and malignant liver lesions by assessment of tumoral perfusion parameters.Methods Materials.Seventy-three patients with known focal liver lesions, including 45 benign (16 FNH, 27 angiomas, and 2 abscesses) and 28 malignant ones (17 metastases, 9 HCCs, and 2 cholangiocarcinoma) underwent 1.5 T MRI upper abdominal study, with standard protocol that included dynamic contrast-enhanced sequences. On dedicated workstation, time-intensity curves were determined and the following perfusion parameters were calculated: relative arterial, venous and late enhancement (RAE, RVE, RLE), maximum enhancement (ME), relative enhancement (RE), and time to peak (TTP).Results.All diagnoses were established either by histopathology or imaging follow-up. Perfusion mean values calculated in benign lesions were RAE 33.8%, RVE 66.03%, RLE 80.63%, ME 776.00%, MRE 86.27%, and TTP 146.95 sec. Corresponding perfusion values calculated in malignant lesions were RAE 22.47%, RVE 40.54%, RLE 47.52%, ME 448.78%, MRE 49.85%, and TTP 183.79 sec. Statistical difference (p<0.05) was achieved in all the perfusion parameters calculated, obtaining different cluster of perfusion kinetics between benign and malignant lesions.Conclusions.DSCE-MRI depicts kinetic differences in perfusion parameters among the different common liver lesions, related to tumour supply and microvascular characteristics.

Published
2015
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42. Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients

Author

Pietro Andrea Bonaffini, Cristina Capraro, Davide Fior, Rocco Corso, Davide Leni, Davide Ippolito, Sandro Sironi, Ippolito, D, Fior, D, Bonaffini, P, Capraro, C, Leni, D, Corso, R, and Sironi, S

Subjects
Male, Radiology, Nuclear Medicine and Imaging, Neoplasm, Residual, Radiofrequency ablation, Hepatocellular carcinoma, medicine.medical_treatment, Contrast Media, Perfusion scanning, Blood volume, Treatment response, law.invention, law, Image Processing, Computer-Assisted, Prospective Studies, Prospective cohort study, Computed tomography, Perfusion-CT, Aged, 80 and over, Medicine (all), Liver Neoplasms, General Medicine, Middle Aged, Radiographic Image Enhancement, Treatment Outcome, Liver, Liver Neoplasm, Catheter Ablation, Radiographic Image Interpretation, Computer-Assisted, Female, Radiology, Perfusion, Human, medicine.medical_specialty, Carcinoma, Hepatocellular, Reproducibility of Result, Catheter ablation, Transarterial chemoembolization, Parenchyma, Multidetector Computed Tomography, medicine, Humans, Chemoembolization, Therapeutic, Aged, business.industry, Reproducibility of Results, medicine.disease, Prospective Studie, business
Abstract

Purpose To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. Materials and methods Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50 mL of non ionic contrast agent (350 mg I/mL) at a flow rate of 6 mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). Results A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2 ± 6.3; AP 10.4 ± 7; BV 4.05 ± 4.8; TTP 38.9 ± 4.2; HPI 9.9 ± 9.2, whereas in partially treated lesions were: HP 43.2 ± 15.1 mL/s/100 g; AP 38.7 ± 8.8 mL/min; BV 20.7 ± 9.5 mL/100 mg; TTP 24 ± 3.7 s; HPI 61.7 ± 7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2 ± 4; AP 12.3 ± 3.4; BV 11.8 ± 2.8; TTP 43.9 ± 2.9; and HPI 17.1 ± 9.8. A significant difference (P < 0.001) was found for all parameters between residual viable tumor tissue (P < 0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC. Conclusion According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients. © 2014 Elsevier Ireland Ltd.

Published
2014

43. Tumour-related neoangiogenesis: Functional dynamic perfusion computed tomography for diagnosis and treatment efficacy assessment in hepatocellular carcinoma

Author

Davide Ippolito, Alessandra Casiraghi, Cristina Capraro, Sandro Sironi, Cammillo Talei Franzesi, Davide Fior, Francesco Vacirca, Davide Leni, Rocco Corso, Ippolito, D, Fior, D, TALEI FRANZESI, C, Capraro, C, Casiraghi, A, Leni, D, Vacirca, F, Corso, R, and Sironi, S

Subjects
Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Radiofrequency ablation, Hepatocellular carcinoma, Biopsy, Fine-Needle, CT-perfusion, Blood volume, Perfusion scanning, law.invention, law, Internal medicine, Multidetector Computed Tomography, Medicine, Humans, Prospective Studies, Chemoembolization, Therapeutic, Prospective cohort study, Aged, Aged, 80 and over, Neovascularization, Pathologic, Hepatology, business.industry, Medicine (all), Liver Neoplasms, Trans-arterial chemoembolization, MDCT, Gastroenterology, Middle Aged, medicine.disease, Neoangiogenesi, Prospective Studie, Treatment Outcome, Liver, Liver Neoplasm, Catheter Ablation, Radiology, business, Liver cancer, Perfusion, Human
Abstract

Background Aim of the study was to determine the value of perfusion computed tomography in the quantitative assessment of tumour-related neoangiogenesis for the diagnosis and treatment of hepatocellular carcinoma lesions. Methods Overall, 47 consecutive patients with cirrhotic liver disease, with a high risk of hepatocellular carcinoma, and undergoing standard surveillance (six-month intervals) were eligible for inclusion in this prospective study; based on Barcelona Clinic Liver Cancer guidelines, 27 patients were enrolled. Perfusion computed tomography was performed in 29 biopsy-proven hepatocellular carcinoma lesions before and after treatment with transarterial chemoembolization or radiofrequency ablation. The dynamic study was performed with a 256-slice multidetector-computed tomography scanner; the following parameters were measured: hepatic perfusion, arterial perfusion, blood volume, hepatic perfusion index, and time-to-peak in all patients. Results Hepatocellular carcinoma lesions had the following median perfusion values: perfusion 46.3 mL/min/100 g; blood volume 20.4 mL/100 mg; arterial perfusion 42.9 mL/min; hepatic perfusion index 92.5%; time to peak 18.7 s. Significantly lower perfusion values were obtained in correctly treated lesions or surrounding parenchyma than in viable hepatocellular carcinoma tissue. Conclusions In hepatocellular carcinoma, perfusion computed tomography could contribute to a non-invasive quantification of tumour blood supply related to the formation of new arterial structures, and enable the assessment of therapeutic response.

Published
2014

44. Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

Author

Davide Ippolito, Davide Fior, Silvia Girolama Drago, Sandro Sironi, Cammillo Talei Franzesi, Ippolito, D, Drago, S, TALEI FRANZESI, C, Fior, D, and Sironi, S

Subjects
Male, Colorectal cancer, Biopsy, Multiplanar reconstruction, Diagnostic accuracy, Computed tomography, 030218 nuclear medicine & medical imaging, Mesorectal fascia, 0302 clinical medicine, Rectal cancer, Fascia, Aged, 80 and over, medicine.diagnostic_test, Multi detector computed tomography, Gastroenterology, Equipment Design, General Medicine, Middle Aged, musculoskeletal system, Magnetic Resonance Imaging, medicine.anatomical_structure, Magnetic resonance, Neoplasm Invasiveness, 030220 oncology & carcinogenesis, cardiovascular system, Female, Radiology, Adult, musculoskeletal diseases, medicine.medical_specialty, Tomography Scanners, X-Ray Computed, Adenocarcinoma, 03 medical and health sciences, Predictive Value of Tests, Multidetector Computed Tomography, medicine, Humans, Retrospective Cohort Study, cardiovascular diseases, Aged, Neoplasm Staging, Retrospective Studies, Rectal Neoplasms, business.industry, Reproducibility of Results, Magnetic resonance imaging, medicine.disease, body regions, business
Abstract

AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography (MDCT) as compared with conventional magnetic resonance imaging (MRI), in identifying mesorectal fascia (MRF) invasion in rectal cancer patients. METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner (ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 mAs. Imaging data were reviewed as axial and as multiplanar reconstructions (MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images (DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed. RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91 (41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged (45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant (P = 0.02). CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.

Published
2016
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45. Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels

Author

Giovanni Pizzolo, Patrizia Bonadonna, Luca Castellani, Francesco Frattini, Omar Perbellini, Sabrina Colarossi, Marco Chilosi, Roberta Zanotti, Chiara Bonetto, Beatrice Caruso, Giovanni Passalacqua, Annarita Dama, Daniela Dal Fior, Gianenrico Senna, Giovanni Martinelli, Bonadonna P, Perbellini O, Passalacqua G, Caruso B, Colarossi S, Dal Fior D, Castellani L, Bonetto C, Frattini F, Dama A, Martinelli G, Chilosi M, Senna G, Pizzolo G, and Zanotti R.

Subjects
Adult, Male, Allergy, Etiology, Adolescent, Mastocytosis enzymology epidemiology pathology, Immunology, Mast cell activation syndrome, Tryptase, Biology, Insect bites and stings, Article, Young Adult, Bone Marrow, Clone Cells pathology, Proto-Oncogene Proteins, Cytology, Biopsy, medicine, Immunology and Allergy, Animals, Humans, Point Mutation, Mast Cells, Systemic mastocytosis, Child, Anaphylaxis, Aged, Skin Tests, medicine.diagnostic_test, Incidence, Insect Bites and Stings, Bone Marrow pathology, Female, Hymenoptera, Middle Aged, Tryptases, medicine.disease, Clone Cells, Proto-Oncogene Proteins c-kit, biology.protein, medicine.symptom, Mastocytosis
Abstract

Background Anaphylaxis after Hymenoptera stings has been reported in subjects with mastocytosis, but few data exist regarding disease prevalence in populations allergic to these insects. Objective The incidence of clonal mast cell (MC) disorders in subjects with both systemic reactions to Hymenoptera stings and increased serum baseline tryptase (sBT) levels was assessed by using bone marrow (BM) aspirates and biopsy specimens. Methods Subjects with a history of a systemic reaction caused by a Hymenoptera sting underwent the standard diagnostic work-up for Hymenoptera allergy, and sBT levels were measured. Subjects with an increased sBT level had BM evaluation that included histology/cytology, flow cytometry, and detection of KIT mutations. Results Forty-four (11.6%) of 379 subjects with systemic reactions had increased sBT levels (>11.4 ng/mL), and 31 (70.5%) of these had a history of anaphylaxis. Thirty-four subjects with increased sBT levels underwent a BM analysis. Histology detected diagnostic or subdiagnostic MC infiltrates in 22 (65%) of 34 patients. Abnormal MCs were identified by means of flow cytometry and cytology in 26 (78.8%) of 33 and 20 (58.8%) of 34 subjects, respectively. A KIT mutation was detected in 17 (54.8%) of 31 subjects. The diagnosis was indolent systemic mastocytosis in 21 (61.7%) of 34 subjects and monoclonal MC activation syndrome in 9 (26.5%) of 34 subjects. All subjects with anaphylaxis had one of those 2 disorders. Conclusion The concomitant presence of systemic reactions (especially anaphylaxis) after Hymenoptera stings and increased sBT levels strongly suggests that a BM examination is indicated for the diagnosis of clonal MC disease.

Published
2008

46. Preoperative Computed Tomography to Predict and Stratify the Risk of Severe Pancreatic Fistula After Pancreatoduodenectomy

Author

Luca Nespoli, Salvatore Barbaro, Davide Paolo Bernasconi, Davide Ippolito, Davide Fior, Marta Sandini, Luca Gianotti, Melissa Baini, Sandini, M, Bernasconi, D, Ippolito, D, Nespoli, L, Baini, M, Barbaro, S, Fior, D, and Gianotti, L

Subjects
Male, Multivariate analysis, health care facilities, manpower, and services, medicine.medical_treatment, Computed tomography, Decision Support Technique, 0302 clinical medicine, Postoperative Complications, Retrospective Studie, Risk Factors, Outcome Assessment, Health Care, Abdominal fat, Pancrea, Body Fat Distribution, Multivariate Analysi, health care economics and organizations, medicine.diagnostic_test, Medicine (all), Gastroenterology, General Medicine, Middle Aged, Pancreaticoduodenectomy, humanities, medicine.anatomical_structure, Pancreatic fistula, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Radiology, Tomography, Pancreas, Human, Research Article, Adult, medicine.medical_specialty, Logistic Model, Observational Study, Risk Assessment, Preoperative care, Decision Support Techniques, Outcome Assessment (Health Care), 03 medical and health sciences, Pancreatic Fistula, Preoperative Care, medicine, Humans, Aged, Retrospective Studies, Pancreatic duct, Hepatology, business.industry, Risk Factor, Retrospective cohort study, Stepwise regression, medicine.disease, Logistic Models, ROC Curve, Multivariate Analysis, Postoperative Complication, Objective information, Tomography, X-Ray Computed, business
Abstract

The aim of this article is to assess whether measures of abdominal fat distribution, visceral density, and antropometric parameters obtained from computed tomography (CT) may predict postoperative pancreatic fistula (POPF) occurrence. We analyzed 117 patients who underwent pancreatoduodenectomy (PD) and had a preoperative CT scan as staging in our center. CT images were processed to obtain measures of total fat volume (TFV), visceral fat volume (VFV), density of spleen, and pancreas, and diameter of pancreatic duct. The predictive ability of each parameter was investigated by receiver-operating characteristic (ROC) curves methodology and assessing optimal cutoff thresholds. A stepwise selection method was used to determine the best predictive model. Clinically relevant (grades B and C) POPF occurred in 24 patients (20.5%). Areas under ROC-curves showed that none of the parameters was per se significantly predictive. The multivariate analysis revealed that a VFV >2334 cm3, TFV >4408 cm3, pancreas/spleen density ratio

Published
2015
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47. Combined value of apparent diffusion coefficient-standardized uptake value max in evaluation of post-treated locally advanced rectal cancer

Author

Chiara Trattenero, Davide Ippolito, Davide Fior, Luca Guerra, Cammillo Talei Franzesi, Sandro Sironi, Silvia Girolama Drago, Elena De Ponti, Ippolito, D, Fior, D, Trattenero, C, DE PONTI, E, Drago, S, Guerra, L, TALEI FRANZESI, C, and Sironi, S

Subjects
Neoadjuvant treatment, Pathology, medicine.medical_specialty, Colorectal cancer, business.industry, Locally advanced, Observational Study, Standardized uptake value, medicine.disease, FDG-PET/CT, Tumor regression grade, Magnetic resonance imaging, Apparent diffusion coefficient, medicine, Effective diffusion coefficient, Fdg pet ct, Functional imaging, business, Nuclear medicine, Value (mathematics), Advanced rectal cancer
Abstract

AIM: To assess the clinical diagnostic value of functional imaging, combining quantitative parameters of apparent diffusion coefficient (ADC) and standardized uptake value (SUV) max, before and after chemo-radiation therapy, in prediction of tumor response of patients with rectal cancer, related to tumor regression grade at histology. METHODS: A total of 31 patients with biopsy proven diagnosis of rectal carcinoma were enrolled in our study. All patients underwent a whole body (18)FDG positron emission tomography (PET)/computed tomography (CT) scan and a pelvic magnetic resonance (MR) examination including diffusion weighted (DW) imaging for staging (PET1, RM1) and after completion (6.6 wk) of neoadjuvant treatment (PET2, RM2). Subsequently all patients underwent total mesorectal excision and the histological results were compared with imaging findings. The MR scanning, performed on 1.5 T magnet (Philips, Achieva), included T2-weighted multiplanar imaging and in addition DW images with b-value of 0 and 1000 mm(2) /s. On PET/CT the SUVmax of the rectal lesion were calculated in PET1 and PET2. The percentage decrease of SUVmax (.SUV) and ADC (.ADC) values from baseline to presurgical scan were assessed and correlated with pathologic response classified as tumor regression grade (Mandard's criteria; TRG1 = complete regression, TRG5 = no regression). RESULTS: After completion of therapy, all the patients were submitted to surgery. According to the Mandard's criteria, 22 tumors showed complete (TRG1) or subtotal regression (TRG2) and were classified as responders; 9 tumors were classified as non responders (TRG3, 4 and 5). Considering all patients the mean values of SUVmax in PET 1 was higher than the mean value of SUVmax in PET 2 (P < 0.001), whereas the mean ADC values was lower in RM1 than RM2 (P < 0.001), with a.SUV and.ADC respectively of 60.2% and 66.8%. The best predictors for TRG response were SUV2 (threshold of 4.4) and ADC2 (1.29 x 10-3 mm(2)/s) with high sensitivity and specificity. Combining in a single analysis both the obtained median value, the positive predictive value, in predicting the different group category response in related to TRG system, presented R-2 of 0.95. CONCLUSION: The functional imaging combining ADC and SUVmax in a single analysis permits to detect changes in cellular tissue structures useful for the assessment of tumour response after the neoadjuvant therapy in rectal cancer, increasing the sensitivity in correct depiction of treatment response than either method alone

Published
2015
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48. Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain.

Author

Femia M, Valenti Pittino C, Fumarola EM, Tramarin M, Papa M, Giurazza F, Francioso AP, Fior D, Moramarco LP, Antonini G, Vercelli R, and Cariati M

Abstract

Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and disability, particularly affecting women. While traditionally attributed to chronic wear and tear, recent evidence highlights multifactorial pathogenesis involving low-grade inflammation and neoangiogenesis. Current therapeutic options include physical therapy, pharmacotherapy, and total knee arthroplasty (TKA). However, a subset of patients remain symptomatic despite conservative measures, necessitating the development of minimally invasive interventions. Genicular artery embolization (GAE) emerges as a promising option, targeting neovascularization and inflammatory processes in OA. This paper reviews the pathophysiological basis, patient selection criteria, procedural details, and outcomes of GAE. Notably, GAE demonstrates efficacy in relieving knee pain and improving function in patients refractory to conventional therapy. While further research is warranted to elucidate its long-term outcomes and compare it with existing modalities, GAE represents a novel approach in the management of symptomatic knee OA, potentially delaying or obviating the need for surgical intervention. Here, we synthesize the relevant literature, technical details of the procedure, and future perspectives. Moreover, the success of GAE prompts the exploration of transarterial embolization in other musculoskeletal conditions, underscoring the evolving role of interventional radiology in personalized pain management strategies.

Published
2024
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49. Endovascular management of KILT syndrome and COVID-19-related extensive deep vein thrombosis in a pregnant patient: A case report.

Author

Fior D, Pileri M, Rovere A, Moramarco LP, Santucci D, Grasso RF, and Faiella E

Abstract

We report on a 20-year-old pregnant woman who tested positive for SARS-CoV-2 and was diagnosed with KILT syndrome, a rare condition that increases the risk of thrombotic events. The patient showed signs of deep vein thrombosis that extended from the bilateral iliac vein to the inferior vena cava (IVC), which was treated with placement of an IVC filter and endovascular thromboaspiration/thrombolysis. The IVC was successfully recanalized; however, during follow-up, thrombotic restenosis occurred at the filter level, requiring filter removal. This case highlights the potential benefits of endovascular thromboaspiration/thrombolysis and IVC filter placement in patients with KILT syndrome presenting with acute thrombotic events., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Published
2024
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50. Transoral percutaneous radiofrequency ablation with a steerable needle and cementoplasty under CBCT and infrared augmented reality navigation system guidance for the treatment of a C1 solitary plasmacytoma: A case report.

Author

Faiella E, Pileri M, Santucci D, Pusceddu C, Fior D, Riva F, Tagliaferri C, Moramarco LP, Zobel BB, and Grasso RF

Abstract

We report a case of a 40-year-old female with a solitary plasmacytoma of the right transverse apophysis of C1 who underwent combined transoral ablation using a curved steerable needle and cementoplasty under CBCT and infra-red augmented reality navigation system. An imaging work-up revealed an osteolytic lesion determining partial collapse of the right lateral mass of C1 and involving the vertebral foramen. After a biopsy, that revealed a solid tissue consistent with plasmacytoma, it was decided to proceed with radiation therapy. Subsequent PET-CT restaging scans showed residual tumors treated with a transoral percutaneous approach, combining ablation and cementoplasty. This report evaluates the benefits of this combined procedure and the transoral approach, focusing on the advantages of steerable devices and navigation systems., (© 2023 Published by Elsevier Inc. on behalf of University of Washington.)

Published
2023
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