482 results on '"Lorenzo Bonomo"'
Search Results
2. Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis
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Benedetta Gui, Anna Lia Valentini, Valeria Ninivaggi, Maura Miccò, Viola Zecchi, Pier Paolo Grimaldi, Francesco Cambi, Maurizio Guido, and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intralesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, pelvic peritoneum, uterosacral ligaments, and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter, and nerves. Moreover, rare extrapelvic endometriosis implants can be localized in the upper abdomen, subphrenic fold, or in the abdominal wall. Magnetic resonance imaging (MRI) represents a problem-solving tool among other imaging modalities. MRI is an advantageous technique, because of its multiplanarity, high contrast resolution, and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extrapelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should keep in mind these atypical localizations in patients with suspected endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.
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- 2017
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3. The morbidly adherent placenta: when and what association of signs can improve MRI diagnosis? Our experience
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Anna Lia Valentini, Benedetta Gui, Valeria Ninivaggi, Maura Miccò, Michela Giuliani, Luca Russo, Maria Giulia Marini, Mauro Tintoni, Anna Franca Cavaliere, and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSE:We aimed to verify whether combination of specific signs improves magnetic resonance imaging (MRI) accuracy in morbidly adherent placenta (MAP).METHODS:MRI findings for MAP were retrospectively evaluated in 27 women. Histopathology was the reference standard, showing MAP in eight of 27 cases. Specificity, sensitivity, positive predictive value, and negative predictive value were calculated for all MRI signs. Two skilled radiologists analyzed MRI findings, resolving discrepancies by consensus, using three alternative diagnostic criteria during three consecutive sections. First criterion: at least one of reported MRI signs indicates MAP and the absence of any sign is normal; second criterion: at least one statistically significant sign indicates MAP and no sign or nonsignificant sign is normal; third criterion: at least two statistically significant signs indicate MAP and no sign, nonsignificant sign, or only one significant sign is normal.RESULTS:Using the first criterion yielded an unacceptable rate of false positive results (78.9%). Using the second criterion there were less false positive results (31.5%), and diagnostic accuracy of the second criterion was significantly higher than the first; the third criterion correctly classified 100% of cases.CONCLUSION:Only specific MRI signs can correctly predict MAP at histopathology, particularly when multiple (at least two) specific signs are observed together.
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- 2017
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4. Missed lung cancer: when, where, and why?
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Annemilia del Ciello, Paola Franchi, Andrea Contegiacomo, Giuseppe Cicchetti, Lorenzo Bonomo, and Anna Rita Larici
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Missed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer on chest radiographs and on CT, often very similar in nature to each other. Observer error is the most significant one and comprises scanning error, recognition error, decision-making error, and satisfaction of search. Tumor characteristics such as lesion size, conspicuity, and location are also crucial in this context. Even technical aspects can contribute to the probability of skipping lung cancer, including image quality and patient positioning and movement. Albeit it is hard to remove missed lung cancer completely, strategies to reduce observer error and methods to improve technique and automated detection may be valuable in reducing its likelihood.
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- 2017
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5. Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings
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Benedetta Gui, Francesco Maria Danza, Anna Lia Valentini, Maria Elena Laino, Alessandro Caruso, Brigida Carducci, Elena Rodolfino, Ersilia Devicienti, and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.
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- 2016
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6. MRI anatomy of parametrial extension to better identify local pathways of disease spread in cervical cancer
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Anna Lia Valentini, Benedetta Gui, Maura Miccò, Michela Giuliani, Elena Rodolfino, Valeria Ninivaggi, Marta Iacobucci, Marzia Marino, Maria Antonietta Gambacorta, Antonia Carla Testa, Gian Franco Zannoni, and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
This paper highlights an updated anatomy of parametrial extension with emphasis on magnetic resonance imaging (MRI) assessment of disease spread in the parametrium in patients with locally advanced cervical cancer. Pelvic landmarks were identified to assess the anterior and posterior extensions of the parametria, besides the lateral extension, as defined in a previous anatomical study. A series of schematic drawings and MRI images are shown to document the anatomical delineation of disease on MRI, which is crucial not only for correct image-based three-dimensional radiotherapy but also for the surgical oncologist, since neoadjuvant chemoradiotherapy followed by radical surgery is emerging in Europe as a valid alternative to standard chemoradiation.
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- 2016
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7. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe
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Giulia Veronesi, David R. Baldwin, Claudia I. Henschke, Simone Ghislandi, Sergio Iavicoli, Matthijs Oudkerk, Harry J. De Koning, Joseph Shemesh, John K. Field, Javier J. Zulueta, Denis Horgan, Lucia Fiestas Navarrete, Maurizio Valentino Infante, Pierluigi Novellis, Rachael L. Murray, Nir Peled, Cristiano Rampinelli, Gaetano Rocco, Witold Rzyman, Giorgio Vittorio Scagliotti, Martin C. Tammemagi, Luca Bertolaccini, Natthaya Triphuridet, Rowena Yip, Alexia Rossi, Suresh Senan, Giuseppe Ferrante, Kate Brain, Carlijn van der Aalst, Lorenzo Bonomo, Dario Consonni, Jan P. Van Meerbeeck, Patrick Maisonneuve, Silvia Novello, Anand Devaraj, Zaigham Saghir, and Giuseppe Pelosi
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consensus ,statement ,screening ,lung cancer ,mortality ,reduction ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39–61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the “Initiative for European Lung Screening (IELS)”—a large international group of physicians and other experts concerned with lung cancer—agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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- 2020
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8. Lung nodules: size still matters
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Anna Rita Larici, Alessandra Farchione, Paola Franchi, Mario Ciliberto, Giuseppe Cicchetti, Lucio Calandriello, Annemilia del Ciello, and Lorenzo Bonomo
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Diseases of the respiratory system ,RC705-779 - Abstract
The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.
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- 2017
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9. Diagnosis and management of hemoptysis
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Anna Rita Larici,, Paola Franchi,, Mariaelena Occhipinti,, Andrea Contegiacomo,, Annemilia del Ciello,, Lucio Calandriello,, Maria Luigia Storto,, Riccardo Marano,, and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Hemoptysis is the expectoration of blood that originates from the lower respiratory tract. It is usually a self-limiting event but in fewer than 5% of cases it may be massive, representing a life-threatening condition that warrants urgent investigations and treatment. This article aims to provide a comprehensive literature review on hemoptysis, analyzing its causes and pathophysiologic mechanisms, and providing details about anatomy and imaging of systemic bronchial and nonbronchial arteries responsible for hemoptysis. Strengths and limits of chest radiography, bronchoscopy, multidetector computed tomography (MDCT), MDCT angiography and digital subtraction angiography to assess the cause and lead the treatment of hemoptysis were reported, with particular emphasis on MDCT angiography. Treatment options for recurrent or massive hemoptysis were summarized, highlighting the predominant role of bronchial artery embolization. Finally, a guide was proposed for managing massive and nonmassive hemoptysis, according to the most recent medical literature.
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- 2014
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10. Open issues in Physics and Imaging in Radiation Oncology
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Ludvig P. Muren and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2017
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11. Comparison between 18F-Fluorodeoxyglucose Positron Emission Tomography and Sentinel Lymph Node Biopsy for Regional Lymph Nodal Staging in Patients with Melanoma: A Review of the Literature
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Paoletta Mirk, Giorgio Treglia, Marco Salsano, Pietro Basile, Alessandro Giordano, and Lorenzo Bonomo
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Aim. to compare 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) to sentinel lymph node biopsy (SLNB) for regional lymph nodal staging in patients with melanoma. Methods. We performed a literature review discussing original articles which compared FDG-PET to SLNB for regional lymph nodal staging in patients with melanoma. Results and Conclusions. There is consensus in the literature that FDG-PET cannot replace SLNB for regional lymph nodal staging in patients with melanoma.
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- 2011
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12. Usefulness of Ultrasound Imaging in Detecting Psoriatic Arthritis of Fingers and Toes in Patients with Psoriasis
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Clara De simone, Giacomo Caldarola, Magda D'Agostino, Angelo Carbone, Cristina Guerriero, Lorenzo Bonomo, Pierluigi Amerio, and Nicola Magarelli
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Immunologic diseases. Allergy ,RC581-607 - Abstract
Background. Given that clinical evaluation may underestimate the joint damage and that early treatment can slow down psoriatic arthritis (PsA) progression, screening psoriasis patients with imaging tools that can depict early PsA changes would entail clear benefits. Objective. To compare the ability of X-ray and ultrasound (US) examination in detecting morphological abnormalities consistent with early PsA in patients with psoriasis, using rheumatological evaluation as the gold standard for diagnosis. Methods. Patients with chronic plaque psoriasis and no previous PsA diagnosis attending our outpatient dermatology clinic and reporting finger/toe joint and/or tendon pain underwent X-ray and US evaluation; they were subsequently referred to a rheumatologist for clinical examination and review of imaging findings. Results. Abnormal US and/or X-ray findings involving at least one finger and/or toe (joints and/or tendons) were seen in 36/52 patients: 11 had one or more X-ray abnormalities, including erosion, joint space narrowing, new bone formation, periarticular soft tissue swelling, and periarticular osteoporosis; 36 had suspicious changes on US. Conclusion. US proved valuable in detecting joint and/or tendon abnormalities in the fingers and toes of patients with suspicious changes. The dermatologist should consider US to obtain an accurate assessment of suspicious findings.
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- 2011
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13. Detection of cluster of microcalcifications based on watershed segmentation algorithm.
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Claudio Marrocco, Mario Molinara, Francesco Tortorella, Pierluigi Rinaldi, Lorenzo Bonomo, Alfredo Ferrarotti, Cesare Aragno, and Salvatore Schiano lo Moriello
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- 2012
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14. A multidisciplinary approach to the design and development of a CAD system for the detection of clustered microcalcifications.
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Claudio Marrocco, Mario Molinara, Francesco Tortorella, Alfredo Ferrarotti, Pierluigi Rinaldi, Lorenzo Bonomo, Cesare Aragno, and Salvatore Schiano lo Moriello
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- 2011
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15. COVID-19 pneumonia: current evidence of chest imaging features, evolution and prognosis
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Maria Luigia Storto, Anna Rita Larici, Riccardo Marano, Giuseppe Cicchetti, and Lorenzo Bonomo
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medicine.medical_specialty ,High-resolution computed tomography ,Polymers and Plastics ,Coronavirus disease 2019 (COVID-19) ,Evolution ,Computed tomography ,Review ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,medicine ,COVID-19 pneumonia ,Imaging findings ,General Environmental Science ,Chest imaging ,medicine.diagnostic_test ,business.industry ,Chest X-ray ,Prognosis ,medicine.disease ,Independent factor ,Pneumonia ,030220 oncology & carcinogenesis ,Radiology ,business - Abstract
COVID-19 pneumonia represents a global threatening disease, especially in severe cases. Chest imaging, with X-ray and high-resolution computed tomography (HRCT), plays an important role in the initial evaluation and follow-up of patients with COVID-19 pneumonia. Chest imaging can also help in assessing disease severity and in predicting patient’s outcome, either as an independent factor or in combination with clinical and laboratory features. This review highlights the current knowledge of imaging features of COVID-19 pneumonia and their temporal evolution over time, and provides recent evidences on the role of chest imaging in the prognostic assessment of the disease.
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- 2021
16. Sociodemographic determinants of knowledge on the figure of radiologist: results of a survey in large university hospital
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Biagio Merlino, Stefania Boccia, Giuseppe Cicchetti, Lorenzo Bonomo, Nikola Panic, and Emanuele Leoncini
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lcsh:R5-920 ,knowledge ,medicine.medical_specialty ,Modern medicine ,Secondary education ,business.industry ,lcsh:Public aspects of medicine ,public health ,Primary education ,lcsh:RA1-1270 ,Radiological examination ,University hospital ,Sociodemographic determinants ,Radiological weapon ,Medicine ,Outpatient clinic ,survey ,Radiology ,lcsh:Medicine (General) ,radiologist ,business ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA - Abstract
IntroductionDespite overlaying an irreplaceable role as a key diagnostic tool in modern medicine, the role of radiologist still appears to be unclear to patients.Methods We conducted a survey in outpatient clinic of Radiological Sciences Department of the University Hospital “A. Gemelli” in Rome, aiming to assess how correct patients identify the figure of the radiologist. The patients were interviewed by the trained physician using structured questionnaire.Results We included the number of 259 patients. Majority were female 63.3%, most were 60-69 years old (24.3%), have finished second grade secondary school (35.1%) and were subjected to magnetic resonance (28.6%) while the least were subjected to chest X-ray (8.1%). Only 38.7% answered correctly to question No 1 “Who performed your examination?”, and only 30.9% correctly identified the radiologist as a person interpreting the exam (question No 2 “Who is going to interpret your radiological examination?”). Overall, 16.8% responded correctly to the both questions. Significantly less patients with primary school (OR: 0.18, CI 95% 0.06-0.49) and first grade secondary school (OR: 0.37, CI 95% 0.18-0.75) correctly addressed the question No 1 in compare to those with second grade secondary school. The first grade secondary education (OR: 0.43, CI 95% 0.20-0.92) was inversely associated with correct answer to question No 2. Patients with primary education were significantly less prone to give both correct answers (OR: 0.12, CI 95% 0.02-0.60).Conclusion We report insufficient knowledge among patients on radiologist’s role in healthcare system. The level of knowledge is associated with level of education.
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- 2022
17. Functional topography of the secondary somatosensory cortex for nonpainful and painful stimuli: an fMRI study.
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Antonio Ferretti, Claudio Babiloni, Cosimo Del Gratta, Massimo Caulo, Armando Tartaro, Lorenzo Bonomo, Paolo Maria Rossini, and Gian Luca Romani
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- 2003
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18. Topographic Organization of the Human Primary and Secondary Somatosensory Cortices: Comparison of fMRI and MEG Findings.
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Cosimo Del Gratta, Stefania Della Penna, Antonio Ferretti, Raffaella Franciotti, Vittorio Pizzella, Armando Tartaro, K. Torquati, Lorenzo Bonomo, Gian Luca Romani, and Paolo Maria Rossini
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- 2002
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19. Management of incidental pulmonary nodule in CT: a survey by the Italian College of Chest Radiology
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Giampaolo Gavelli, Giancarlo Cortese, Maurizio Zompatori, Cristiano Rampinelli, Alessandra Farchione, Nicola Sverzellati, Roberto Iezzi, Roberta Polverosi, Giuseppe Cicchetti, Anna Rita Larici, Carmelo Privitera, Chiara Romei, Adele Valentini, and Lorenzo Bonomo
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Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Lung Neoplasms ,education ,Computed tomography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Pulmonary nodule ,Medical imaging ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Practice Patterns, Physicians' ,Chest radiology ,Neuroradiology ,Incidental Findings ,Solitary pulmonary nodule ,medicine.diagnostic_test ,business.industry ,General surgery ,Solitary Pulmonary Nodule ,Nodule (medicine) ,Interventional radiology ,General Medicine ,medicine.disease ,Italy ,030220 oncology & carcinogenesis ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Guideline Adherence ,medicine.symptom ,Tomography, X-Ray Computed ,business - Abstract
The aim of this study is to present the results of the Italian survey on the management of pulmonary nodules incidentally identified at computed tomography (CT). An online electronic survey, consisting of 23 multiple-choice questions, was created using the SurveyMonkey web-based tool. The questionnaire was developed by the Board of the Italian College of Chest Radiology of the Italian Society of Medical and Interventional Radiology (SIRM) and by an experienced group of Italian Academic Chest Radiologists. The link to the online electronic survey was submitted by email to all the SIRM members. A total of 767 radiologists, corresponding to 7.5% of all the SIRM members, participated in the online survey. The majority of participants (92%) routinely describe the attenuation of pulmonary nodules in the report, and 84.1% recommend the further follow-up, with 92.7% of respondents taking CT nodule morphological features into consideration. The 57.7% of participants adhere to the Fleischner Society guidelines for the management of incidental pulmonary nodules. However, 56.6% and 75.6% of respondents have a more cautious approach than that recommended by the guidelines and tend to use a shorter follow-up for both solid and ground-glass nodules, respectively. Finally, 94.5% of participants favor congresses and refresher courses dedicated to insights on lung nodule diagnosis and management. This survey demonstrates that the management of pulmonary nodules incidentally detected on CT is still complex and controversial. The majority of SIRM members express a need for an update on this topic.
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- 2019
20. Recommendations for implementing lung cancer screening with low-dose computed tomography in Europe
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David R Baldwin, Claudia I. Henschke, Rachael L Murray, Anand Devaraj, Nir Peled, Alexia Rossi, Javier J. Zulueta, Giulia Veronesi, Rowena Yip, Katherine Emma Brain, Giorgio V. Scagliotti, Luca Bertolaccini, Witold Rzyman, Lucia Fiestas Navarrete, Pierluigi Novellis, Giuseppe Pelosi, Suresh Senan, Sergio Iavicoli, Simone Ghislandi, Cristiano Rampinelli, John K. Field, Denis Horgan, Gaetano Rocco, Giuseppe Ferrante, Lorenzo Bonomo, Martin C. Tammemägi, Matthijs Oudkerk, Jan P. van Meerbeeck, Natthaya Triphuridet, Carlijn M. van der Aalst, Harry J. de Koning, Dario Consonni, Zaigham Saghir, Patrick Maisonneuve, Silvia Novello, Joseph Shemesh, M. Infante, Veronesi, G, Baldwin, D. R, Henschke, C, Ghislandi, S, Iavicoli, S, Oudkerk, M, De Koning, H. J, Shemesh, J, Field, J. K, Zulueta, J. J, Horgan, D, Navarrete, L. F, Infante, M. V, Novellis, P, Murray, R. L, Peled, N, Rampinelli, C, Rocco, G, Witold, R, Scagliotti, G. V, Tammemagi, M. C, Bertolaccini, L, Triphuridet, N, Yip, R, Rossi, A, Senan, S, Ferrante, G, Brain, K, van der Aalst, C, Bonomo, L, Consonni, D, Van Meerbeeck, J. P, Maisonneuve, P, Novello, S, Devaraj, A, Saghir, Z, Pelosi, G., Public Health, Radiation Oncology, and CCA - Imaging and biomarkers
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Cancer Research ,medicine.medical_specialty ,BASE-LINE ,Consensus ,Cost effectiveness ,ASBESTOS EXPOSURE ,Review ,lcsh:RC254-282 ,OBSTRUCTIVE PULMONARY-DISEASE ,law.invention ,COST-EFFECTIVENESS ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Randomized controlled trial ,law ,Cancer screening ,Medicine ,Lung emphysema ,030212 general & internal medicine ,Mortality ,Lung cancer ,INDIVIDUAL RISK ,Computed tomography ,Reduction ,integumentary system ,business.industry ,SELECTION CRITERIA ,Implementation ,Low dose ,Screening ,Statement ,GLOBAL BURDEN ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,SMOKING-CESSATION INTERVENTION ,medicine.disease ,3. Good health ,Quality-adjusted life year ,RISK PREDICTION MODEL ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,National Lung Screening Trial ,Human medicine ,business ,Lung cancer screening ,MALIGNANT MESOTHELIOMA - Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39–61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the “Initiative for European Lung Screening (IELS)”—a large international group of physicians and other experts concerned with lung cancer—agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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- 2020
21. Exploring technical issues in personalized medicine: NSCLC survival prediction by quantitative image analysis-usefulness of density correction of volumetric CT data
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Alessandra Farchione, Giuseppe Cicchetti, Roberto Gatta, Vincenzo Valentini, Stefano Lo Cicero, Paola Franchi, Riccardo Manfredi, Lorenzo Bonomo, Carlotta Masciocchi, Anna Rita Larici, and Maria Teresa Congedo
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Normalization (statistics) ,Adult ,Male ,Cone beam computed tomography ,Lung Neoplasms ,Biotechnology innovation ,Correction methods ,NSCLC ,Personalized medicine ,Radiomics ,Textural analysis ,Aged ,Aged, 80 and over ,Carcinoma, Non-Small-Cell Lung ,Cone-Beam Computed Tomography ,Contrast Media ,Female ,Humans ,Middle Aged ,Neoplasm Staging ,Predictive Value of Tests ,Radiographic Image Interpretation, Computer-Assisted ,Retrospective Studies ,Tumor Burden ,Precision Medicine ,Logistic regression ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Computer-Assisted ,80 and over ,Medicine ,Radiology, Nuclear Medicine and imaging ,Non-Small-Cell Lung ,Neuroradiology ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Receiver operating characteristic ,business.industry ,Carcinoma ,Radiographic Image Interpretation ,General Medicine ,Data set ,030220 oncology & carcinogenesis ,Predictive value of tests ,Akaike information criterion ,business ,Nuclear medicine - Abstract
The aim of this study was to apply density correction method to the quantitative image analysis of non-small cell lung cancer (NSCLC) computed tomography (CT) images, determining its influence on overall survival (OS) prediction of surgically treated patients. Clinicopathological (CP) data and preoperative CT scans, pre- and post-contrast medium (CM) administration, of 57 surgically treated NSCLC patients, were retrospectively collected. After CT volumetric density measurement of primary gross tumour volume (GTV), aorta and tracheal air, density correction was conducted on GTV (reference values: aortic blood and tracheal air). For each resulting data set (combining CM administration and normalization), first-order statistical and textural features were extracted. CP and imaging data were correlated with patients 1-, 3- and 5-year OS, alone and combined (uni-/multivariate logistic regression and Akaike information criterion). Predictive performance was evaluated using the ROC curves and AUC values and compared among non-normalized/normalized data sets (DeLong test). The best predictive values were obtained when combining CP and imaging parameters (AUC values: 1 year 0.72; 3 years 0.82; 5 years 0.78). After normalization resulted an improvement in predicting 1-year OS for some of the grey level size zonebased features (large zone low grey level emphasis) and for the combined CP-imaging model, a worse performance for grey level co-occurrence matrix (cluster prominence and shade) and first-order statistical (range) parameters for 1- and 5-year OS, respectively. The negative performance of cluster prominence in predicting 1-year OS was the only statistically significant result (p value 0.05). Density corrections of volumetric CT data showed an opposite influence on the performance of imaging quantitative features in predicting OS of surgically treated NSCLC patients, even if no statistically significant for almost all predictors.
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- 2020
22. Use of High-intensity Focused Ultrasound in the Management of Extra-abdominal Desmoid Tumors
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Lorenzo Bonomo, Alessandro Napoli, Paolo Spinnato, Alberto Bazzocchi, Margherita Bartocci, Giancarlo Facchini, Ugo Albisinni, and Pejman Ghanouni
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medicine.medical_specialty ,Extra abdominal ,business.industry ,High intensity ,medicine.medical_treatment ,medicine.disease ,Ablation ,High-intensity focused ultrasound ,Focused ultrasound ,Aggressive fibromatosis ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Published
- 2017
23. Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis
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Viola Zecchi, Lorenzo Bonomo, Pier Paolo Grimaldi, Valeria Ninivaggi, Maura Miccò, Francesco Cambi, Maurizio Guido, Anna Lia Valentini, and Benedetta Gui
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endometriosis MRI ,Pathology ,medicine.medical_specialty ,Endometriosis ,Female ,Humans ,Magnetic Resonance Imaging ,Pelvis ,030218 nuclear medicine & medical imaging ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,medicine ,Radiology, Nuclear Medicine and imaging ,Cervix ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,medicine.diagnostic_test ,business.industry ,Pelvic pain ,Magnetic resonance imaging ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vagina ,Uterine cavity ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intralesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, pelvic peritoneum, uterosacral ligaments, and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter, and nerves. Moreover, rare extrapelvic endometriosis implants can be localized in the upper abdomen, subphrenic fold, or in the abdominal wall. Magnetic resonance imaging (MRI) represents a problem-solving tool among other imaging modalities. MRI is an advantageous technique, because of its multiplanarity, high contrast resolution, and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extrapelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should keep in mind these atypical localizations in patients with suspected endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.
- Published
- 2017
24. Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings
- Author
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Elena Rodolfino, Lorenzo Bonomo, Ersilia Devicienti, Francesco Danza, Maria Elena Laino, Anna Lia Valentini, Brigida Carducci, Alessandro Caruso, and Benedetta Gui
- Subjects
medicine.medical_specialty ,business.industry ,CT cesarean delivery ,Rectus sheath ,Multidetector ct ,medicine.disease ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Hematoma ,medicine.anatomical_structure ,medicine ,Radiology, Nuclear Medicine and imaging ,Endometritis ,Radiology ,Rectus sheath hematoma ,Cardiology and Cardiovascular Medicine ,Abscess ,business ,Pelvic Infection ,030217 neurology & neurosurgery ,Pelvis ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA - Abstract
Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.
- Published
- 2016
25. CT Radiomics Signature of Tumor and Peritumoral Lung Parenchyma to Predict Nonsmall Cell Lung Cancer Postsurgical Recurrence Risk
- Author
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Alessandra Farchione, Vincenzo Valentini, Giuseppe Cicchetti, Riccardo Manfredi, Stefano Margaritora, Tugba Akinci D'Antonoli, Anna Rita Larici, Alessandra Ottavianelli, A. Martino, Lorenzo Bonomo, Jacopo Lenkowicz, and Marco Chiappetta
- Subjects
medicine.medical_specialty ,TNM staging system ,030218 nuclear medicine & medical imaging ,Recurrence risk ,Multidetector computed tomography ,03 medical and health sciences ,0302 clinical medicine ,Radiomics ,Lung neoplasms ,Carcinoma, Non-Small-Cell Lung ,Parenchyma ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Lung ,Retrospective Studies ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,business.industry ,Area under the curve ,Nomogram ,Prognosis ,Nomograms ,030220 oncology & carcinogenesis ,Non small cell ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Rationale and Objectives To estimate recurrence risk after surgery in nonsmall cell lung cancer (NSCLC) patients by employing tumoral and peritumoral radiomics analysis. Materials and Methods One-hundred twenty-four surgically treated stage IA–IIB NSCLC patients’ data from 2008 to 2013 were retrospectively collected. Patient outcome was defined as local recurrence (LR), distant metastasis (DM), and (sum of LR and DM) total recurrence (TR) at follow-up. Volumetric region of interests (ROIs) were drawn for the tumor, peritumoral lung parenchyma (2 cm around the tumor) and involved lobe on CT images. Ninety-four (morphological, first-order, textural, fractal-based) radiomics features were extracted from the ROIs and datasets were created from single or combined ROIs. Predictive models were built with radiomics signature (RS) and clinicopathological data, and the area under the curve (AUC) was used to evaluate the performance. Radiomics score was calculated with the best models’ feature coefficients, low- and high-risk groups of patients defined accordingly. Kaplan–Meier curves were built, and the log-rank test was used for comparison among low- and high-risk groups. Differences in recurrence risk among the two risk groups were calculated (chi-square test). Results Fifty-six patients developed TR (25 LR, 31 DM). The tumor-node-metastasis (TNM) stage recurrence predictability (AUCTR 0.680; AUCDM 0.672; AUCLR 0.580) was substantially improved when RS was added to the predictive model (AUCTR 0.760; AUCDM 0.759; AUCLR 0.750). Seventy-five percent of high-risk patients developed TR. Recurrence risk of the high-risk group was 16-fold higher than that of the low-risk group (p Conclusion Combination of the tumoral and peritumoral RS with TNM staging system outperformed TNM staging alone in individualized recurrence risk estimation of patients with surgically treated NSCLC.
- Published
- 2019
26. Magnetic resonance imaging appearance of oxidized regenerated cellulose in breast cancer surgery
- Author
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Maurizio Romani, Lorenzo Bonomo, Silvia Eleonora Di Giovanni, Enida Bufi, Gianluca Franceschini, Chiara Buccheri, Rita Fubelli, Michela Giuliani, Paolo Belli, Federico Padovano, Pierluigi Rinaldi, Federica Patrolecco, and Rossella Rella
- Subjects
Adult ,Gadolinium DTPA ,medicine.medical_specialty ,Settore MED/18 - CHIRURGIA GENERALE ,Breast Implants ,medicine.medical_treatment ,Contrast Media ,Breast Neoplasms ,Mastectomy, Segmental ,Oncoplastic procedures ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Breast cancer ,Breast-conserving surgery ,Nuclear Medicine and Imaging ,Absorbable Implants ,Image Interpretation, Computer-Assisted ,Biopsy ,medicine ,Humans ,Cellulose, Oxidized ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Neuroradiology ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Medicine (all) ,Ultrasound ,Magnetic resonance imaging ,Interventional radiology ,General Medicine ,Middle Aged ,medicine.disease ,Absorbable implants ,Oxidized regenerated cellulose ,Radiology, Nuclear Medicine and Imaging ,Magnetic Resonance Imaging ,Surgery ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
To describe magnetic resonance imaging (MRI) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in surgical cavity. We retrospectively reviewed 51 MRI examinations performed between January 2009 and January 2014 in 51 patients who underwent BCS with ORC implantation. In 29/51 (57 %) cases, MRIs showed abnormal findings with three main MRI patterns: (1) complex masses: hyperintense collections on T2-weighted (w) images with internal round hypointense nodules without contrast enhancement (55 %); (2) completely hyperintense collections (17 %); and (3) completely hypointense lesions (28 %). All lesions showed rim enhancement on T1w images obtained in the late phase of the dynamic study with a type 1 curve. Diffusion-weighted imaging was negative in all MRIs and, in particular, 22/29 (76 %) lesions were hyperintense but showing ADC values >1.4 × 10−3 mm2/s, while the remaining 7/29 (24 %) lesions were hypointense. In four cases, linear non-mass-like enhancement was detected at the periphery of surgical cavity; these patients were addressed to a short-term follow-up, and the subsequent examinations showed the resolution of these findings. When applied to surgical residual cavity, ORC can lead alterations in surgical scar. This could induce radiologists to misinterpret ultrasonographic and mammographic findings, addressing patients to MRI or biopsy; so knowledge of MRI specific features of ORC, it is essential to avoid misdiagnosis of recurrence.
- Published
- 2016
27. Mammographic and Ultrasonographic Findings of Oxidized Regenerated Cellulose in Breast Cancer Surgery: A 5-Year Experience
- Author
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Silvia Eleonora Di Giovanni, Maurizio Romani, Rita Fubelli, Paolo Belli, Chiara Buccheri, Enida Bufi, Lorenzo Bonomo, Michela Giuliani, Federica Patrolecco, Rossella Rella, Pierluigi Rinaldi, Gianluca Franceschini, and Cristina Borelli
- Subjects
Adult ,Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,Mastectomy, Segmental ,Absorbable implants ,Breast cancer ,Breast-conserving surgery ,medicine ,Humans ,Cellulose, Oxidized ,In patient ,Post-surgical imaging ,Surgical scar ,Ultrasonography ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,business.industry ,Middle Aged ,medicine.disease ,United States ,Oxidized regenerated cellulose ,Surgery ,Tumor recurrence ,Oncology ,Female ,Ultrasonography, Mammary ,Radiology ,Doppler ultrasound ,business ,Mammography - Abstract
Background The purpose of this study was to describe the ultrasonographic (US) and mammographic (MX) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in the surgical cavity and their size variations in follow-up. Materials and Methods We retrospectively reviewed 417 MX and 743 US images performed between January 2009 and January 2014 for 262 women who underwent breast-conserving surgery. All patients underwent US, only 203 women underwent MX examination. Results In 170 of 262 patients, US examinations showed abnormal findings. Three main US patterns were identified: (1) complex masses: well-encapsulated ipoisoechoic lesions with circumscribed margins with internal hyperechoic nodules (56%); (2) hypoanechoic lesions without internal hyperechoic nodules (24%); and (3) completely anechoic collections (20%). Moreover, Doppler ultrasound examination was performed on all of the patients. In 95 of 203 patients, MX examinations showed abnormalities. Four main MX patterns were identified: (1) round or oval opacity with circumscribed margins (58%); (2) round or oval opacity with indistinct or ill-defined margins (17%); (3) irregular opacity with indistinct or spiculated margins (9%); and (4) architectural distortion or focal asymmetry (15%). Most of the lesions showed a decrease in size at US and MX follow-up examination and the decrease was statistically significant (P Conclusion When applied to the surgical residual cavity, ORC aids to control local hemorrhage and reduce the risk of postoperative infections, but can lead to alterations in surgical scar. Thus, knowledge of the radiological findings might allow avoidance of misdiagnosis of tumor recurrence or unnecessary diagnostic examinations.
- Published
- 2015
28. Lung nodules: size still matters
- Author
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Lorenzo Bonomo, Paola Franchi, Mario Ciliberto, Lucio Calandriello, Alessandra Farchione, Annemilia Del Ciello, Giuseppe Cicchetti, and Anna Rita Larici
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Context (language use) ,Malignancy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Multidetector Computed Tomography ,medicine ,Humans ,Lung cancer ,Nodules size ,Early Detection of Cancer ,Cell Proliferation ,lcsh:RC705-779 ,Lung ,business.industry ,Solitary Pulmonary Nodule ,Nodule (medicine) ,lcsh:Diseases of the respiratory system ,Prognosis ,medicine.disease ,Tumor Burden ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Predictive value of tests ,Disease Progression ,Multiple Pulmonary Nodules ,Radiology ,medicine.symptom ,Indeterminate ,business - Abstract
The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.
- Published
- 2017
29. Comparison of CT and MR angiography in evaluation of peripheral arterial disease before endovascular intervention
- Author
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Vittorio Semeraro, Carmine Di Stasi, Riccardo Marano, Alessandro Cina, Lorenzo Bonomo, Giancarlo Savino, and Roberto Iezzi
- Subjects
Male ,medicine.medical_specialty ,Arterial disease ,Contrast Media ,endovascular intervention ,peripheral arterial disease, endovascular intervention, ct mr ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Arterial segment ,0302 clinical medicine ,peripheral arterial disease ,Nuclear Medicine and Imaging ,Multidetector Computed Tomography ,80 and over ,medicine ,Endovascular procedures ,Magnetic resonance angiography (MRA) ,Multidetector computed tomography (MDCT) ,Peripheral arterial disease ,Tibial arteries ,Aged ,Aged, 80 and over ,Endovascular Procedures ,Female ,Humans ,Leg ,Magnetic Resonance Angiography ,Middle Aged ,Peripheral Arterial Disease ,Prospective Studies ,Radiological and Ultrasound Technology ,Medicine (all) ,Radiology, Nuclear Medicine and Imaging ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Endovascular treatment ,ct mr ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Computed tomography angiography ,medicine.diagnostic_test ,business.industry ,Mr angiography ,General Medicine ,Peripheral ,cardiovascular system ,Radiology ,business - Abstract
Background Multidetector computed tomography angiography (MDCTA) and magnetic resonance angiography (MRA) are accurate techniques for selecting patients with peripheral arterial disease for surgical and endovascular treatment. No studies in the literature have directly compared MDCTA and MRA to establish which one should be employed, in patients suitable for both techniques, before endovascular treatment. Purpose To compare diagnostic performance of MDCTA vs MRA before endovascular intervention. Material and Methods We prospectively compared MDCTA (64 slices scanner) and MRA (1.5 T scanner; 3D gadolinium-enhanced bolus-chase acquisition plus time resolved acquisition on calves) to stratify 35 patients according to the TASC II score and a runoff severity score. We also evaluated the accuracy of both techniques in each arterial segment. Selective angiography performed during the treatment was the standard of reference. Results MDCTA and MRA accurately classify disease in the aorto-iliac (accuracy 0.92 for MDCTA and MRA) and femoro-popliteal (MDCTA 0.94, MRA 0.90) segments. MDCTA was more accurate in stratifying disease in the infrapopliteal segments (0.96 vs. 0.9) and in assessing the impairment of runoff arteries (0.92 vs. 0.85) at per-segment analysis. MDCTA showed a higher confidence and a shorter examination time. Conclusion Our results suggest that MDCTA can be considered as a first-line investigation in patients being candidates for endovascular procedures when clinical history or duplex sonographic evaluation are indicative of severe impairment of the infrapopliteal segment.
- Published
- 2015
30. The role of contrast-enhanced ultrasound (CEUS) in visualizing atherosclerotic carotid plaque vulnerability: Which injection protocol? Which scanning technique?
- Author
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Roberto Iezzi, Angela Maria Rosaria Ferrante, Guido Rindi, Libero Lauriola, Francesco Snider, Lorenzo Bonomo, Gianluigi Petrone, Claudio Vincenzoni, and Mf La Torre
- Subjects
Male ,medicine.medical_specialty ,carotid plaque ,medicine.medical_treatment ,Population ,Sulfur Hexafluoride ,Contrast Media ,Carotid endarterectomy ,medicine.disease_cause ,Sensitivity and Specificity ,Asymptomatic ,Injections ,Predictive Value of Tests ,medicine ,Humans ,Carotid Stenosis ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,education ,Phospholipids ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Aged ,Ultrasonography ,Endarterectomy, Carotid ,education.field_of_study ,Settore MED/08 - ANATOMIA PATOLOGICA ,business.industry ,Ultrasound ,General Medicine ,Gold standard (test) ,Middle Aged ,Settore MED/22 - CHIRURGIA VASCOLARE ,Vulnerable plaque ,Plaque, Atherosclerotic ,CEUS ,Female ,Radiology ,medicine.symptom ,business ,Mechanical index ,Contrast-enhanced ultrasound - Abstract
Purpose To correlate the degree of plaque vulnerability as determined by contrast-enhanced ultrasound (CEUS) with histological findings. Secondary objectives were to optimize the CEUS acquisition technique and image evaluation methods. Materials and methods Fifty consecutive patients, either symptomatic and asymptomatic referring to our department in order to perform carotid endarterectomy (TEA), were enrolled. Each patient provided informed consent before undergoing CEUS. Ultrasound examination was performed using high-frequency (8–14 MHz) linear probe and a non-linear pulse inversion technique (mechanical index: 0.09–1.3). A double contrast media injection (Sonovue, 2 mL and 4 mL; Bracco, Italy) was performed. Two videotapes were recorded for every injection: early “dynamic” phase and late “flash” phase, performed with 6 high mechanical index impulses. Movies were quantitatively and qualitatively evaluated. Qualitative and quantitative evaluation were statistically compared to immunohistological diagnosis of vulnerable plaque, considered as gold standard. Results Qualitative CEUS evaluation obtained high statistical results when compared to immunohistological results, with values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 94%, 68%, 87%, 85% and 86%, respectively, which became higher if considering only asymptomatic patient, with a NPV of 91%. Nevertheless, quantitative software evaluation proved less effective and could not reach similar results. Conclusion Carotid plaque enhancement assessed with CEUS well correlates with histological assessment of plaque instability. CEUS may provide valuable information for plaque risk stratification and may play a role in the indication to treatment of patients with carotid stenoses, particularly in asymptomatic population.
- Published
- 2015
31. Trans-Arterial Chemoembolization with Irinotecan-Loaded Drug-Eluting Beads (DEBIRI) and Capecitabine in Refractory Liver Prevalent Colorectal Metastases: A Phase II Single-Center Study
- Author
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Michele Basso, Lorenzo Bonomo, Alessandra Cassano, Ersilia Devicienti, Elena Rodolfino, Carlo Barone, Roberto Iezzi, Valentina Angela Marsico, Eleonora Cerchiaro, and A. Guerra
- Subjects
Male ,Oncology ,Antimetabolites, Antineoplastic ,medicine.medical_specialty ,medicine.medical_treatment ,Irinotecan ,Single Center ,Gastroenterology ,Disease-Free Survival ,Capecitabine ,Drug Delivery Systems ,Refractory ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Prospective Studies ,Chemoembolization, Therapeutic ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Aged ,Chemotherapy ,Drug eluting beads ,business.industry ,Liver Neoplasms ,Middle Aged ,Antineoplastic Agents, Phytogenic ,digestive system diseases ,Treatment Outcome ,Chemoembolization ,Hepatic ,Interventional Oncology ,Liver ,Neoplasm ,Tumor ,Camptothecin ,Colorectal Neoplasms ,Feasibility Studies ,Female ,Radiology, Nuclear Medicine and Imaging ,Cardiology and Cardiovascular Medicine ,Trans arterial chemoembolization ,business ,medicine.drug - Abstract
The purpose of this study was to evaluate feasibility, safety, tolerance, and efficacy of drug-eluting beads loaded with irinotecan (DEBIRI) in combination with capecitabine in the treatment of mCRC refractory to chemotherapy in patients affected by liver predominant metastatic disease.Twenty patients affected by CRC hepatic metastasis with liver-dominant disease, who had progression after two or more lines of chemotherapy, were enrolled. TACE with 100 mg of Irinotecan loaded into 2-ml of 70-150 µm drug-eluting beads was administrated every 4 weeks in patients with unilobar disease (2 treatments) and every 2 weeks in patients with bilobar disease (4 treatments). All patients assumed capecitabine 1000 mg/m(2) twice daily on days 1-14 every 3 weeks, until disease progression. Primary endpoints were safety, tolerance and overall disease control (ODC); secondary endpoints were progression free survival (PFS) and overall survival (OS).A total of 54 treatments were performed (54/66, 82%). No intra/peri-procedural death occurred. During the mean follow-up of 11 months, two partial responses (PR) were reported with ODC of 60% (2 PR + 10 stable disease). PFS and OS were 4 and 7.3 months, respectively. Univariate analysis showed that patients presenting with KRAS wild-type, good ECOG performance status and unilobar disease had a better prognosis. Only performance status (ECOG) correlated with OS in multivariate analysis (p = 0.03).DEBIRI with capecitabine seem to be a safe, technically feasible and well-tolerated treatment in chemotherapy refractory liver prevalent colorectal metastases.
- Published
- 2015
32. Comprehensive CT Cardiothoracic Imaging
- Author
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Riccardo Marano, Lorenzo Bonomo, Giancarlo Savino, Valentina Silvestri, Agostino Meduri, Luigi Natale, Biagio Merlino, Federica Pirro, and Claudia Rutigliano
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Radiography ,Critical Care and Intensive Care Medicine ,medicine.disease ,Inferior vena cava ,Coronary artery disease ,medicine.vein ,Medical imaging ,Patent foramen ovale ,medicine ,Tomography ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Chest radiograph ,Cardiac imaging - Abstract
In the past, thoracic and cardiac imaging were two distinct specialties of radiology. The technical evolution, however, has changed their boundaries with an important impact on CT imaging practices and has opened the new era of "cardiothoracic" imaging, due to the strong anatomic, mechanical, physiologic, physiopathologic, and therapeutic cardiopulmonary correlations. Modern thoracic radiologists can no longer avoid the assessment of heart and coronary arteries, as they used to do with earlier generations of CT scanner. The advent of ECG gating and state-of-art CT scanner faster rotation speed, high spatial and temporal resolution, high-pitch mode, shorter acquisition time, and dedicated cardiac reconstruction algorithms has opened new possibilities for chest imaging, integrating cardiac morphologic and even functional information within a diagnostic chest CT scan. The aim of this review is to briefly show and summarize the concept of integrated cardiothoracic imaging, which redefines the boundaries of chest CT imaging, opening the door to a new radiologic specialty.
- Published
- 2015
33. Freshwater drowning in a child: A case study demonstrating the role of post-mortem computed tomography
- Author
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Claudio Guerra, Giuseppe Vetrugno, Laura Filograna, Lorenzo Bonomo, Tommaso Tartaglione, and Adriano Fileni
- Subjects
PMCT ,medicine.medical_specialty ,Forensic pathology ,Injury control ,Accident prevention ,Poison control ,Bronchi ,Fresh Water ,Autopsy ,freshwater drowning ,case study ,Humans ,case report ,Medicine ,Post mortem computed tomography ,Lung ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,post-mortem CT ,drowning ,business.industry ,Health Policy ,Infant ,Maxillary Sinus ,radiology ,Post mortem ct ,Surgery ,Trachea ,Issues, ethics and legal aspects ,Radiology ,Tomography, X-Ray Computed ,business ,Law - Abstract
In recent years, modern imaging techniques have gained ground in forensics. A crucial question is whether virtual autopsy is capable of replacing traditional autopsy. Forensic diagnosis of freshwater drowning (FWD) is based on the evidence of findings from external inspection (e.g. frothy fluid exuding from the mouth and nostrils), internal examination (e.g. pulmonary congestion, enlargement of heart chambers) and biochemical analysis (haemodilution), findings which are non-specific. The detection of diatoms in organs of the systemic circulation may be of some assistance, but this analysis is rarely performed and is of debatable validity. An 18-month-old child was found dead at home in a swimming pool. Considering the family's wishes to avoid autopsy, the district attorney authorised a whole-body post-mortem computed tomography scan (PMCT). The main imaging findings were frothy fluid in the upper airways, fluid in the trachea and main bronchi, many pulmonary nodular ground glass opacities (GGO) in non-dependent regions and haemodilution. CT imaging did not show any other forensically relevant abnormality. A high concordance was found between the CT findings reported in the literature in cases of FWD and the imaging results. Thus, after the exclusion of other causes of death, advised by the forensic pathologist, the district attorney closed the case and the death was attributed to FWD. This case report demonstrates that PMCT imaging in cases of suspected FWD can provide some important findings for the diagnosis of FWD as the cause of death.
- Published
- 2015
34. Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver
- Author
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Felice Giuliante, Riccardo Inchingolo, Lorenzo Bonomo, Marzia Ciresa, Fabio Maria Vecchio, Maurizio Pompili, Luca Miele, Anna Maria De Gaetano, and Davide Curione
- Subjects
Liver Cirrhosis ,Male ,Settore MED/18 - CHIRURGIA GENERALE ,Contrast Media ,Diagnosis ,80 and over ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Neuroradiology ,Aged, 80 and over ,Observer Variation ,Liver Neoplasms ,hepatocellular carcinoma ,General Medicine ,Hepatobiliary contrast agent (delayed phase imaging ,Middle Aged ,Magnetic Resonance Imaging ,Liver ,Hepatocellular carcinoma ,Female ,Radiology ,medicine.symptom ,Adult ,medicine.medical_specialty ,Apparent diffusion coefficient (ADC) ,Carcinoma, Hepatocellular ,Sensitivity and Specificity ,Diagnosis, Differential ,parasitic diseases ,medicine ,Carcinoma ,Humans ,Effective diffusion coefficient ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Hepatocellular carcinoma (HCC) ,Aged ,Retrospective Studies ,business.industry ,Settore MED/09 - MEDICINA INTERNA ,DPI) ,Diffusion-weighted imaging (DWI) ,Reproducibility of Results ,Hepatocellular ,Nodule (medicine) ,medicine.disease ,Hyperintensity ,Diffusion Magnetic Resonance Imaging ,Hepatobiliary contrast agent (delayed phase imaging, DPI) ,Differential ,Differential diagnosis ,business ,Nuclear medicine ,Diffusion MRI - Abstract
To investigate the utility of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and the correlation with hepatobiliary phase (delayed phase imaging, DPI) findings in the differentiation of cirrhotic hepatocellular nodules. Forty-three patients with 53 pathology-proven nodules (29 hepatocellular carcinomas (HCCs), 13 high-grade (HGDNs) and 11 low-grade dysplastic nodules (LGDNs); mean size 2.17 cm, range 1–4 cm), who underwent liver MRI with DWI and DPI sequences, were retrospectively reviewed. Lesions were classified as hypointense, isointense, or hyperintense relative to the adjacent liver parenchyma. ADC of each nodule, of the surrounding parenchyma, and lesion-to-liver ratio were calculated. Hyperintensity versus iso/hypointensity on DWI, hypointensity versus iso/hyperintensity on DPI, and the mean lesion-to-liver ratio showed a statistically significant difference both between HCCs versus DNs and between “HCCs + HGDNs” versus LGDNs (p
- Published
- 2014
35. Applications of Ultrasound Elastography in Musculoskeletal Imaging: Technical Aspects and Review of the Literature
- Author
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Antonio Cipriani, Antonio Maria Leone, Michele La Torre, Santi Rapisarda, Nicola Magarelli, Lorenzo Bonomo, Claudia Dell'atti, and Laura Filograna
- Subjects
medicine.medical_specialty ,Musculoskeletal imaging ,030219 obstetrics & reproductive medicine ,business.industry ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Ultrasound elastography ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,INGLESE ,business ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA - Published
- 2017
36. The morbidly adherent placenta: when and what association of signs can improve MRI diagnosis? Our experience
- Author
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Lorenzo Bonomo, Anna Franca Cavaliere, Benedetta Gui, Valeria Ninivaggi, Luca Russo, M. Tintoni, Maria Giulia Marini, Anna Lia Valentini, Michela Giuliani, and Maura Miccò
- Subjects
Adult ,medicine.medical_specialty ,Morbidly adherent placenta ,Placenta ,Gestational Age ,Placenta Accreta ,Hysterectomy ,MRI ,placenta ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Predictive Value of Tests ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Abdominal Imaging ,Association (psychology) ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Cesarean Section ,Magnetic resonance imaging ,Middle Aged ,Predictive value ,Magnetic Resonance Imaging ,Surgery ,Mri diagnosis ,Histopathology ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Sign (mathematics) - Abstract
PURPOSE We aimed to verify whether combination of specific signs improves magnetic resonance imaging (MRI) accuracy in morbidly adherent placenta (MAP). METHODS MRI findings for MAP were retrospectively evaluated in 27 women. Histopathology was the reference standard, showing MAP in eight of 27 cases. Specificity, sensitivity, positive predictive value, and negative predictive value were calculated for all MRI signs. Two skilled radiologists analyzed MRI findings, resolving discrepancies by consensus, using three alternative diagnostic criteria during three consecutive sections. First criterion: at least one of reported MRI signs indicates MAP and the absence of any sign is normal; second criterion: at least one statistically significant sign indicates MAP and no sign or nonsignificant sign is normal; third criterion: at least two statistically significant signs indicate MAP and no sign, nonsignificant sign, or only one significant sign is normal. RESULTS Using the first criterion yielded an unacceptable rate of false positive results (78.9%). Using the second criterion there were less false positive results (31.5%), and diagnostic accuracy of the second criterion was significantly higher than the first; the third criterion correctly classified 100% of cases. CONCLUSION Only specific MRI signs can correctly predict MAP at histopathology, particularly when multiple (at least two) specific signs are observed together.
- Published
- 2017
37. Ultrasound Molecular Imaging With BR55 in Patients With Breast and Ovarian Lesions: First-in-Human Results
- Author
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K. Valluru, Sanjiv S. Gambhir, Lorenzo Bonomo, Pierluigi Rinaldi, Antonia Carla Testa, Gianluigi Petrone, Amelie M. Lutz, Maurizio Martini, Guido Rindi, and Jürgen K. Willmann
- Subjects
Cancer Research ,medicine.medical_specialty ,Pathology ,Urology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,parasitic diseases ,Heart rate ,Medicine ,Humans ,Breast ,Prospective cohort study ,Ultrasonography ,Settore MED/08 - ANATOMIA PATOLOGICA ,business.industry ,Cancer ,Kinase insert domain receptor ,ORIGINAL REPORTS ,medicine.disease ,Molecular Imaging ,Clinical trial ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Blood pressure ,Oncology ,030220 oncology & carcinogenesis ,cardiovascular system ,Immunohistochemistry ,business ,Breast Neoplasms / diagnostic imaging - Abstract
Purpose We performed a first-in-human clinical trial on ultrasound molecular imaging (USMI) in patients with breast and ovarian lesions using a clinical-grade contrast agent (kinase insert domain receptor [KDR] –targeted contrast microbubble [MBKDR]) that is targeted at the KDR, one of the key regulators of neoangiogenesis in cancer. The aim of this study was to assess whether USMI using MBKDR is safe and allows assessment of KDR expression using immunohistochemistry (IHC) as the gold standard. Methods Twenty-four women (age 48 to 79 years) with focal ovarian lesions and 21 women (age 34 to 66 years) with focal breast lesions were injected intravenously with MBKDR (0.03 to 0.08 mL/kg of body weight), and USMI of the lesions was performed starting 5 minutes after injection up to 29 minutes. Blood pressure, ECG, oxygen levels, heart rate, CBC, and metabolic panel were obtained before and after MBKDR administration. Persistent focal MBKDR binding on USMI was assessed. Patients underwent surgical resection of the target lesions, and tissues were stained for CD31 and KDR by IHC. Results USMI with MBKDR was well tolerated by all patients without safety concerns. Among the 40 patients included in the analysis, KDR expression on IHC matched well with imaging signal on USMI in 93% of breast and 85% of ovarian malignant lesions. Strong KDR-targeted USMI signal was present in 77% of malignant ovarian lesions, with no targeted signal seen in 78% of benign ovarian lesions. Similarly, strong targeted signal was seen in 93% of malignant breast lesions with no targeted signal present in 67% of benign breast lesions. Conclusion USMI with MBKDR is clinically feasible and safe, and KDR-targeted USMI signal matches well with KDR expression on IHC. This study lays the foundation for a new field of clinical USMI in cancer.
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- 2017
38. Missed lung cancer: When, where, and why?
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Giuseppe Cicchetti, Andrea Contegiacomo, Lorenzo Bonomo, Annemilia Del Ciello, Anna Rita Larici, and Paola Franchi
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Oncology ,medicine.medical_specialty ,Lung Neoplasms ,Radiography ,Anatomical structures ,Context (language use) ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Chest Imaging ,Lung lesion ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Diagnostic Errors ,Lung cancer ,Tomography ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,business.industry ,Pulmonary vessels ,respiratory system ,medicine.disease ,Mass Chest X-Ray ,respiratory tract diseases ,X-Ray Computed ,030220 oncology & carcinogenesis ,Satisfaction of search ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Missed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer on chest radiographs and on CT, often very similar in nature to each other. Observer error is the most significant one and comprises scanning error, recognition error, decision-making error, and satisfaction of search. Tumor characteristics such as lesion size, conspicuity, and location are also crucial in this context. Even technical aspects can contribute to the probability of skipping lung cancer, including image quality and patient positioning and movement. Albeit it is hard to remove missed lung cancer completely, strategies to reduce observer error and methods to improve technique and automated detection may be valuable in reducing its likelihood.
- Published
- 2017
39. COPD
- Author
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Anna Rita Larici, Paola Franchi, Giuseppe Cicchetti, and Lorenzo Bonomo
- Published
- 2017
40. Effect of breast cancer phenotype on diagnostic performance of MRI in the prediction to response to neoadjuvant treatment
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Daniela Terribile, Enida Bufi, Lorenzo Bonomo, Paolo Belli, Luigia Nardone, Gianluca Franceschini, Gianluigi Petrone, and Marialuisa Di Matteo
- Subjects
Settore MED/18 - CHIRURGIA GENERALE ,medicine.medical_treatment ,Breast Neoplasms ,Neoadjuvant chemotherapy ,breast cancer ,Breast cancer ,Predictive Value of Tests ,Neoadjuvant treatment ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Effective diffusion coefficient ,Radiology, Nuclear Medicine and imaging ,Human Epidermal Growth Factor Receptor 2 ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Chemotherapy ,business.industry ,Reproducibility of Results ,Diffusion weighted imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Phenotype ,Complete Pathological response ,Neoadjuvant Therapy ,Treatment Outcome ,Chemotherapy, Adjuvant ,Hormone receptor ,RECIST classification ,Female ,Nuclear medicine ,business ,Diffusion MRI - Abstract
The estimation of response to neoadjuvant chemotherapy (NAC) is useful in the surgical decision in breast cancer. We addressed the diagnostic reliability of conventional MRI, of diffusion weighted imaging (DWI) and of a merged criterion coupling morphological MRI and DWI. Diagnostic performance was analysed separately in different tumor subtypes, including HER2+ (human epidermal growth factor receptor 2)/HR+ (hormone receptor) (hybrid phenotype).Two-hundred and twenty-five patients underwent MRI before and after NAC. The response to treatment was defined according to the RECIST classification and the evaluation of DWI with apparent diffusion coefficient (ADC). The complete pathological response - pCR was assessed (Mandard classification).Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), HER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of cases. Average ADC was statistically higher after NAC (p0.001) among patients showing pCR vs. those who had not pCR. The RECIST classification showed adequate performance in predicting the pCR in Triple Negative (area under the receiver operating characteristic curve, ROC AUC=0.9) and in the HER2+ subgroup (AUC=0.826). Lower performance was found in the Luminal and Hybrid subgroups (AUC 0.693 and 0.611, respectively), where the ADC criterion yielded an improved performance (AUC=0.787 and 0.722). The coupling of morphological and DWI criteria yielded maximally improved performance in the Luminal and Hybrid subgroups (AUC=0.797 and 0.761).The diagnostic reliability of MRI in predicting the pCR to NAC depends on the tumor phenotype, particularly in the Luminal and Hybrid subgroups. In these cases, the coupling of morphological MRI evaluation and DWI assessment may facilitate the diagnosis.
- Published
- 2014
41. Intussusception in childhood: role of sonography on diagnosis and treatment
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Lorenzo Bonomo, Iacopo Valente, Margherita Bartocci, C. Manzoni, G. Fabrizi, and S. Speca
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Pediatrics ,medicine.medical_specialty ,business.industry ,General surgery ,Ultrasound ,Acute abdominal pain ,General Medicine ,medicine.disease ,Intussusception (medical disorder) ,Internal Medicine ,medicine ,Original Article ,Radiology, Nuclear Medicine and imaging ,business - Abstract
The aim of this study was to determine the role of ultrasound in the diagnosis and treatment of pediatric patients with acute abdominal pain caused by intussusceptions.We performed a retrospective study of all pediatric patients with acute abdominal pain caused by intussusceptions and that underwent ultrasound examination at the emergency service of the Radiology Department between November 2007 and June 2013. The role of ultrasonography in the diagnosis of intussusceptions has been assessed by comparing the echographic presumptive diagnosis with the final diagnosis of discharge. Its importance in the treatment has been assessed by determining the value of ultrasound findings in the choice of the best treatment.The ultrasound examination was positive in 16/18 patients with a final diagnosis of intussusception. Some sonographic findings seemed to be able to predict the opportunity to resort to non-surgical therapeutic options like hydrostatic or pneumatic reduction of the intestinal segments invaginated. In our casuistry, five children presented characteristics typical of this subgroup and underwent barium enema which provided the reduction of the intestinal segments involved. The future challenge will be to perform non-surgical ultrasound-guided reductions to avoid the exposure of the infants to ionizing radiations.Ultrasonography is essential not only in the diagnosis, but also it adds important elements in the therapeutic choice and could play in the future an important role in non-surgical reduction of intestinal intussusceptions in pediatric patients.Accertare il ruolo dell'ecografia nella diagnosi e trattamento dei pazienti pediatrici con dolore addominale acuto causato da invaginazione intestinale.Abbiamo eseguito uno studio retrospettivo su tutti i pazienti pediatrici con dolore addominale acuto causato da intussuscezione e sottoposti ad esame ecografico presso il servizio di emergenza del Dipartimento di Radiologia tra il Novembre 2007 ed il Giugno 2013. Il ruolo dell'ecografia nella diagnosi di intussuscezione è stato valutato comparando la diagnosi presuntiva ecografica con la diagnosi finale di dimissione; per ciò che concerne la sua importanza nel trattamento, ci si è basati sull'influenza dei reperti ecografici sul percorso terapeutico.Su 18 pazienti con diagnosi finale di intussuscezione l'esame ecografico è risultato positivo in 16 casi; inoltre è stato possibile osservare che alcuni reperti ecografici sembrano essere in grado di predire l'opportunità di ricorrere ad opzioni terapeutiche non chirurgiche, vale a dire riduzione idrostatica o pneumatica del segmento intestinale invaginato. Nella nostra casistica, 5 bambini hanno presentato caratteristiche tali da rientrare in questo sottogruppo, e pertanto sono stati sottoposti a clisma opaco, tramite cui in 3 casi si è ottenuto lo svaginamento dei segmenti intestinali. La sfida futura sarà sottoporre questo sottogruppo di pazienti a riduzione non chirurgica sotto guida ecografica, evitando così l'esposizione del bambino a radiazioni ionizzanti.l'ecografia risulta fondamentale non solo nella fase diagnostica, ma aggiunge elementi di peso nella decisione terapeutica e potrebbe rivestire, in futuro, un ruolo di primo piano in qualità di guida nella riduzione non chirurgica dell'invaginazione intestinale nel paziente pediatrico.
- Published
- 2014
42. Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features
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Marzia Marino, Lorenzo Bonomo, Valeria Ninivaggi, Marta Iacobucci, Anna Lia Valentini, and Benedetta Gui
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Deep infiltrating endometriosis ,MRI ,Round ligament of the uterus ,Endometriosis ,Female ,Humans ,Magnetic Resonance Imaging ,Pelvis ,Round Ligament of Uterus ,Urology ,Uterosacral ligament ,Uterus ,Rectum ,medicine ,Radiology, Nuclear Medicine and imaging ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Round Ligament ,business.industry ,Pelvic pain ,Gastroenterology ,Magnetic resonance imaging ,General Medicine ,Anatomy ,medicine.disease ,ROUND LIGAMENT MRI ENDOMETRIOSIS ,medicine.anatomical_structure ,Vagina ,medicine.symptom ,business - Abstract
Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images.
- Published
- 2014
43. Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications
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Pier Paolo Grimaldi, Benedetta Gui, Anna Lia Valentini, Maria Giulia Marini, Maura Miccò, Lorenzo Bonomo, Anna Maria Telesca, and Francesco Cambi
- Subjects
medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,medicine.medical_treatment ,Aftercare ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Cervical cancer ,Chemotherapy ,Hysterectomy ,medicine.diagnostic_test ,Radiotherapy ,business.industry ,CT ,MRI ,complications ,gynaecologic cancers ,post-therapy imaging ,Magnetic resonance imaging ,medicine.disease ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Uterine Neoplasms ,Female ,Radiology ,business ,After treatment - Abstract
Uterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.
- Published
- 2016
44. Aging Airways: between Normal and Disease. A Multidimensional Diagnostic Approach by Combining Clinical, Functional, and Imaging Data
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Lorenzo Bonomo, Anna Rita Larici, Mariaelena Occhipinti, and Raffaele Antonelli Incalzi
- Subjects
medicine.medical_specialty ,Pathology ,spirometry ,Multidimensional assessment ,Disease ,Normal aging ,Review ,Imaging data ,030218 nuclear medicine & medical imaging ,Pathology and Forensic Medicine ,Restrictive respiratory disease ,multidimensional approach ,airway disease, aging, computed tomography, imaging, respiratory function tests ,03 medical and health sciences ,0302 clinical medicine ,post-processing imaging techniques ,Medicine ,Respiratory function ,Intensive care medicine ,Lung function ,business.industry ,Cell Biology ,aging airways ,parametric response maps ,030228 respiratory system ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Older people - Abstract
The lack of data on lung function decline in the aging process as well as the lack of gold standards to define obstructive and restrictive respiratory disease in older people point out the need for a multidimensional assessment and interpretation of the aging airways. By integrating clinical data together with morphologic and morphometric findings clinicians can assess the airways with a more comprehensive perspective, helpful in the interpretation of the "grey zone" between normal aging and disease. This review focuses on the value of a multidimensional approach in the study of the aging airways, including clinical findings, respiratory function tests, and imaging as parts of a whole. Nowadays this multidimensional diagnostic approach can be used in daily clinical practice. In next future, it can be implemented by the analysis of exhaled gases, post-processing imaging techniques, and genetic analysis, that will hopefully reduce the gaps in knowledge of normal aging and airway disease in older people.
- Published
- 2016
45. Effect of Needle Size in Ultrasound-guided Core Needle Breast Biopsy: Comparison of 14-, 16-, and 18-Gauge Needles
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Federica Petta, Maurizio Romani, Michela Giuliani, Alba Di Leone, Lorenzo Bonomo, Paolo Belli, Rossella Rella, Antonino Mulè, Enida Bufi, Pierluigi Rinaldi, Gina Fabrizi, and Giorgio Carlino
- Subjects
Core needle ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Core needle breast biopsy ,Breast Neoplasms ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Breast cancer ,Diagnosis ,Ultrasound ,Biopsy ,80 and over ,Medicine ,Humans ,Breast ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Neoadjuvant therapy ,Ultrasonography, Interventional ,Ultrasonography ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Aged ,Retrospective Studies ,Mammary ,Aged, 80 and over ,Interventional ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Prognosis ,Ultrasound guided ,Needle size ,Oncology ,Needles ,030220 oncology & carcinogenesis ,Core needle biopsy ,Female ,Radiology ,Ultrasonography, Mammary ,medicine.symptom ,business ,Follow-Up Studies - Abstract
The aim of the present study was to assess the diagnostic accuracy of ultrasound-guided core needle biopsy (US-CNB) of breast lesions, comparing smaller needles (16- and 18-gauge) with the 14-gauge needle, and to analyze the lesion characteristics influencing US-CNB diagnostic performance.All the patients provided informed consent before the biopsy procedure. The data from breast lesions that had undergone US-CNB in our institution from January 2011 to January 2015 were retrospectively reviewed. The inclusion criterion was the surgical histopathologic examination findings of the entire lesion or radiologic follow-up data for ≥ 24 months. The exclusion criterion was the use of preoperative neoadjuvant therapy. The US-CNB results were compared with the surgical pathologic results or with the follow-up findings in the 3 needle size groups (14-, 16-, and 18-gauge). The needle size- and lesion characteristic-specific diagnostic accuracy parameters were evaluated. Statistical analysis was performed using a dedicated software program, and P ≤ .01 was considered significant.A total of 1118 US-CNB cases (1042 patients) were included. Of the 1118 cases, 630 (56.3%) were in the 14-gauge group, 136 (12.2%) in the 16-gauge, and 352 (31.5%) in the 18-gauge needle group. Surgery was performed on 800 lesions (71.6%). Of these, 619 were malignant, 77 were high risk, and 104 were benign. The remaining 318 lesions (28.4%) underwent follow-up imaging studies. All the lesions were stable and, therefore, were considered benign. No differences were observed in the diagnostic accuracy parameters among the 3 needle size groups (P.01). The false-negative rate was greater for lesions 10 mm (7.2%) (P .01) but without statistically significant differences among the 3 gauges (P.01).US-CNB performed with small needles (16 and 18 gauge) had the same diagnostic accuracy as that performed with 14-gauge needles, regardless of the lesion characteristics.
- Published
- 2016
46. Foot CT perfusion in patients with peripheral arterial occlusive disease (PAOD): A feasibility study
- Author
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Francesco Snider, Lorenzo Bonomo, Roberta Dattesi, Marco Santoro, Giovanni Tinelli, Roberto Iezzi, and M. La Torre
- Subjects
Male ,medicine.medical_specialty ,Perfusion Imaging ,Iomeprol ,Arterial Occlusive Diseases ,Perfusion scanning ,Peripheral Arterial Disease ,chemistry.chemical_compound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Aged, 80 and over ,Reproducibility ,Foot ,business.industry ,Endovascular Procedures ,General Medicine ,Institutional review board ,Peripheral ,Treatment Outcome ,medicine.anatomical_structure ,chemistry ,Feasibility Studies ,PAOD ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,Perfusion ,Foot (unit) ,Artery - Abstract
Purpose To prospectively assess the technical feasibility and reproducibility of quantitative foot perfusion multidetector-row computed tomography (MDCT) in patients with peripheral occlusive artery disease (PAOD) and to evaluate perfusion parameters changes after endovascular treatment. Materials and methods Institutional review board approval and informed patient consent were obtained. 10 patients older than 65 years (mean 74.1 years, range 66–95 years) with PAOD and who were referred to our department for single-limb endovascular treatment were enrolled prospectively. All patients underwent foot CT perfusion examinations before and within 72 h after endovascular treatment. A 64-row CT lightspeed VCT scanner (GE Medical Systems) was used with acquisition of eight contiguous 5-mm reconstructed sections (60-s acquisition time; 40 mL Iomeprol 400 mgI/mL, @4 mL/s). Data were analyzed by two blinded readers using commercially available software to calculate perfusion parameters. Inter-observer and intra-observer agreement of perfusion CT analysis was assessed using Bland–Altman analyses and intra-class correlation coefficient (ICC). Changes in perfusion parameters after endovascular treatment were assessed using Wilcoxon's test. Results Good inter-observer and intra-observer agreement was obtained in all patients. Good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. By comparing perfusion parameters in the treated foot, a significantly shorter mean transit time (MTT) was obtained. Conclusions Foot CT perfusion is a feasible and reproducible technique. A significant decrease of MTT between pre- and post-revascularization suggests improved flow in the below-the-knee arteries.
- Published
- 2013
47. Radiological findings in mammary autologous fat injections: A multi-technique evaluation
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Marzia Salgarello, Giuseppe Visconti, Melania Costantini, Antonio Cipriani, Rita Fubelli, Lorenzo Bonomo, Enida Bufi, and Paolo Belli
- Subjects
Adult ,medicine.medical_specialty ,Mammaplasty ,medicine.medical_treatment ,Transplantation, Autologous ,Breast Diseases ,Breast cancer ,Settore MED/19 - CHIRURGIA PLASTICA ,medicine ,Humans ,Mammography ,Radiology, Nuclear Medicine and imaging ,Fat necrosis ,Prospective Studies ,Prospective cohort study ,Aged ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,medicine.diagnostic_test ,business.industry ,Wide local excision ,Calcinosis ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Transplantation ,Adipose Tissue ,mammary autologous fat injections ,Female ,Ultrasonography, Mammary ,Radiology ,business ,Mastectomy - Abstract
Aim To describe the radiological appearance of normal and pathological findings resulting from mammary autologous fat injections (lipofilling). Materials and methods Informed consent and institutional review board approval were obtained. From January 2008 to December 2010, all patients that had undergone breast lipofilling at our institution (Catholic University) were consecutively enrolled. The site and amount of autologous fat injections were known. Mammography, ultrasonography, and magnetic resonance imaging (MRI) were prospectively obtained preoperatively, and 6 and 12 months after the procedure. Normal and pathological findings were described. Results Twenty-four patients (mean age 50.8 ± 10.5 years; range 26–70 years) were included. Fourteen patients underwent lipofilling after mastectomy, eight after wide local excision, one as a treatment for a congenital asymmetry, and one as a treatment for Poland syndrome. No severe complications were observed after treatment. Normal findings due to lipofilling (“oil cysts”) were identified in 23 cases using ultrasound and in 16 using MRI. Liponecrosis, the most frequently observed complication, was detected in four cases using ultrasound and in eight by MRI. In one case mammography showed calcific fat necrosis. Mean amount of fat injected was 114.8 ± 55 ml. The average amount of fat grafted in patients who developed liponecrosis was 158.4 ± 42.7 versus 104.6 ± 52.3 ml (p = 0.0043, t-test). In one case breast cancer recurrence was diagnosed. Conclusion Normal findings due to lipofilling are better identified by ultrasound, and pathological findings are best identified using MRI. Liponecrosis most frequently occurs when large amounts of fat are injected. In the authors' experience lipofilling does not interfere with breast cancer early diagnosis.
- Published
- 2013
48. Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques
- Author
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J. Reid Spears, Francesco Tricarico, Stefan O. Schoenberg, Young Jun Cho, Anthony M. Hlavacek, John W. Nance, U. Joseph Schoepf, Riccardo Marano, Francesco Secchi, Rozemarijn Vliegenthart, Ullrich Ebersberger, Lorenzo Bonomo, Paul Apfaltrer, Giancarlo Savino, and Cardiovascular Centre (CVC)
- Subjects
Male ,Image quality ,INFANTS ,Coronary Angiography ,Effective dose (radiation) ,Image noise ,Child ,Computed tomography ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Neuroradiology ,Iterative image reconstruction ,medicine.diagnostic_test ,Radiation dose ,Ultrasound ,General Medicine ,TUBE CURRENT MODULATION ,CONGENITAL HEART-DISEASE ,Cardiovascular Diseases ,Child, Preschool ,CHEST ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Tomography ,Radiology ,Algorithms ,medicine.medical_specialty ,Pediatric imaging ,Adolescent ,Iterative reconstruction ,Radiation Dosage ,Sensitivity and Specificity ,CANCER RISKS ,AGE ,Radiation Protection ,PEDIATRIC CT ,medicine ,Humans ,COMPUTED-TOMOGRAPHY ,Radiology, Nuclear Medicine and imaging ,EXPOSURE ,Congenital heart disease ,business.industry ,Infant, Newborn ,Cardiovascular CT angiography ,Infant ,Reproducibility of Results ,ADULTS ,Angiography ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reductions.Forty neonates and children underwent low radiation CTA with or without ECG synchronisation. Data were reconstructed with FBP, IRIS and SAFIRE. For ECG-synchronised studies, half-dose image acquisitions were simulated. Signal noise was measured and IQ graded. Effective dose (ED) was estimated.Mean absolute and relative image noise with IRIS and full-dose SAFIRE was lower than with FBP (P IR improves image noise, SNR, CNR and subjective IQ compared with FBP in low-radiation-dose paediatric CTA and allows further dose reductions without compromising diagnostic IQ.aEuro cent Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children.aEuro cent Using half traditional radiation dose image quality is higher with iterative reconstruction.aEuro cent Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.
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- 2012
49. Can Breast Cancer Biopsy Influence Sentinel Lymph Node Status?
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Maurizio Romani, Michela Giuliani, Pierluigi Rinaldi, Paolo Belli, Damiano Arciuolo, A Infante, Lorenzo Bonomo, Antonino Mulè, Silvia Eleonora Di Giovanni, Federica Patrolecco, and Rossella Rella
- Subjects
0301 basic medicine ,Cancer Research ,Dissemination ,Metastases ,Cell displacement ,Metastasis ,0302 clinical medicine ,Breast ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,education.field_of_study ,medicine.diagnostic_test ,Biopsy, Needle ,Needle size ,medicine.anatomical_structure ,Oncology ,Neoplasm Micrometastasis ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Female ,Radiology ,Ultrasonography, Mammary ,Sentinel Lymph Node ,Breast biopsy ,Image-Guided Biopsy ,medicine.medical_specialty ,Sentinel lymph node ,Population ,Biopsy, Fine-Needle ,Breast Neoplasms ,03 medical and health sciences ,Breast cancer ,Neoplasm Seeding ,Ultrasound ,Biopsy ,Preoperative Care ,medicine ,Humans ,education ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Sentinel Lymph Node Biopsy ,Cancer ,medicine.disease ,Surgery ,Axilla ,030104 developmental biology ,Lymph Node Excision ,Biopsy, Large-Core Needle ,business - Abstract
Introduction We evaluated whether the needle size could influence metastasis occurrence in the axillary sentinel lymph node (SLN) in ultrasound-guided core needle biopsy (US-CNB) of breast cancer (BC). Materials and Methods The data from all patients with breast lesions who had undergone US-CNB at our institution from January 2011 to January 2015 were retrospectively reviewed. A total of 377 BC cases were included using the following criteria: (1) percutaneous biopsy-proven invasive BC; and (2) SLN dissection with histopathologic examination. The patients were divided into 2 groups according to the needle size used: 14 gauge versus 16 or 18 gauge. SLN metastasis classification followed the 7th American Joint Committee on Cancer (2010) TNM pathologic staging factors: macrometastases, micrometastases, isolated tumor cells, or negative. Only macrometastases and micrometastases were considered positive, and the positive and negative rates were calculated for the overall population and for both needle size groups. Results Of the 377 BC cases, 268 US-CNB procedures were performed using a 14-gauge needle and 109 with a 16- or 18-gauge needle, respectively. The negative rate was significantly related statistically with the needle size, with a greater prevalence in the 14-gauge group on both extemporaneous analysis ( P = .019) and definitive analysis ( P = .002). The macrometastasis rate was 17% (63 of 377) for the 14-gauge and 3% (12 of 377) for the 16- and 18-gauge needles, respectively. Conclusion Our preliminary results have suggested that use of a large needle size in CNB does not influence SLN status; thus, preoperative breast biopsy can be considered a safe procedure in the diagnosis of malignant breast lesions.
- Published
- 2016
50. MRI anatomy of parametrial extension to better identify local pathways of disease spread in cervical cancer
- Author
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Marzia Marino, Elena Rodolfino, Maria Antonietta Gambacorta, Marta Iacobucci, Antonia Carla Testa, Lorenzo Bonomo, Benedetta Gui, Anna Lia Valentini, Michela Giuliani, Valeria Ninivaggi, Gian Franco Zannoni, and Maura Miccò
- Subjects
cervical cancer ,medicine.medical_treatment ,Cervical cancer, parametrium anatomy, MRI ,Locally advanced ,Uterine Cervical Neoplasms ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,parametrium anatomy ,Image Interpretation, Computer-Assisted ,Parametrium ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Abdominal Imaging ,Radical surgery ,magnetic resonance imaging ,parametrium ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Cervical cancer ,medicine.diagnostic_test ,business.industry ,Parametrial ,cervical cancer, parametrium ,Magnetic resonance imaging ,Anatomy ,medicine.disease ,Magnetic Resonance Imaging ,cervice uterina, anatomia, parametrio, RM ,Radiation therapy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Disease Progression ,Female ,Peritoneum ,Cardiology and Cardiovascular Medicine ,business ,MRI - Abstract
This paper highlights an updated anatomy of parametrial extension with emphasis on magnetic resonance imaging (MRI) assessment of disease spread in the parametrium in patients with locally advanced cervical cancer. Pelvic landmarks were identified to assess the anterior and posterior extensions of the parametria, besides the lateral extension, as defined in a previous anatomical study. A series of schematic drawings and MRI images are shown to document the anatomical delineation of disease on MRI, which is crucial not only for correct image-based three-dimensional radiotherapy but also for the surgical oncologist, since neoadjuvant chemoradiotherapy followed by radical surgery is emerging in Europe as a valid alternative to standard chemoradiation.
- Published
- 2016
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