European review for medical and pharmacological sciences, 2016
OBJECTIVE To evaluate the diagnostic performance of unenhanced MRI (UE-MRI) for malignant breast ... more OBJECTIVE To evaluate the diagnostic performance of unenhanced MRI (UE-MRI) for malignant breast lesions and its reproducibility. PATIENTS AND METHODS We retrospectively included 118 patients who had breast MRI. DWI and STIR images were read in combination and referred to as UE-MRI; the presence or absence of the malignant lesion was noted by two observers. Their results were compared with those of final histopathology or with a two-year negative follow-up for diagnostic performance assessment; ROC curves were built. Diagnostic performance was stratified according to lesion site and size. Interobserver agreement was evaluated through the Cohen's k statistic. RESULTS Specificity of STIR and DWI was 99.3% and 95.7% for Reader 1; 99.3% and 96.4% for Reader 2. Sensitivity was 76.5% and 76.5% for Reader 1; 77.5% and 77.6% for Reader 2. The ROC AUC (Reader 1) was 0.869 and 0.844 for STIR and DWI, respectively (p<0.001 both); for Reader 2, values were 0.874 and 0.853 respectively (p...
Purpose We performed a first-in-human clinical trial on ultrasound molecular imaging (USMI) in pa... more 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 underwen...
European review for medical and pharmacological sciences, 2015
In breast augmentation surgery, breast symmetry depends on the breast tissue, implants and chest ... more In breast augmentation surgery, breast symmetry depends on the breast tissue, implants and chest wall. Any asymmetry of the anterior thoracic wall can influence the breast shape. If breast asymmetry is detected in the preoperative evaluation, a chest wall deformity should be suspected. Until now, very few reports describe the use of MRI to objectively assess breast and chest measurements with the aim of providing customized augmentation. This study describes the use of MRI to evaluate breast and chest wall asymmetry, and considers the feasibility of preoperative measurements which are useful for performing an objective preoperative evaluation. Between April 2012 and February 2013, 13 patients underwent chest/breast MRI scan. Scans were performed on a 1.5 T scanner using a single T1 FSE non-suppressed axial sequence, without contrast administration. Acquisitions included the breast and chest wall. Specific measurements were obtained to assess the overall shape of the chest wall and b...
To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CT... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), while SNR and CNR were higher (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv. 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. • Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children. • Using half traditional radiation dose image quality is higher with iterative reconstruction. • Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.
To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) u... more To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) and to estimate the potential for radiation dose savings. Sixty five consecutive patients (48 men; 59.3 ± 7.7 years) prospectively underwent cCTA and coronary catheter angiography (CCA). Full radiation dose data, using all projections, were reconstructed with FBP. To simulate image acquisition at half the radiation dose, 50% of the projections were discarded from the raw data. The resulting half-dose data were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Full-dose FBP and half-dose iterative reconstructions were compared with regard to image noise and image quality, and their respective accuracy for stenosis detection was compared against CCA. Compared with full-dose FBP, half-dose iterative reconstructions showed significantly (p = 0.001 - p = 0.025) lower image noise and slightly higher image quality. Iterative reconstruction improved the accuracy of stenosis detection compared with FBP (per-patient: accuracy 96.9% vs. 93.8%, sensitivity 100% vs. 100%, specificity 94.6% vs. 89.2%, NPV 100% vs. 100%, PPV 93.3% vs. 87.5%). Iterative reconstruction significantly reduces image noise without loss of diagnostic information and holds the potential for substantial radiation dose reduction from cCTA.
This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the ye... more This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.
A pulmonary nodule is a frequent and often incidental finding, and still represents a diagnostic ... more A pulmonary nodule is a frequent and often incidental finding, and still represents a diagnostic challenge for radiologists. Although most solitary nodules are related to benign disease, some represent stage I lung cancers. and need to be distinguished from benign nodules in a cost-effective manner. The aim of diagnostic assessment should be to allow early treatment of small malignant nodules but avoid unnecessary biopsy or surgery, with their attendant risks, in patients with benign disease. The advent of Multislice Computed Tomography (MSCT) technology has sparked new interest in the non-invasive assessment of pulmonary nodules. Thanks to its ability to scan the whole thoracic volume with thinner collimations, this technology allows a more accurate identification and characterisation of pulmonary nodules, as well as the determination of perfusion patterns and growth rates. In this paper we present an algorithm for the diagnostic workup of incidentally detected small pulmonary nodu...
L’embolizzazione delle arterie uterine e una procedura radiologica minimamente invasiva sempre pi... more L’embolizzazione delle arterie uterine e una procedura radiologica minimamente invasiva sempre piu spesso utilizzata come alternativa all’isterectomia ed alla miomectomia per il trattamento dei fibromi uterini sintomatici. Ampie casistiche internazionali e studi clinici randomizzati hanno dimostrato che questa procedura ha una bassa morbilita ed una efficacia clinica paragonabile a quella delle terapie chirurgiche convenzionali. Inoltre, analisi economiche della letteratura internazionale hanno documentato minori costi ospedalieri ed un rapporto costo/efficacia piu favorevole per l’embolizzazione rispetto all’isterectomia ed alla miomectomia. Poiche non esistono, a tutt’oggi, dati economici comparativi relativi al contesto socio-sanitario italiano, ci e sembrato utile valutare i costi ospedalieri e sociali dell’embolizzazione e confrontarli con quelli dell’isterectomia e della miomectomia effettuate per via laparotomica. Abbiamo calcolato retrospettivamente i costi ospedalieri (dire...
European review for medical and pharmacological sciences, 2015
Incidence of intrahepatic mass-forming cholangiocarcinoma (IMCC) is increasing worldwide, especia... more Incidence of intrahepatic mass-forming cholangiocarcinoma (IMCC) is increasing worldwide, especially in patients with chronic liver disease. The small and the histologically well-differentiated IMCCs in chronic liver disease could be arterially hypervascular lesions with/without washout on computed tomography (CT) and magnetic resonance imaging (MRI), mimicking typical hepatocellular carcinoma (HCC). The aim of this work is to evaluate contrast enhancement (CE) patterns of IMCCs at quadri-phasic multidetector CT (4-MDCT) and MRI, using imaging-clinicopathologic correlation. The 4-MDCT and MR images of 56 histologically confirmed IMCCs were retrospectively evaluated for tumor morphology and enhancement features. Enhancement pattern was defined according to the behavior of the nodule in arterial (AP), portal venous (PVP) and equilibrium phases (EP), and dynamic pattern was described according to enhancement progression throughout the different phases. Arterial and dynamic enhancement ...
The aims of this study were to investigate the added value of diffusion-weighted imaging (DWI) in... more The aims of this study were to investigate the added value of diffusion-weighted imaging (DWI) in pancreatic neuroendocrine tumor (pNET) evaluation and to compare magnetic resonance imaging (MRI) to Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) results. Morphological MRI (T2-weighted [T2-w] + contrast-enhanced [CE] T1-w) and DWI (T2-w + DWI) and Ga-DOTANOC PET/CT in 25 patients/30 pNETs were retrospectively evaluated. Per-patient and per-lesion detection rates (pDR and lDR, respectively) were calculated. Apparent diffusion coefficient values were compared among pNET and surrounding and normal pancreas (control group, 18 patients). Apparent diffusion coefficient and standardized uptake value (SUV) values were compared among different grading and staging groups. No statistically significant differences in PET/CT and MRI session detection rates were found (morphological MRI and DW-MRI, 88% pDR and 87% lDR; combined evaluation, 92% pDR and 90% lDR; Ga-DOTANOC PET/CT, 88% pDR and 80% lDR). Consensus reading (morphological/DW-MRI + PET/CT) improved pDR and lDR (100%). Apparent diffusion coefficient mean value was significantly lower compared with surrounding and normal parenchyma (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The apparent diffusion coefficient and SUV values of pNETs among different grading and staging groups were not statistically different. Conventional MRI, DW-MRI + T2-w sequences, and Ga-DOTANOC PET/CT can be alternative tools in pNET detection. Diffusion-weighted MRI could be valuable in patients with clinical suspicion but negative conventional imaging findings. However, the consensus reading of the 3 techniques seems the best approach.
This study was undertaken to determine the accuracy of magnetic resonance (MR) imaging in the pre... more This study was undertaken to determine the accuracy of magnetic resonance (MR) imaging in the preoperative staging of patients with clinically localised cervical cancer eligible for less extensive surgery. Fifty-three patients with biopsy-proven carcinoma of the uterine cervix and eligible for conservative surgery prospectively underwent MR imaging. Images were assessed for tumour site and size, infiltration of the cervical stroma, infiltration of vaginal fornices and relationship between the tumour and the internal os of the endocervical canal and the presence and dimensions of pelvic and lumboaortic lymph nodes (cutoff values 1 cm and 0.5 cm minimum axial diameter). MR imaging data were compared with the histopathological findings. The endocervix was the site of origin of 25% (13/53) of the cervical tumours and the exocervix the site of origin of 75% (40/53). In the assessment of cervical stroma infiltration, there was agreement between MR imaging and histopathology in 75% of case...
Resume L’imagerie medicale est devenue est un des secteurs principal du systeme de soins mais le ... more Resume L’imagerie medicale est devenue est un des secteurs principal du systeme de soins mais le manque d’une classification europeenne radiologique communement acceptee est aujourd’hui un handicap. Le principal objectif de l’ERDDS est de definir une classification radiologique europeenne de reference, qu’elle soit medicale ou administrative. Les retombees attendues sont les suivantes :- En rendant disponible cette classification, il sera possible de standardiser les indicateurs de performances, et d’effectuer ainsi des comparaisons (benchmarking).- Une telle classification devrait servir de base pour les RIS (approche multilingue)- D’une maniere generale toute les procedures basees sur les teletransmissions devraient tirer profit d’une telle classification. Dans ce projet, sont impliquees les societes italienne, espagnole, francaise et tcheque de radiologie ainsi qu’un certain nombre de sites radiologiques europeens.
European review for medical and pharmacological sciences, 2016
OBJECTIVE To evaluate the diagnostic performance of unenhanced MRI (UE-MRI) for malignant breast ... more OBJECTIVE To evaluate the diagnostic performance of unenhanced MRI (UE-MRI) for malignant breast lesions and its reproducibility. PATIENTS AND METHODS We retrospectively included 118 patients who had breast MRI. DWI and STIR images were read in combination and referred to as UE-MRI; the presence or absence of the malignant lesion was noted by two observers. Their results were compared with those of final histopathology or with a two-year negative follow-up for diagnostic performance assessment; ROC curves were built. Diagnostic performance was stratified according to lesion site and size. Interobserver agreement was evaluated through the Cohen's k statistic. RESULTS Specificity of STIR and DWI was 99.3% and 95.7% for Reader 1; 99.3% and 96.4% for Reader 2. Sensitivity was 76.5% and 76.5% for Reader 1; 77.5% and 77.6% for Reader 2. The ROC AUC (Reader 1) was 0.869 and 0.844 for STIR and DWI, respectively (p<0.001 both); for Reader 2, values were 0.874 and 0.853 respectively (p...
Purpose We performed a first-in-human clinical trial on ultrasound molecular imaging (USMI) in pa... more 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 underwen...
European review for medical and pharmacological sciences, 2015
In breast augmentation surgery, breast symmetry depends on the breast tissue, implants and chest ... more In breast augmentation surgery, breast symmetry depends on the breast tissue, implants and chest wall. Any asymmetry of the anterior thoracic wall can influence the breast shape. If breast asymmetry is detected in the preoperative evaluation, a chest wall deformity should be suspected. Until now, very few reports describe the use of MRI to objectively assess breast and chest measurements with the aim of providing customized augmentation. This study describes the use of MRI to evaluate breast and chest wall asymmetry, and considers the feasibility of preoperative measurements which are useful for performing an objective preoperative evaluation. Between April 2012 and February 2013, 13 patients underwent chest/breast MRI scan. Scans were performed on a 1.5 T scanner using a single T1 FSE non-suppressed axial sequence, without contrast administration. Acquisitions included the breast and chest wall. Specific measurements were obtained to assess the overall shape of the chest wall and b...
To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CT... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), while SNR and CNR were higher (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv. 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. • Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children. • Using half traditional radiation dose image quality is higher with iterative reconstruction. • Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.
To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) u... more To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) and to estimate the potential for radiation dose savings. Sixty five consecutive patients (48 men; 59.3 ± 7.7 years) prospectively underwent cCTA and coronary catheter angiography (CCA). Full radiation dose data, using all projections, were reconstructed with FBP. To simulate image acquisition at half the radiation dose, 50% of the projections were discarded from the raw data. The resulting half-dose data were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Full-dose FBP and half-dose iterative reconstructions were compared with regard to image noise and image quality, and their respective accuracy for stenosis detection was compared against CCA. Compared with full-dose FBP, half-dose iterative reconstructions showed significantly (p = 0.001 - p = 0.025) lower image noise and slightly higher image quality. Iterative reconstruction improved the accuracy of stenosis detection compared with FBP (per-patient: accuracy 96.9% vs. 93.8%, sensitivity 100% vs. 100%, specificity 94.6% vs. 89.2%, NPV 100% vs. 100%, PPV 93.3% vs. 87.5%). Iterative reconstruction significantly reduces image noise without loss of diagnostic information and holds the potential for substantial radiation dose reduction from cCTA.
This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the ye... more This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.
A pulmonary nodule is a frequent and often incidental finding, and still represents a diagnostic ... more A pulmonary nodule is a frequent and often incidental finding, and still represents a diagnostic challenge for radiologists. Although most solitary nodules are related to benign disease, some represent stage I lung cancers. and need to be distinguished from benign nodules in a cost-effective manner. The aim of diagnostic assessment should be to allow early treatment of small malignant nodules but avoid unnecessary biopsy or surgery, with their attendant risks, in patients with benign disease. The advent of Multislice Computed Tomography (MSCT) technology has sparked new interest in the non-invasive assessment of pulmonary nodules. Thanks to its ability to scan the whole thoracic volume with thinner collimations, this technology allows a more accurate identification and characterisation of pulmonary nodules, as well as the determination of perfusion patterns and growth rates. In this paper we present an algorithm for the diagnostic workup of incidentally detected small pulmonary nodu...
L’embolizzazione delle arterie uterine e una procedura radiologica minimamente invasiva sempre pi... more L’embolizzazione delle arterie uterine e una procedura radiologica minimamente invasiva sempre piu spesso utilizzata come alternativa all’isterectomia ed alla miomectomia per il trattamento dei fibromi uterini sintomatici. Ampie casistiche internazionali e studi clinici randomizzati hanno dimostrato che questa procedura ha una bassa morbilita ed una efficacia clinica paragonabile a quella delle terapie chirurgiche convenzionali. Inoltre, analisi economiche della letteratura internazionale hanno documentato minori costi ospedalieri ed un rapporto costo/efficacia piu favorevole per l’embolizzazione rispetto all’isterectomia ed alla miomectomia. Poiche non esistono, a tutt’oggi, dati economici comparativi relativi al contesto socio-sanitario italiano, ci e sembrato utile valutare i costi ospedalieri e sociali dell’embolizzazione e confrontarli con quelli dell’isterectomia e della miomectomia effettuate per via laparotomica. Abbiamo calcolato retrospettivamente i costi ospedalieri (dire...
European review for medical and pharmacological sciences, 2015
Incidence of intrahepatic mass-forming cholangiocarcinoma (IMCC) is increasing worldwide, especia... more Incidence of intrahepatic mass-forming cholangiocarcinoma (IMCC) is increasing worldwide, especially in patients with chronic liver disease. The small and the histologically well-differentiated IMCCs in chronic liver disease could be arterially hypervascular lesions with/without washout on computed tomography (CT) and magnetic resonance imaging (MRI), mimicking typical hepatocellular carcinoma (HCC). The aim of this work is to evaluate contrast enhancement (CE) patterns of IMCCs at quadri-phasic multidetector CT (4-MDCT) and MRI, using imaging-clinicopathologic correlation. The 4-MDCT and MR images of 56 histologically confirmed IMCCs were retrospectively evaluated for tumor morphology and enhancement features. Enhancement pattern was defined according to the behavior of the nodule in arterial (AP), portal venous (PVP) and equilibrium phases (EP), and dynamic pattern was described according to enhancement progression throughout the different phases. Arterial and dynamic enhancement ...
The aims of this study were to investigate the added value of diffusion-weighted imaging (DWI) in... more The aims of this study were to investigate the added value of diffusion-weighted imaging (DWI) in pancreatic neuroendocrine tumor (pNET) evaluation and to compare magnetic resonance imaging (MRI) to Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) results. Morphological MRI (T2-weighted [T2-w] + contrast-enhanced [CE] T1-w) and DWI (T2-w + DWI) and Ga-DOTANOC PET/CT in 25 patients/30 pNETs were retrospectively evaluated. Per-patient and per-lesion detection rates (pDR and lDR, respectively) were calculated. Apparent diffusion coefficient values were compared among pNET and surrounding and normal pancreas (control group, 18 patients). Apparent diffusion coefficient and standardized uptake value (SUV) values were compared among different grading and staging groups. No statistically significant differences in PET/CT and MRI session detection rates were found (morphological MRI and DW-MRI, 88% pDR and 87% lDR; combined evaluation, 92% pDR and 90% lDR; Ga-DOTANOC PET/CT, 88% pDR and 80% lDR). Consensus reading (morphological/DW-MRI + PET/CT) improved pDR and lDR (100%). Apparent diffusion coefficient mean value was significantly lower compared with surrounding and normal parenchyma (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The apparent diffusion coefficient and SUV values of pNETs among different grading and staging groups were not statistically different. Conventional MRI, DW-MRI + T2-w sequences, and Ga-DOTANOC PET/CT can be alternative tools in pNET detection. Diffusion-weighted MRI could be valuable in patients with clinical suspicion but negative conventional imaging findings. However, the consensus reading of the 3 techniques seems the best approach.
This study was undertaken to determine the accuracy of magnetic resonance (MR) imaging in the pre... more This study was undertaken to determine the accuracy of magnetic resonance (MR) imaging in the preoperative staging of patients with clinically localised cervical cancer eligible for less extensive surgery. Fifty-three patients with biopsy-proven carcinoma of the uterine cervix and eligible for conservative surgery prospectively underwent MR imaging. Images were assessed for tumour site and size, infiltration of the cervical stroma, infiltration of vaginal fornices and relationship between the tumour and the internal os of the endocervical canal and the presence and dimensions of pelvic and lumboaortic lymph nodes (cutoff values 1 cm and 0.5 cm minimum axial diameter). MR imaging data were compared with the histopathological findings. The endocervix was the site of origin of 25% (13/53) of the cervical tumours and the exocervix the site of origin of 75% (40/53). In the assessment of cervical stroma infiltration, there was agreement between MR imaging and histopathology in 75% of case...
Resume L’imagerie medicale est devenue est un des secteurs principal du systeme de soins mais le ... more Resume L’imagerie medicale est devenue est un des secteurs principal du systeme de soins mais le manque d’une classification europeenne radiologique communement acceptee est aujourd’hui un handicap. Le principal objectif de l’ERDDS est de definir une classification radiologique europeenne de reference, qu’elle soit medicale ou administrative. Les retombees attendues sont les suivantes :- En rendant disponible cette classification, il sera possible de standardiser les indicateurs de performances, et d’effectuer ainsi des comparaisons (benchmarking).- Une telle classification devrait servir de base pour les RIS (approche multilingue)- D’une maniere generale toute les procedures basees sur les teletransmissions devraient tirer profit d’une telle classification. Dans ce projet, sont impliquees les societes italienne, espagnole, francaise et tcheque de radiologie ainsi qu’un certain nombre de sites radiologiques europeens.
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