P Benussi

Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy

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Publications (7)7.23 Total impact

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    ABSTRACT: PURPOSE: The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. MATERIALS AND METHODS: A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). RESULTS: The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. CONCLUSIONS: MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
    La radiologia medica 06/2012; 117(6):939-952. · 1.46 Impact Factor
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    ABSTRACT: This study was done to compare the parameters of left ventricular (LV) function obtained by multidetector computed tomography coronary angiography (MDCT-CA) using 64-slice equipment with those obtained using twodimensional echocardiography (2D-SE) considered as reference standard. Between April 2008 and September 2009, 116 consecutive patients were studied with both techniques. We analysed the parameters commonly sampled in echocardiography and related them with those retrieved with MDCT-CA: septal thickness, posterior wall thickness, diameter of ascending aorta, diameter and volumes in end-systolic and end-diastolic phase, ejection fraction, stroke volume, cardiac output and heart mass. Good correlation was found measuring septal thickness (r=0.470; p=0.001), and diameters of the ascending aorta. Correlation between systolic and diastolic diameters obtained with the two techniques was good. Poor correlation was attained measuring thickness of the posterior wall (r=0.243; p=0.104). MDCT-CA consistently overestimated the average volumes; diastolic and systolic volumes showed significant correlation (r=0.0456; p= 0.002; r=0.640; p<0.001). Ejection fraction agreement showed a significant correlation (r=0.626; p<0.001). MDCT-CA provides parameters of cardiac function comparable to those found in echocardiography. MDCT-CA although used primarily for coronary noninvasive imaging can provide additional information on ventricular function useful to the diagnostic workup of cardiac patients.
    La radiologia medica 01/2011; 116(4):505-20. · 1.46 Impact Factor
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    ABSTRACT: Anomalies of the coronary arteries are congenital and in most of the cases asymptomatic, although they may present with severe symptoms such as angina pectoris or cardiac arrest. Multidetector CT coronary angiography (MDCT-CA) permits, through curved multiplanar reconstructions and three-dimensional reformatting, noninvasive visualisation of the coronary tree and its variants and anomalies, providing a more accurate alternative to conventional coronary angiography (CCA). The purpose of this pictorial essay is to describe the main variants and anomalies of the coronary arteries using MDCT imaging with multiplanar and three-dimensional reconstructions.
    La radiologia medica 02/2010; 115(5):679-92. · 1.46 Impact Factor
  • Radiologia Medica - RADIOL MED. 01/2010; 115(5):679-692.
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    ABSTRACT: Multidetector-row computed tomography coronary angiography (MDCT-CA) produces high-level radiation dose because of submillimetre slice thickness and short scan time. As a result, manufacturers have produced different dose-saving protocols that may, however, reduce image quality and thus diagnostic accuracy. The aim of our study was to assess the diagnostic quality of MDCT-CA using different dose-saving protocols. Between April and August 2008, we examined 65 patients with 64-slice MDCT-CA: 6/65 using the step-and-shoot dose-saving protocol, 45/65 the cardiac dose right protocol and 14/65 using a standard protocol. Image quality was evaluated on a per-patient and per-segment basis, and the effective dose of each protocol was recorded. In the per-patient analysis, image quality was excellent in 100% of the step-and-shoot protocols, in 91.1% of the cardiac dose right protocols and in 85.8% of the standard protocols. Effective dose to the patient considering the whole study (i.e. scout, calcium score, triggering and MDCT-CA) was 20.49 mSv in the standard protocol, 14.8 mSv in the cardiac dose right protocol and 6.63 mSv in the step-and-shoot protocol. The radiologist should apply the appropriate protocol in relation to the clinical indications, type of patient and information required in order to spare as much dose as possible while maintaining high image quality.
    La radiologia medica 09/2009; 114(8):1196-213. · 1.46 Impact Factor
  • Radiologia Medica - RADIOL MED. 01/2009; 114(8):1196-1213.
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    ABSTRACT: Multidetector computed tomography-coronary angiography allows quantification of coronary stenosis with a high level of accuracy; however, the inherent inaccuracy of visual score still remains. Computed quantitative vessel analysis systems (quantitative computed tomographic angiography [QCTA]) aim to overcome this limitation. The aim of our study was to evaluate the accuracy of QCTA in comparison with quantitative coronary angiography (QCA) and visual score using the QCA. Two operators visually scored 30 consecutive patients referred for multidetector computed tomography-coronary angiography to assess stenotic segments according to a modified 17-segment American Heart Association classification model. Coronary angiography was performed within 1 week. The degree of stenosis was classified as 0%, lower than 20% (wall irregularities), lower than 50% (without significant disease), and higher than 50% (significant disease). Each segment was then analyzed using electronic calipers of the QCTA system. Data were compared with QCA results. Each segment was finally classified as fibrofatty, mixed, and calcified. Comparisons between QCTA results, visual score, and QCA were performed by means of Spearman rank correlation. Interobserver variability is calculated using κ statistics. From a total of 870 segments, 69 were diseased. Interobserver agreement between the 2 operators resulted very high (κ = 0.97). A good correlation was found between visual score and QCA (ρ = 0.932, P < 0.0001) and between visual score and QCTA (ρ = 0.845, P < 0.0001). A moderate correlation was found between QCTA and QCA (ρ = 0.810, P < 0.0001). The accuracy of QCTA is comparable with that of QCA and visual score especially in noncalcified vessels. Editing of the vessel contours in case of calcified vessels is helpful in correctly estimating the right percentage of stenosis.
    Journal of computer assisted tomography 34(5):652-9. · 1.38 Impact Factor