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Martina Perazzolo Marra,
Gaetano Thiene,
Manuel De Lazzari,
Fiorella Calabrese, Carmelo Lacognata,
Stefania Rizzo,
Luisa Cacciavillani,
Francesco Tona,
Francesco Corbetti,
Sabino Iliceto,
Cristina Basso
Circulation 03/2012; 125(12):e499-502. · 14.74 Impact Factor
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Anna Pozza,
Marco Scarpa, Carmelo Lacognata,
Francesco Corbetti,
Claudia Mescoli,
Cesare Ruffolo,
Mauro Frego,
Renata D'Incà,
Romeo Bardini,
Massimo Rugge,
Giacomo Carlo Sturniolo,
Imerio Angriman
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ABSTRACT: Crohn's disease (CD) is a life-long, chronic, relapsing condition requiring often morphological assessment. MR enterography (MRE) offers advantages of not using ionizing radiation and yielding intraluminal and intra-abdominal informations. The aim of our study was to identify how MRE can be useful in planning surgical procedures.
In this retrospective study, 35 patients who underwent MRE and then surgery for CD were enrolled from 2006 to 2010. MRE findings were compared to intraoperative findings. Histology of operative specimens, systemic inflammatory parameters, and fecal lactoferrin were also evaluated. Cohen's κ agreement test, sensitivity and sensibility, uni-/multivariate logistic regression, and non-parametric statistics were performed.
MRE identified bowel stenosis with a sensitivity of 0.95 (95% CI 0.76-0.99) and a specificity of 0.72 (95% CI 0.39-0.92). The concordance of MRE findings with intraoperative findings was high [Cohen's κ = 0.72 (0.16)]. Abscesses were detected at MRE with a sensitivity of 0.92 (95% CI 0.62-0.99) and a specificity of 0.90 (95% CI 0.69-0.98) with a Cohen's κ = 0.82 (0.16). The grade of proximal bowel dilatation resulted to be a significant predictor of the possibility of using strictureplasty instead of/associated to bowel resection either at univariate or at multivariate analysis.
Our study confirmed that MRE findings correlate significantly with disease activity. Detailed information about abscess could suggest percutaneous drainage that could ease the following surgery or avoid emergency laparotomy. Proximal bowel dilatation can suggest the possibility to perform bowel sparing surgery such as strictureplasty.
Journal of Gastrointestinal Surgery 07/2011; 15(10):1689-98. · 2.83 Impact Factor
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Federico Migliore,
Alessandro Zorzi,
Martina Perazzolo Marra,
Cristina Basso,
Francesco Corbetti,
Manuel De Lazzari,
Giuseppe Tarantini,
Paolo Buja, Carmelo Lacognata,
Gaetano Thiene,
Domenico Corrado,
Sabino Iliceto
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ABSTRACT: The Wellens' electrocardiogram (ECG) pattern of dynamic T-wave inversion in the anterior leads is observed in clinical conditions characterized by reversible left ventricular (LV) dysfunction (stunned myocardium), either ischemic or nonischemic. The pathophysiologic basis of this ECG pattern remains to be elucidated.
The purpose of this study was to report the contrast-enhanced cardiac magnetic resonance (CE-CMR) findings in 4 cases of Wellens' ECG pattern associated with transient LV dysfunction from a variety of clinical conditions such as myocardial bridge, coronary artery dissection, cholecystitis, and takotsubo syndrome.
All patients underwent CE-CMR at the time of acute clinical manifestations and after 6 to 8 weeks of follow-up to assess the presence and dynamics of LV myocardial changes.
In all patients, the Wellens' ECG abnormalities were associated with increased signal intensity of the LV myocardium on T2-weighted sequences suggesting myocardial edema, in the absence of late enhancement on postcontrast sequences. Repolarization abnormalities and myocardial edema had a parallel time course with persistence beyond recovery of mechanical abnormalities. T-wave inversion was associated with transient prolongation of the QTc interval in all cases.
The study results suggest that myocardial edema rather than systolic dysfunction underlies the Wellens' ECG pattern, regardless of the causative mechanism.
Heart rhythm: the official journal of the Heart Rhythm Society 05/2011; 8(10):1629-34. · 4.56 Impact Factor
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Martina Perazzolo Marra,
Luisa Cacciavillani,
Francesco Corbetti,
Giuseppe Tarantini,
Angelo Bruno Ramondo,
Massimo Napodano,
Cristina Basso, Carmelo Lacognata,
Armando Marzari,
Francesco Maddalena,
Sabino Iliceto
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ABSTRACT: Percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) is sometimes complicated by microvascular damage and hemorrhage. Hemoglobin degradation products have magnetic susceptibility effects which help in detecting hemorrhagic AMI by T₂ -weighted cardiac magnetic resonance (CMR) images.
To investigate the possibility to detect intramyocardial hemorrhage after AMI and to assess its contribution to the delayed hypoenhanced core on late gadolinium enhancement (LGE) CMR, a feature traditionally referred to as microvascular obstruction.
Consecutive patients with AMI who underwent PCI and CMR were investigated. Hypointense zones T₂ -weighted images were labelled as "hemorrhagic" AMI. Areas of late hypoenhancement on LGE CMR were considered as regions of persistent microvascular damage (PMD). Only transmural AMI were considered.
A total number of 108 transmural AMI patients were eventually enrolled and divided into two groups according to the presence of hypoenhancement on T₂ images. Thirty-two patients showed an hypointense stria within the high signal intensity zone on T₂ -weighted images; all these patients showed midmural PMD on LGE. Among the remaining 76 patients, only 14 (18.4%) showed PMD in the subendocardial region. The angiographic outcome was worse in patients with hemorrhagic AMI, with a lower prevalence of TIMI 3 (65.6% vs. 96.1%, P = 0.017) and higher prevalence of myocardial blush grade 0 (84.4% vs. 13.2%, P < 0.001) post-PCI.
T₂ -weighted CMR in reperfused AMI allows identification of hemorrhage, related to PMD areas on LGE images and to a worse reperfusion profile on angiography. These features open new avenues of investigation for prognostic assessment of reperfused AMI.
Echocardiography 10/2010; 27(9):1120-9. · 1.24 Impact Factor
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Martina Perazzolo Marra,
Francesco Corbetti,
Luisa Cacciavillani,
Giuseppe Tarantini,
Angelo Bruno Ramondo,
Massimo Napodano,
Cristina Basso, Carmelo Lacognata,
Armando Marzari,
Francesco Maddalena,
Sabino Iliceto
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ABSTRACT: Although angiographic perfusion has been traditionally evaluated by myocardial blush grade (MBG), pathophysiologic features underlying different MBG and the persistent blush, traditionally called staining, have been poorly explained. The aim of the study was to evaluate the correlation between MBG and morphologic aspects on cardiac magnetic resonance (CMR).
Myocardial blush grade and morphologic aspects on contrast-enhanced CMR, with special reference to staining phenomenon and persistent microvascular damage (PMD), were evaluated in a consecutive series of patients with acute myocardial infarction (AMI) treated by primary percutaneous coronary intervention.
A total number of 294 AMI patients were enrolled and classified into 2 groups, that is, MBG 0/1 (115, 39%) and MBG 2/3 (179, 61%), according to the angiographic profile. By comparing MBG 0/1 versus MBG 2/3 patients, the former exhibited a larger enzymatic infarct size (P < .001) and a greater infarct size index (P < .001) and PMD (P < .001). In the MBG 0/1 group, a subgroup of 51 patients with staining phenomenon (MBG 0 staining) was also identified, with a worse CMR profile as PMD (P < .001). Multivariate analysis confirmed the strong association between MBG 0/1 and mean number of segments with transmural necrosis (odds ratio 1.62, 95% CI 1.17-2.24, P = .003) and PMD index (odds ratio 3.13, 95% CI 1.19-8.29, P = .021).
In AMI patients treated by primary percutaneous coronary intervention, angiographic parameters of impaired reperfusion correlate with PMD as detected by contrast CMR. Among patients with MBG 0, the presence of the so-called staining phenomenon identifies a subgroup of patients with more severe PMD.
American heart journal 06/2010; 159(6):1124-32. · 4.65 Impact Factor
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Cristina Basso,
Francesco Corbetti,
Caterina Silva,
Aierken Abudureheman, Carmelo Lacognata,
Luisa Cacciavillani,
Giuseppe Tarantini,
Martina Perazzolo Marra,
Angelo Ramondo,
Gaetano Thiene,
Sabino Iliceto
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ABSTRACT: The purposes of this study were to assess the ex vivo cardiovascular magnetic resonance (CMR) signals of pathologically proved hemorrhagic myocardial infarction (MI) and to correlate these with in vivo CMR findings. Late gadolinium hypoenhancement within a hyperenhanced area in reperfused acute MI is ascribed to severe microvascular obstruction. The hearts of 2 patients, who died from cardiogenic shock after acute MIs and who had undergone coronary recanalization and in vivo CMR, were examined by T(2) and T(1) late enhancement sequences as well as by gross and histologic investigation. Four corresponding short-axis slices of each cardiac specimen from the base to the left ventricular apex were selected to assess the extent of MI and hemorrhage and were compared with the in vivo T(2) and late enhancement CMR scans. On pathologic examination, the extent of MI was 57 +/- 30% and 44 +/- 24%, and the extent of hemorrhage was 23 +/- 13% and 19 +/- 8% of the left ventricular area, respectively, showing progressive increases from the base to the apex. The low-signal intensity areas observed by ex vivo T(2) CMR strongly correlated with the hemorrhage quantified on histology (R = 0.93, p = 0.0007). Using ex vivo late gadolinium sequences, bright areas surrounded by thin dark rims, consistent with magnetic susceptibility effects, were detected, corresponding with hemorrhage. On in vivo CMR images, low-signal intensity and hyperintense areas with peripheral susceptibility artifacts were observed within the MI core on T(2) and late gadolinium sequences, respectively. In conclusion, in reperfused MI, CMR hypointense T(2) signal and susceptibility effects within the late gadolinium hypoenhanced areas are consistent with interstitial hemorrhage due to irreversible vascular injury, as proved by pathologic study.
The American Journal of Cardiology 11/2007; 100(8):1322-7. · 3.37 Impact Factor
