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ABSTRACT: The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease.
145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n = 75) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n = 70). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel follow-through examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by χ² testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient.
Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p<0.05: statistically significant difference). No significant difference was present for others sites (p>0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv).
PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.
The British journal of radiology 10/2010; 84(998):112-9. · 2.11 Impact Factor
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ABSTRACT: This study was done to evaluate the diagnostic role of enteroclysis with multidetector computed tomography (MDCT) and single-detector CT (SDCT) in patients affected by small-bowel Crohn's disease.
Forty-five patients underwent abdominal SDCT (n=20) or 16-row MDCT (n=25) after administration of methylcellulose by nasojejunal tube. Each examination was assessed for small-bowel distension and site and characteristics of the diseased loops. The two CT techniques were then compared. Results were compared with double-contrast enteroclysis performed in all patients and with ileoscopy performed in 28 patients.
In comparison with double-contrast enteroclysis, sensitivity, specificity and diagnostic accuracy were 90%, 71% and 89% for SDCT and 92%, 83% and 90% for MDCT. Ileoscopy confirmed the absence of disease in five patients and the presence of Crohn's disease in 20. Compared with SDCT, MDCT reduced scanning time and respiratory artefacts and permitted better multiplanar reconstructions.
MDCT is superior to SDCT because it allows a better spatial resolution and improves depiction of the pathological patterns of Crohn's disease.
La radiologia medica 01/2008; 112(8):1188-200. · 1.44 Impact Factor
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ABSTRACT: PurposeThis study was done to evaluate the diagnostic role of enteroclysis with multidetector computed tomography (MDCT) and single-detector
CT (SDCT) in patients affected by small-bowel Crohn’s disease.
Materials and methodsForty-five patients underwent abdominal SDCT (n=20) or 16-row MDCT (n=25) after administration of methylcellulose by nasojejunal
tube. Each examination was assessed for small-bowel distension and site and characteristics of the diseased loops. The two
CT techniques were then compared. Results were compared with double-contrast enteroclysis performed in all patients and with
ileoscopy performed in 28 patients.
ResultsIn comparison with double-contrast enteroclysis, sensitivity, specificity and diagnostic accuracy were 90%, 71% and 89% for
SDCT and 92%, 83% and 90% for MDCT. Ileoscopy confirmed the absence of disease in five patients and the presence of Crohn’s
disease in 20. Compared with SDCT, MDCT reduced scanning time and respiratory artefacts and permitted better multiplanar reconstructions.
ConclusionsMDCT is superior to SDCT because it allows a better spatial resolution and improves depiction of the pathological patterns
of Crohn’s disease.
ObiettivoValutare il ruolo diagnostico dell’enteroclisi-TC multidetettore (TCMD) e singolo detettore (TCSD) in pazienti con morbo di
Crohn dell’intestino tenue.
Materiali e metodiQuarantacinque pazienti sono stati sottoposti ad enteroclisi-TC a singolo detettore (n=20) o multidetettore (n=25) previa
somministrazione di metilcellulosa tramite sondino naso-digiunale. Abbiamo valutato grado di distensione delle anse, sede
e caratteristiche delle anse patologiche, ed abbiamo messo a confronto le due tecniche. I risultati sono stati confrontati
con quelli del clisma del tenue in tutti i pazienti, con l’ileoscopia in 28.
RisultatiConfrontando i dati TC con quelli del clisma del tenue, abbiamo riscontrato valori di sensibilità, specificità ed accuratezza
diagnostica rispettivamente del 90%, 71% e 89% con la TCSD e del 92, 83 e 90% con la TCMD. L’ileoscopia ha confermato i reperti
di normalità in 5 pazienti e un morbo di Crohn in 20. La TCMD è risultata superiore alla TCSD poiché ha permesso di ottenere
una riduzione dei tempi di esecuzione, meno artefatti respiratori e ricostruzione multiplanari di migliore qualità rispetto
alla TCSD.
ConclusioniLa TCMD è da preferire alla TCSD per la sua migliore risoluzione spaziale e perché consente una migliore rappresentazione
dei segni patologici di malattia di Crohn.
La radiologia medica 11/2007; 112(8):1188-1200. · 1.44 Impact Factor
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ABSTRACT: The aim of this study was to assess the diagnostic potential of multidetector computed tomography (MDCT) in the evaluation of small-bowel neoplasms.
We studied 120 patients with suspected small-bowel disease by 16-slice MDCT after oral administration of a polyethylene glycol solution (n=56) or methylcellulose via a nasojejunal tube (n=64). Unenhanced and contrast-enhanced CT was performed. Contrast-enhanced CT images were acquired 40 s after IV injection of 130 ml of iodinated contrast agent at a rate of 3 ml/s. Multiplanar reconstructions were performed at the end of the examinations.
Fifteen patients were found to be affected by small-bowel neoplasm (six had non-Hodgkin's lymphoma, three had carcinoid tumour, two had Peutz-Jeghers syndrome, two had adenocarcinoma, two had melanoma metastases, one had lipoma). In the remaining patients, 58 cases of Crohn's disease and seven miscellaneous diseases were detected. All findings were confirmed by barium studies, surgery or endoscopy.
MDCT performed after bowel-loop distension with low-density contrast material and IV administration of iodinated contrast agent is a reliable method for diagnosing and staging small-bowel neoplasms.
La radiologia medica 11/2007; 112(7):1013-25. · 1.44 Impact Factor
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ABSTRACT: To verify the diagnostic accuracy of per oral pneumocolon in the identification of both normal and pathological patterns in patients with suspected or proven small bowel disease.
Per oral pneumocolon was performed after small bowel follow-through examinations in a series of 42 selected patients. The terminal ileum visibility, the loop location and possible pathological patterns were evaluated separately before and after insufflation. In post-insufflation images the presence/absence of reflux and grade of reflux were evaluated.
The diagnostic quality of per oral pneumocolon as compared with per oral small bowel examination was superior in 23 of the 42 patients (54.8%; group 1), similar in nine of the 42 (21.4%; group 2), and inferior in 10 of the 42 (23.8%; group 3). Transvalvular reflux was present in 22 of 23 (95.6%) patients from group 1 and only in one of 10 patients (10%) from group 3 (p<0.001: statistically significant difference). Among the 24 of 42 (57.1%) patients with suspected or proven Crohn's disease, per oral pneumocolon increased the confidence with which the ileum was considered normal in 12 patients and it allowed a better evaluation of the disease extent and the differentiation between prolonged spasms and stenosis in five patients.
In conclusion per oral pneumocolon should be performed after a small bowel follow-through examination in selected patients.
Clinical Radiology 01/2007; 61(12):1016-22. · 1.95 Impact Factor
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American Journal of Roentgenology 04/2004; 182(3):828-9. · 2.78 Impact Factor
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ABSTRACT: To evaluate the usefulness of magnetic resonance (MR) cholangiopancreatography (MRCP) before and after secretin administration in diagnosing santorinicele in patients with pancreas divisum.
One hundred seven patients suspected of having pancreatic disease underwent MRCP before and after secretin administration (S-MRCP). S-MRCP images were evaluated for pancreas divisum and santorinicele and for size of the main pancreatic duct and santorinicele. The onset of duodenal filling was calculated on dynamic S-MRCP images.
Pancreas divisum was detected in five (5%) of 107 patients at MRCP and in 10 (9%) of 107 patients at S-MRCP. Santorinicele was detected in three (21%) of 14 patients at MRCP and in an additional four (seven [50%] of 14) patients at S-MRCP in patients with pancreas divisum. Santorinicele was confirmed in six of seven patients at endoscopic retrograde cholangiopancreatography (ERCP); in one of seven patients, ERCP was unsuccessful. The duct of Santorini was significantly (P: <.05) larger in the pancreatic head in patients with pancreas divisum and santorinicele (3.6 mm) compared with those with only pancreas divisum (2.2 mm). A noteworthy reduction in size of the pancreatic duct (26%) and of the santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was delayed significantly in patients with santorinicele (2.1 vs 1.3 minutes; P: <.05).
S-MRCP helps in identifying pancreas divisum and santorinicele, which may be the cause of impeded pancreatic outflow.
Radiology 11/2000; 217(2):403-8. · 5.73 Impact Factor
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ABSTRACT: To assess whether secretin stimulation improves visualization of the pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP) in patients with severe chronic pancreatitis or suspected pancreatic disease.
Thirty-one patients (group 1) with chronic pancreatitis and 84 patients (group 2) with clinical and/or laboratory findings suggestive of pancreatic disease who did not have ductal alterations at ultrasonography (US) and/or computed tomography (CT) underwent MRCP before and up to 10 minutes after secretin stimulation. Size of the main pancreatic duct (head, body, tail) and duodenal filling before and after secretin stimulation were measured quantitatively. Image quality, number of main pancreatic ductal segments visualized, visualization of side branches, ductal narrowing, endoluminal filling defects, and presence of pancreas divisum were analyzed qualitatively.
In both groups, the size of the main pancreatic duct increased significantly 3 minutes after secretin stimulation. Reduced duodenal filling was detected in patients with severe chronic pancreatitis (P < .001). The number of segments of the main pancreatic duct visualized improved from 85 (91%) to 93 (100%) of 93 in group 1 and from 164 (65%) to 245 (97%) of 252 (P < .001) in group 2. Visualization of side branches improved from 22 (71%) to 31 (100%) of 31 in group 1 and from three (4%) to 53 (63%) of 84 (P < .001) in group 2. Pancreas divisum was visualized in one additional patient in group 1 and in six additional patients in group 2.
The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of exocrine reserve.
Radiology 03/2000; 214(3):849-55. · 5.73 Impact Factor
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ABSTRACT: Magnetic Resonance pancreatography (MRP) was performed before and after the intravenous injection of secretin to assess the improvement in pancreatic duct visualization and to perform a dynamic study of the pancreatic exocrine function.
20 MRP examinations were performed in 18 patients with suspected or known chronic pancreatitis. Coronal T2-weighted half-Fourier SSFSE images were obtained with a phased array surface coil. Images were obtained before and up to 10 minutes after the injection of 1 cu/kg b.w. secretin. Quantitative image analysis included main pancreatic duct enlargement over time after secretin injection and the amount of duodenal filling. Qualitative image analysis included: overall image quality improvement, number of pancreatic duct segments visualized, secondary ducts dilation, intraductal filling defects, the presence of pancreas divisum.
After secretin injection the overall image quality was judged sufficient in 2 patients and satisfactory in 18 patients. The number of pancreatic duct segments visualized increased from 40/57 (79%) to 57/57 (100%); secondary ducts were visualized in 4 patients before secretin compared to 18 after secretin. The number of stenosis visualized increased from 6 to 9, while intraluminal filling defects increased from 2 to 6. Pancreas divisum was detected in 2 patients after secretin versus 0 before secretin. The main pancreatic duct enlargement was statistically significant in the head of the pancreas (p < .05). Duodenal filling was normal in 13 patients and decreased in 7.
Secretin injection extends the capabilities of MRP in visualizing the morphologic features of pancreatic ducts. The depiction of pancreatic ducts, stenosis, filling defects and pancreas divisum was improved after secretin injection. The exocrine function of the pancreas can be evaluated analyzing the entity and the timing of the duodenal filling.
La radiologia medica 10/1998; 96(3):226-31. · 1.44 Impact Factor
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ABSTRACT: The diagnosis and treatment of pancreatic ductal carcinoma are managed, in our hospital, by a team of radiologist, surgeons, radiotherapists and pathologists. In periodic meetings they discuss the clinical cases before and after clinico-radiologic staging. Patients are entered one of three different treatment routes, based on their general status, on disease stage, tumor size and its arrangement around common bile duct and main pancreatic duct. Thirty-eight patients were studied: 23 of them, considered as resectable on the basis of imaging (CT, US) findings, were submitted to radical surgery and intraoperative radiotherapy (route I); of 11 unresectable cases, 8 had a bilio-digestive bypass and interstitial brachitherapy with 125I seeds (tumor size < 3 cm). Eleven patients unresectable by imaging and 1 by surgery followed treatment route II, characterized by radio-chemotherapy followed by intraluminal radiotherapy with 192Ir wires, relative to residual tumor size and to lesion arrangement around access ways. Four patients with metastases and "adequate" tumor size entered treatment route III-i.e., merely palliative luminal radiotherapy. This preliminary note stresses the importance of polyspecialistic team work in the diagnosis and treatment of pancreatic ductal carcinomas.
La radiologia medica 05/1993; 85(5):615-24. · 1.44 Impact Factor
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ABSTRACT: The normal and pathological US features of different types of bilioenterostomy (hepaticojejunostomy, choledochoduodenostomy, polyductal bilioenteric anastomosis) are described, as observed in a prospective study of 27 patients, for a total number of 35 (18 normal and 17 abnormal) examinations. For 20 patients with hepaticojejunostomy, the bilioenteric anastomosis was identified on 13/13 normal examinations and 10/12 pathological examinations. For 2 patients with choledochoduodenostomy, the bilioenteric anastomosis was identified on 2/2 examinations. For 5 patients with polyductal bilioenteric anastomosis (each patient having 2 or 3 anastomoses), all surgical anastomoses were separately identified on 6/8 examinations; as for the remaining 2 patients, 2/3 and 1/3 anastomoses were seen. An abnormal condition was correctly recognized in all the 11 patients with local disease (lithiasis and benign biliary stricture, 2 patients; benign biliary stricture, 5 patients; primary cholangiocarcinoma, 1 patient; recurrent malignancy, 3 patients); in 1 patient, parenchymal and biliary abnormalities due to vascular obstruction were misinterpreted as a result of benign stricture. US can demonstrate the surgical anastomoses between the resected common bile duct or second order intrahepatic ducts and the jejunal loop, with typical features according to the type of surgery performed. Knowledge of such normal appearances after bilioenteric surgery is mandatory in order to detect and correctly evaluate such possible abnormalities at this site as lithiasis and benign or malignant strictures.
La radiologia medica 10/1992; 84(3):252-60. · 1.44 Impact Factor
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ABSTRACT: In our University, many different radiosurgical options are available to treat rectal carcinoma. Selecting the patients to submit to treatment requires accurate clinical and radiological staging. A team of radiologists, radiotherapists, surgeons, endoscopists and pathologists has been created to stage the patients and to follow the final results. The team have decided the diagnostic and therapeutic protocols. The patients with rectal cancer undergo radiotherapy after staging and are subsequently restaged. If indicated, surgery is performed and histology is compared with restaging, to assess the accuracy of the diagnostic procedures. All diagnostic and therapeutic decisions are made collectively by the team, during scheduled meetings. All data are stored in a computer program. This paper deals with the working method we used, its advantages and the outcome of the first 23 studied patients. Restaging was compared with histology: transrectal US (performed in 8 patients) showed 100% accuracy in evaluating local tumor spread (T). CT had 91% accuracy in defining T and 60% accuracy in N, with a tendency to overstaging. In 78% of patients > 50% reduction of tumor size was observed and the distance from the anal canal increased in 95.5%. This study will provide the overall accuracy of the clinico-radiologic staging, the survival rates and the indication of prognostic signs.
La radiologia medica 09/1992; 84(3):261-73. · 1.44 Impact Factor
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Journal de Radiologie 01/1992; 72(12):663-8. · 0.42 Impact Factor
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ABSTRACT: Hepatocellular carcinoma (HCC) is the commonest primary tumor of the liver; of late, its incidence has increased in the Western world. The authors report their experience with 42 patients affected with HCC; 36 cases were confirmed by fine-needle biopsy (FNAB), and 2 by surgery. All patients were studied with US and CT; 25 of them underwent color-Doppler US, and 30 angiography. In 9 patients, Lipiodol-CT was performed after hepatic arterial chemo-embolization. Thirty-six expansive and expansive-infiltrative lesions were observed, 4 infiltrative ones, and 1 neoplastic thrombosis of the portal vein with no evidence of parenchymal mass; 28 cases were multinodular in nature. US showed the primary lesion in all cases, while CT missed 2 lesions of 15 mm in diameter. In 19 of 25 cases studied with color-Doppler US, arterial pathologic signals were observed. Angiography confirmed all the primary lesions diagnosed by US in 30 patients and was found to be the most sensitive method to reveal multinodular lesions 8-15 mm phi, whereas Lipiodol-CT had higher resolution in detecting nodules up to 3 mm phi. The retrospective review of our results pointed out the capabilities of diagnostic imaging techniques in characterizing and staging HCCs--which is the reason why the role of biopsy has not been emphasized. The whole of the morphofunctional data obtained with the different techniques allowed lesion tissue characterization.
La radiologia medica 05/1991; 81(4):469-78. · 1.44 Impact Factor
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ABSTRACT: From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.
La radiologia medica 05/1991; 81(4):459-63. · 1.44 Impact Factor
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ABSTRACT: Five hundred and two patients with good opacification of the gallbladder were studied by means of ceruletide-assisted cholecystography. A high percentage (15.7; 79 patients) was found to have hyperplastic cholecystoses. So far 26 of these patients have been operated upon because of gallstones or painful symptoms. The x-ray diagnosis was confirmed in all cases. Compared with routine cholecystography, the powerful contraction induced by ceruletide appears to lead to a more frequent recognition of hyperplastic cholecystoses.
Gastrointestinal Radiology 02/1983; 8(3):255-9.
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La radiologia medica 05/1980; 66(4):256-8. · 1.44 Impact Factor
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La radiologia medica 05/1980; 66(4):272-4. · 1.44 Impact Factor
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P Aguzzi,
F Andreoli,
C Bartolozzi,
G Bedogni,
P Bayeli,
G Cacciamani,
E Caenazzo,
M Cammisa,
A Camposampietro,
G Canossi, [......],
G Nieri,
L Norberto,
F Pacini,
U Pagliari,
F Pucci,
G P Rogo,
R Romagnoli,
A Sandri,
C Sogliani-Raschini, A Vecchioli
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ABSTRACT: In 12 X-ray and gastroenterology departments 1570 patients, clinically suspected to have a gastric pathology, have been examined by double contrast (surface) examination of the stomach followed by gastroscopy. Diagnostic accuracy was 93% in respect of endoscopic data, assumed correct by hypothesis. On the basis of a cost and benefit evaluation, made according to the well known criteria, a wider routine use of the double contrast technique is proposed.
La radiologia medica 01/1980; 65(12):867-72. · 1.44 Impact Factor
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Rays 14(1):27-35.
