Nicola Sverzellati

Ospedale Maggiore di Lodi, Lodi, Lombardy, Italy

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Publications (151)433.1 Total impact

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    ABSTRACT: Objectives: To establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience. Materials and methods: 112 observers (96 of whom were thoracic radiologists) categorised CTs of 150 consecutive patients with fibrotic lung disease using the ATS/ERS/JRS/ALAT CT criteria for a UIP pattern (3 categories-UIP, possibly UIP and inconsistent with UIP). The presence of honeycombing, traction bronchiectasis and emphysema was also scored using a 3-point scale (definitely present, possibly present, absent). Observer agreement for the UIP categorisation and for the 3 CT patterns in the entire observer group and in subgroups stratified by observer experience, were evaluated. Results: Interobserver agreement across the diagnosis category scores among the 112 observers was moderate, ranging from 0.48 (IQR 0.18) for general radiologists to 0.52 (IQR 0.20) for thoracic radiologists of 10-20 years' experience. A binary score for UIP versus possible or inconsistent with UIP was examined. Observer agreement for this binary score was only moderate. No significant differences in agreement levels were identified when the CTs were stratified according to multidisciplinary team (MDT) diagnosis or patient age or when observers were categorised according to experience. Observer agreement for each of honeycombing, traction bronchiectasis and emphysema were 0.59±0.12, 0.42±0.15 and 0.43±0.18, respectively. Conclusions: Interobserver agreement for the current ATS/ERS/JRS/ALAT CT criteria for UIP is only moderate among thoracic radiologists, irrespective of their experience, and did not vary with patient age or the MDT diagnosis.
    Thorax 11/2015; DOI:10.1136/thoraxjnl-2015-207252 · 8.29 Impact Factor
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    ABSTRACT: Objective To address the impact of bronchoscopic lung cryobiopsy (BLC) on diagnostic confidence in the multidisciplinary diagnosis of IPF. Methods In this cross-sectional study we selected 117 patients with fibrotic ILDs without a typical usual interstitial pneumonia pattern on HRCT. All cases underwent lung biopsies: 58 were BLC and 59 were SLB. Two clinicians, two radiologists and two pathologists sequentially reviewed clinical-radiological findings and biopsy results, recording at each step in the process their diagnostic impressions and confidence levels. Measurements and Main Results We observed a major increase in diagnostic confidence after the addition of BLC, similar to SLB (from 29 to 63%, p= 0.0003 and from 30 to 65%, P= 0.0016 of high confidence IPF diagnosis, in the BLC group and SLB group respectively). The overall inter-observer agreement in IPF diagnosis was similar for both approaches (BLC overall kappa 0.96; SLB overall kappa 0.93). IPF was the most frequent diagnosis (50% and 39% in the BLC and SLB group respectively; p=0.23). After the addition of histopathologic information 17% of cases in the BLC group and 19% of cases in the SLB group, mostly iNSIP and HP, were reclassified as IPF. Conclusions BLC is a new biopsy method that has a meaningful impact on diagnostic confidence in the multidisciplinary diagnosis of ILDs, and may prove useful in the diagnosis of IPF. This study provides a robust rationale for future studies investigating the diagnostic accuracy of BLC compared to SLB.
    American Journal of Respiratory and Critical Care Medicine 11/2015; DOI:10.1164/rccm.201504-0711OC · 13.00 Impact Factor
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    ABSTRACT: Purpose: It is unclear whether (and, to what extent) radiologists look at and report cardiovascular abnormalities on non-cardio-synchronized standard chest computed tomography (CT). In this study, the frequency and the reporting rate of cardiovascular findings in chest CT examinations were retrospectively assessed. Materials and methods: This study was approved by the institutional review board of each participating center. Four academic centers provided data on 447 subjects who underwent non-ECG-synchronized chest CT examinations for evaluating pulmonary fibrosis (161/447, 36 %), suspected pulmonary embolism (140/447, 31.3 %), or lung cancer staging (146/447, 32.7 %). A total of 220/447 (53.7 %) and 227/447 CT (46.3 %) examinations were evaluated and reported by junior and senior chest radiologists, respectively. Two radiologists with training in cardiac imaging reviewed the same chest CT images looking for the presence of incidental cardiovascular abnormalities using a preformatted score sheet. Inter-observer agreement was assessed using the kappa coefficient of agreement (k). Results: Inter-observer agreement between the study reviewers was moderate to good (0.4-0.73) for most of the incidental cardiovascular findings. At least one incidental cardiovascular finding not documented in the original report was identified by the study reviewers in 225/409 (55 %) of chest CT examinations. A total of 168/266 (63.2 %) potentially clinically significant cardiovascular findings were unreported in the original reports of 177/447 (39.6 %) subjects (p < 0.0001). Senior radiologists tended to more frequently report coronary artery calcification (p = 0.0006), cardiac valves calcification (p = 0.0003), and ascending aorta enlargement (p = 0.01) compared to junior radiologists. Conclusions: Several cardiovascular abnormalities can be reliably identified on standard chest CT. Yet, they are often under-reported, even when they might be relevant to the patient's work-up.
    La radiologia medica 10/2015; DOI:10.1007/s11547-015-0595-0 · 1.34 Impact Factor
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    ABSTRACT: Liquid biopsies can detect biomarkers carrying information on the development and progression of cancer. We demonstrated that a 24 plasma-based microRNA signature classifier (MSC) was capable of increasing the specificity of low dose computed tomography (LDCT) in a lung cancer screening trial. In the present study, we tested the prognostic performance of MSC, and its ability to monitor disease status recurrence in LDCT screening-detected lung cancers. Between 2000 and 2010, 3411 heavy smokers enrolled in two screening programmes, underwent annual or biennial LDCT. During the first five years of screening, 84 lung cancer patients were classified according to one of the three MSC levels of risk: high, intermediate or low. Kaplan-Meier survival analysis was performed according to MSC and clinico-pathological information. Follow-up MSC analysis was performed on longitudinal plasma samples (n = 100) collected from 31 patients before and after surgical resection. Five-year survival was 88.9% for low risk, 79.5% for intermediate risk and 40.1% for high risk MSC (p = 0.001). The prognostic power of MSC persisted after adjusting for tumor stage (p = 0.02) and when the analysis was restricted to LDCT-detected cases after exclusion of interval cancers (p < 0.001). The MSC risk level decreased after surgery in 76% of the 25 high-intermediate subjects who remained disease free, whereas in relapsing patients an increase of the MSC risk level was observed at the time of detection of second primary tumor or metastatic progression. These results encourage exploiting the MSC test for lung cancer monitoring in LDCT screening for lung cancer.
    Oncotarget 10/2015; DOI:10.18632/oncotarget.5210 · 6.36 Impact Factor
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    ABSTRACT: In the updated American Thoracic Society-European Respiratory Society classification of the idiopathic interstitial pneumonias (IIPs), the major entities have been preserved and grouped into (a) "chronic fibrosing IIPs" (idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia), (b) "smoking-related IIPs" (respiratory bronchiolitis-associated interstitial lung disease and desquamative interstitial pneumonia), (c) "acute or subacute IIPs" (cryptogenic organizing pneumonia and acute interstitial pneumonia), and (d) "rare IIPs" (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis). Furthermore, it has been acknowledged that a final diagnosis is not always achievable, and the category "unclassifiable IIP" has been proposed. The diagnostic interpretation of the IIPs is often challenging because other diseases with a known etiology (most notably, connective tissue disease and hypersensitivity pneumonitis) may show similar morphologic patterns. Indeed, more emphasis has been given to the integration of clinical, computed tomographic (CT), and pathologic findings for multidisciplinary diagnosis. Typical CT-based morphologic patterns are associated with the IIPs, and radiologists play an important role in diagnosis and characterization. Optimal CT quality and a systematic approach are both pivotal for evaluation of IIP. Interobserver variation for the various patterns encountered in the IIPs is an issue. It is important for radiologists to understand the longitudinal behavior of IIPs at serial CT examinations, especially for providing a framework for cases that are unclassifiable or in which a histologic diagnosis cannot be obtained. (©)RSNA, 2015.
    Radiographics 10/2015; DOI:10.1148/rg.2015140334 · 2.60 Impact Factor
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    ABSTRACT: Background: Systemic Sclerosis (SSc) is a connective disease impairing respiratory function. SSc worsens patients' Health Assessment Questionnaire (HAQ-DI), Short Form 36 Physical and Mental Component Summary (SF36-PCS and SF36-MCS). The aim of this work is to verify whether there is correlation between quality of life and lung interstitiopathy in SSc patients. Methods: SF36 and HAQ-DI were given to each patient (48 in all). Lung involvement was evaluated with Baseline Dyspnea Index (BDI), spirometry and pulmonary fibrosis radiological assessment (PFRA). Correlations between SF36, HAQ-DI and lung involvement severity were investigated with Spearman's rank test. A p-value<0.05 was considered statistically significant. Results: SF36-PCS and SF36-MCS correlate with BDI (respectively rho=0.553 p=0.0001; rho=0.357 p=0.0150). The best correlating SF36 subsets are Physical Role (rho =0.566 p<0.0001) and Bodily Pain (rho=0.444 p=0.0020). BDI correlates with HAQ-DI (rho=-0.655 p<0.0001). No statistically significant correlation was found between SF36, HAQ-DI and spirometrical values nor PFRA. Conclusions: The SSc patients enrolled have an impaired quality of life as widely demonstrated in literature. Quality of life reduction and functional ability decrease are only related to respiratory subjective impairment (assessed by BDI). Actually no correlation with objective lung damage (assessed by spirometry and PFRA) was detected.
    Acta bio-medica: Atenei Parmensis 09/2015; 86(2):142-148.
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    ABSTRACT: Background Fibroblastic foci profusion on histopathology and severity of traction bronchiectasis on highresolution computed tomography (HRCT) have been shown to be predictors of mortality in patients with idiopathic pulmonary fibrosis (IPF). The aim of this study was to investigate the relationship between fibroblastic foci (FF) profusion and HRCT patterns in patients with a histopathologic diagnosis of usual interstitial pneumonia (UIP), fibrotic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (CHP). Methods The HRCT scans of 162 patients with a histopathologic diagnosis of UIP or fibrotic NSIP (n = 162) were scored on extent of groundglass opacification, reticulation, honeycombing, emphysema and severity of traction bronchiectasis. For each patient, a fibroblastic foci profusion score based on histopathologic appearances was assigned. Relationships between extent of fibroblastic foci and individual HRCT patterns were investigated using univariate correlation analysis and multivariate linear regression. Results Increasing extent of reticulation (P < 0.0001) and increasing severity of traction bronchiectasis (P < 0.0001) were independently associated with increasing FF score within the entire cohort. Within individual multidisciplinary team diagnosis subgroups, the only significant independent association with FF score was severity of traction bronchiectasis in patients with idiopathic pulmonary fibrosis (IPF)/UIP (n = 66, r2 = 0.19, P < 0.0001) and patients with chronic hypersensitivity pneumonitis (CHP) (n = 49, r2 = 0.45, P < 0.0001). Furthermore, FF score had the strongest association with severity of traction bronchiectasis in patients with IPF (r2 = 0.34, P < 0.0001) and CHP (r2 = 0.35, P < 0.0001). There was no correlation between FF score and severity of traction bronchiectasis in patients with fibrotic NSIP. Global disease extent had the strongest association with severity of traction bronchiectasis in patients with fibrotic NSIP (r2 = 0.58, P < 0.0001). Conclusion In patients with fibrotic lung disease, profusion of fibroblastic foci is strikingly related to the severity of traction bronchiectasis, particularly in IPF and CHP. This may explain the growing evidence that traction bronchiectasis is a predictor of mortality in several fibrotic lung diseases.
    BMC Medicine 09/2015; 13(1). DOI:10.1186/s12916-015-0479-0 · 7.25 Impact Factor

  • European Respiratory Journal 09/2015; 46(suppl 59):PA512. DOI:10.1183/13993003.congress-2015.PA512 · 7.64 Impact Factor

  • European Respiratory Journal 09/2015; 46(suppl 59):OA4488. DOI:10.1183/13993003.congress-2015.OA4488 · 7.64 Impact Factor
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    P Spagnolo · G Rossi · A Cavazza · M Bonifazi · I Paladini · F Bonella · N Sverzellati · U Costabel ·
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    ABSTRACT: Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of a wide variety of antigens to which the individual has been previously sensitized. The pathobiology of the disease is not fully understood, but in addition to the triggers that initiate the disease, host/genetic factors are likely to be important, as only a minority of exposed individuals develop HP. Due to the lack of a diagnostic gold standard, the diagnosis of HP is not straightforward and relies on the integration of a number of factors, including history of exposure, precipitating antibodies to the offending antigen, clinical features, bronchoalveolar lavage, and radiological and pathologic features. However, in the appropriate setting, a high index of suspicion is critically important and may obviate the need for more invasive tests. Clinical presentation and natural history vary widely. Acute forms generally resolve without sequelae, while chronic forms, which are caused by persistent low-grade exposures, are associated with poor prognosis. Corticosteroids may be useful in acute episodes for symptomatic relief or in chronic and progressive disease, but their long-term efficacy has never been validated in prospective clinical trials. Ideally, patients with HP should be referred to centers with expertise, as the overlap with other forms of interstitial lung disease may be substantial. Making the correct diagnosis has critical therapeutic and prognostic implications.
    Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 08/2015; 25(4):237-50; quiz follow 250. · 2.60 Impact Factor

  • Cancer Research 08/2015; 75(15 Supplement):932-932. DOI:10.1158/1538-7445.AM2015-932 · 9.33 Impact Factor
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    ABSTRACT: We aimed to assess the relation between basic clinical parameters and evolution of solitary pure ground-glass nodules (pGGN) in the lungs. Baseline and follow-up computed tomography (CT) of patients with solitary pGGN were selected and two radiologists independently reviewed CTs for nodule characterization. CT features of solitary pGGN were: manually measured maximum diameter (D1) and its orthogonal diameter (D2), mean diameter (mD), D1 to D2 ratio as surrogate of roundness, and location according to lobar anatomy. Longitudinal changes were assessed and solitary pGGNs were classified as resolved or persisting. Persisting nodules were further classified as stable or grown according to an increase in mD of ≥2 mm or appearance of solid component. Baseline CT features of solitary pGGNs and clinical metrics of patients were compared between resolved and persisting nodules and, thereafter, between stable and grown lesions. A total of 95 subjects with solitary pGGN were included. After a median 16-month follow-up, 20 nodules resolved, while 75 persisted. Among persisting nodules, 18 were grown and 57 were stable. Grown nodules showed larger D1 and mD compared with stable pGGNs (P < 0.001). Subjects with grown nodules were older (P = 0.021). Logistic regression analyses showed higher likelihood of growth for nodules ≥10 mm (odds ratio [OR], 8.355; P = 0.001) and subjects older than 67 years (OR, 3.656; P = 0.034). Nodules ≥10 mm in subjects older than 67 years showed higher likelihood of growth. These data could contribute to a more individual approach to the management of solitary pGGN.
    Diagnostic and interventional radiology (Ankara, Turkey) 07/2015; 21(5). DOI:10.5152/dir.2015.14457 · 1.43 Impact Factor
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    ABSTRACT: To describe changes over time in extent of idiopathic pulmonary fibrosis (IPF) at multidetector computed tomography (MDCT) assessed by semi-quantitative visual scores (VSs) and fully automatic histogram-based quantitative evaluation and to test the relationship between these two methods of quantification. Forty IPF patients (median age: 70 y, interquartile: 62-75 years; M:F, 33:7) that underwent 2 MDCT at different time points with a median interval of 13 months (interquartile: 10-17 months) were retrospectively evaluated. In-house software YACTA quantified automatically lung density histogram (10th-90th percentile in 5th percentile steps). Longitudinal changes in VSs and in the percentiles of attenuation histogram were obtained in 20 untreated patients and 20 patients treated with pirfenidone. Pearson correlation analysis was used to test the relationship between VSs and selected percentiles. In follow-up MDCT, visual overall extent of parenchymal abnormalities (OE) increased in median by 5 %/year (interquartile: 0 %/y; +11 %/y). Substantial difference was found between treated and untreated patients in HU changes of the 40th and of the 80th percentiles of density histogram. Correlation analysis between VSs and selected percentiles showed higher correlation between the changes (Δ) in OE and Δ 40th percentile (r=0.69; p<0.001) as compared to Δ 80th percentile (r=0.58; p<0.001); closer correlation was found between Δ ground-glass extent and Δ 40th percentile (r=0.66, p<0.001) as compared to Δ 80th percentile (r=0.47, p=0.002), while the Δ reticulations correlated better with the Δ 80th percentile (r=0.56, p<0.001) in comparison to Δ 40th percentile (r=0.43, p=0.003). There is a relevant and fully automatically measurable difference at MDCT in VSs and in histogram analysis at one year follow-up of IPF patients, whether treated or untreated: Δ 40th percentile might reflect the change in overall extent of lung abnormalities, notably of ground-glass pattern; furthermore Δ 80th percentile might reveal the course of reticular opacities.
    PLoS ONE 06/2015; 10(6):e0130653. DOI:10.1371/journal.pone.0130653 · 3.23 Impact Factor
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    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):587.2-588. DOI:10.1136/annrheumdis-2015-eular.6409 · 10.38 Impact Factor
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    ABSTRACT: The aim of the study was to compare both reproducibility and prognostic value of lesion size measurements obtained manually and semiautomatically on computed tomography in advanced non-small cell lung cancer (NSCLC). Manual axial longest diameter, semiautomatic axial longest diameter, and volume of NSCLC lesions were independently analyzed by 4 readers at baseline and after at least 1 cycle of platinum-based chemotherapy. The prognostic value of the proportional change in lesion size between baseline and follow-up CT was evaluated using either RECIST or experimental thresholds derived from the quartiles of the changes as assessed manually or semiautomatically. Semiautomatic axial longest diameter (concordance correlation coefficient [CCC]: 0.980 to 0.987; variation coefficient [VC%]: 6% to 7.3%) and volume (CCC: 0.974 to 0.991; VC%: 5.6% to 9.5%) were more reproducible than manual axial longest diameter (CCC: 0.950 to 0.984; VC%: 6.4% to 11.7%). RECIST categories did not stratify patients with different survival durations. For 3/4 readers, a decrease of ≤70% in lesion volume was associated with shorter survival (median survival: 11 mo, P<0.05; hazard ratio: 5 to 22.2, P<0.05). In advanced NSCLC, semiautomatic measures were more reproducible than manual diameter, and volumetric measurement may better predict patient survival.
    Journal of thoracic imaging 03/2015; Publish Ahead of Print(5). DOI:10.1097/RTI.0000000000000145 · 1.74 Impact Factor
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    ABSTRACT: Purpose: Interstitial lung disease (ILD) related to systemic sclerosis (SSc) is assessed with pulmonary functional tests (PFTs) and semi-quantitative scores based on extent of ILD detectable on chest computed tomography (CT). CT quantitative indexes (QCTIs) are promising tools to assess extent of ILD. This study's aim is to evaluate the validity of QCTI compared with that of chest CT standard evaluation and PFTs. Moreover, QCTI differences between patients' subgroups according to prognostic stratifications were investigated. Methods: ILD-SSc of patients from six rheumatological clinics was routinely assessed with chest CT and PFTs. Patients were clustered according to prognosis based on functional and/or radiological examinations. Finally, chest CTs were processed with OsiriX in order to obtain QCTI. Results: Two hundred fifty-seven SSc patients were enrolled. QCTI correlation between extent of ILD and PFTs range from - 0.60 to 0.58 and from - 0.54 to 0.52, respectively. The majority of QCTI have a different distribution in patients' subgroups based on prognosis. Most of QCTI discriminate patients with an ILD severity leading to a poor prognosis. Conclusions: QCTI assessment of ILD-SSc is comparable to the evaluation based on chest CT and/or PFTs. QCTI values corresponding to severe ILD were identified. QCTIs are excellent candidates for a new and more reliable SSc-ILD assessment.
    Modern Rheumatology 03/2015; DOI:10.3109/14397595.2015.1016200 · 2.40 Impact Factor
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    Mario Silva · Hilario Nunes · Dominique Valeyre · Nicola Sverzellati ·
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    ABSTRACT: The diagnostic imaging contributes significantly to the diagnosis and management of sarcoidosis. Imaging techniques are widely employed in the assessment of thoracic and extra-thoracic involvement from sarcoidosis. For the diagnosis of sarcoidosis, chest radiograph has been the cornerstone of sarcoidosis since 1961, when Scadding proposed a standardized staging system. Currently, computed tomography (CT) represents the reference standard for the assessment of both mediastinal lymph nodes and pulmonary findings. In particular, high-resolution computed tomography (HRCT) is more accurate compared to chest radiography for the detection of subtle parenchymal involvement, and provides comprehensive overview of anatomical detail and abnormalities of lung structures. Notably, HRCT allows for accurate differentiation between reversible and irreversible lung disease, which is cornerstone of prognostication. Radionuclide imaging (gallium-67 and (18)F-fluorodeoxyglucose) provides information about activity of the disease and is also useful for diagnostic workup of patients with unexplained persistent disabling symptoms. Magnetic resonance is sensitive for the detection of sarcoidosis granulomata within myocardium, thus providing detailed roadmap for biopsy. For the management of sarcoidosis, CT is of paramount importance in the detection and differential of most common complications, such as vascular disease and suspicious nodular lesions. Conversely, the role of CT in the follow-up of asymptomatic subjects is still under debate. This review focuses on the role of diagnostic imaging in the diagnosis and follow-up of sarcoidosis.
    Clinical Reviews in Allergy & Immunology 03/2015; 49(1). DOI:10.1007/s12016-015-8478-7 · 5.46 Impact Factor
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    A Ariani · F Lumetti · M Silva · D Santilli · F Mozzani · G Lucchini · G Delsante · N Sverzellati ·

  • Revue des Maladies Respiratoires 01/2015; 32. DOI:10.1016/j.rmr.2014.11.051 · 0.62 Impact Factor

Publication Stats

1k Citations
433.10 Total Impact Points


  • 2015
    • Ospedale Maggiore di Lodi
      Lodi, Lombardy, Italy
  • 2004-2015
    • Università degli studi di Parma
      • Department of Clinical and Experimental Medicine
      Parma, Emilia-Romagna, Italy
  • 2014
    • University of Duisburg-Essen
      Essen, North Rhine-Westphalia, Germany
    • Istituto Nazionale Tumori "Fondazione Pascale"
      Napoli, Campania, Italy
  • 2013
    • Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
      Milano, Lombardy, Italy
  • 2007-2013
    • University Hospital of Parma
      • Reparto di Scienze radiologiche
      Parma, Emilia-Romagna, Italy
  • 2011
    • University of Florence
      • Dipartimento di Scienze Biomediche, Sperimentali e Cliniche
      Florens, Tuscany, Italy