Publications (7)24.94 Total impact
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Article: 64-section multidetector CT of the upper abdomen: optimization of a saline chaser injection protocol for improved vascular and parenchymal contrast enhancement.
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ABSTRACT: To prospectively investigate the effect of varying the injection flow rates of a saline chaser on vascular and parenchymal contrast enhancement during abdominal MDCT. 100 consecutive patients were randomly assigned to four injection protocols. A fixed dose of contrast medium was administered followed by no saline (Protocol A) or 50 mL of saline at 2, 4, or 8 mL/s (Protocols B, C, and D). Peak, time-to-peak, and duration of 90% peak enhancement were determined for aorta, pancreas, and liver. Aortic peak enhancement was significantly higher for Protocol D (369.5 HU) compared with Protocols A and B (332.9 HU and 326.0 HU, respectively; P < 0.05). Pancreatic peak enhancement was significantly higher for Protocols C and D (110.6 HU and 110.9 HU, respectively) compared to Protocol A (92.5 HU; P < 0.05). Aortic and pancreatic time-to-peak enhancement occurred significantly later for Protocol D compared with Protocol A (42.8 s vs. 36.1 s [P < 0.001] and 49.7 s vs. 45.3 s [P = 0.003]). Injecting a saline chaser at high flow rates yields significantly higher peak aortic and pancreatic enhancement, with a slight longer time-to-peak enhancement.European Radiology 05/2011; 21(9):1938-47. · 3.22 Impact Factor -
Article: Perfusion Computed Tomography (PCT) adopting different perfusion metrics: recurrence of brain metastasis or radiation necrosis?
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ABSTRACT: Different perfusion metrics were investigated to determine the accuracy of Perfusion CT (PCT) in differentiating recurrence of brain metastases from radiation necrosis in patients who previously underwent stereotactic radiation therapy (SRT). Twenty patients previously treated with SRT underwent PCT examination of the brain. Normalized Cerebral Blood Volume (nCBV) values within the region of interest (ROI) were calculated. Fractional volumes at nCBV values between 1.0 and 2.25, defined as V(1.0)-V(2.25), were derived as alternative metrics and compared to the conventional method based on the mean CBV value within the lesion (nCBV(mean)). The Mann-Whitney test was used to compare the two patient's groups with recurrence and radiation necrosis with respect to the different nCBV metrics. Predictive powers and optimal thresholds for both the nCBV(mean) and the V(1.0)-V(2.25) were evaluated using the Receiver Operating Characteristic Curves. The gold standard was represented either by the histopathological examination or the Magnetic Resonance (MR) imaging follow-up longer than six months. The differences between the patient's group with recurrence and that with radiation necrosis resulted statistically significant for all the metrics, showing the lowest p-value for V(1.75) and V(2). The metrics based on the fractional volumes were found to show higher predictive powers, with the highest value of 0.96 for V(2.0). Quantitative analysis of the CBV map deriving different metrics may potentially improve the diagnostic accuracy of PCT in differentiating brain metastasis recurrence from radiation necrosis.European journal of radiology 03/2011; 81(6):1246-52. · 2.65 Impact Factor -
Article: Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the Detection of hepatocellular carcinoma in patients with cirrhosis.
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ABSTRACT: To prospectively compare gadoxetate disodium-enhanced magnetic resonance (MR) imaging with multiphasic 64-section multidetector computed tomography (CT) in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. Institutional review board approval and informed patient consent were obtained for this prospective study. Fifty-eight patients (39 men, 19 women; mean age, 63 years; age range, 35-84 years) underwent gadoxetate disodium-enhanced MR imaging and multiphasic 64-section multidetector CT. The imaging examinations were performed within 30 days of each other. The two sets of images were qualitatively analyzed in random order by three independent readers in a blinded and retrospective fashion. Using strict diagnostic criteria for HCC, readers classified all detected lesions with use of a four-point confidence scale. The reference standard was a combination of pathologic proof, conclusive imaging findings, and substantial tumor growth at follow-up CT or MR imaging (range of follow-up, 90-370 days). The diagnostic accuracy, sensitivity, and positive predictive value were compared between the two image sets. Interreader variability was assessed. The accuracy of each imaging method was determined by using an adjusted modified chi(2) test. Eighty-seven HCCs (mean size +/- standard deviation, 1.8 cm +/- 1.5; range, 0.3-7.0 cm) were confirmed in 42 of the 58 patients. Regardless of lesion size, the average diagnostic accuracy and sensitivity for all readers were significantly greater with gadoxetate disodium-enhanced MR imaging (average diagnostic accuracy: 0.88, 95% confidence interval [CI]: 0.80, 0.97; average sensitivity: 0.85, 95% CI: 0.74, 0.96) than with multidetector CT (average diagnostic accuracy: 0.74, 95% CI: 0.65, 0.82; average sensitivity: 0.69, 95% CI: 0.59, 0.79) (P < .001 for each). No significant difference in positive predictive value was observed between the two image sets for each reader. Interreader agreement was good to excellent. Compared with multiphasic 64-section multidetector CT, gadoxetate disodium-enhanced MR imaging yields significantly higher diagnostic accuracy and sensitivity in the detection of HCC in patients with cirrhosis.Radiology 09/2010; 256(3):806-16. · 5.73 Impact Factor -
Article: Multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) in the evaluation of the mandibular invasion by squamous cell carcinomas (SCC) of the oral cavity. Correlation with pathological data.
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ABSTRACT: To retrospectively compare the diagnostic accuracy of magnetic resonance imaging (MRI) and multidetector-row computed tomography (MDCT) in the assessment of the mandibular invasion by squamous cell carcinoma (SCC) having histopathological exams as standard of reference. Institutional review board approval with a waiver of informed patient consent was obtained. Of the 147 patients selected from our database who underwent surgical excision of a tumour arising into the oral cavity, thirty-six patients (26 men, 10 women; mean age, 56 years; range, 30-75 years) with hystologically proven SCC who performed both a preoperative MRI and MDCT, composed our final study population.Images were qualitatively analyzed in consensus by two expert radiologist in head and neck imaging. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were assessed for both MRI and MDCT.Differences in sensitivity, specificity, positive and negative predictive values were calculated at a statistical significance of p < .05. The sensitivity, the specificity and the accuracy of MRI and MDCT in the detection of the mandibular involvement were respectively 93%, 82%, 86% and 79%, 82%, 81%, while the positive predictive value (PPV) and negative predictive value (NPV) were respectively 76%, 95% and 73%, 86%. There wasn't any statistically significant difference in overall diagnostic accuracy between MRI and MDCT in the evaluation of mandibular tumour invasion (p > .05). MRI showed to have a higher sensitivity compare to MDCT in the assessment of mandibular involvement from SCC arising in the oral cavity although none statistically significant differences were noted.Journal of Experimental & Clinical Cancer Research 01/2010; 29:73. · 2.15 Impact Factor -
Article: Hepatocellular carcinoma in patients with cirrhosis: qualitative comparison of gadobenate dimeglumine-enhanced MR imaging and multiphasic 64-section CT.
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ABSTRACT: To prospectively investigate whether combined interpretation of dynamic and hepatobiliary phase magnetic resonance (MR) images can improve the accuracy of gadobenate dimeglumine-enhanced MR imaging in the detection of hepatocellular carcinoma (HCC) compared with either dynamic MR or multiphasic multidetector computed tomographic (CT) images alone. Institutional review board approval and informed patient consent were obtained. Fifty-two patients (39 men, 13 women; mean age, 68 years; range, 38-81 years) suspected of having HCC underwent gadobenate dimeglumine-enhanced MR imaging and multiphasic 64-section multidetector CT. Images were qualitatively analyzed independently by three observers in three separate reading sessions. The alternating free-response receiver operating characteristic (AFROC) method was used to analyze the results. Differences in sensitivity and positive predictive values were calculated at a statistical significance of P < .05. A total of 67 HCCs were detected in 36 patients. The mean area under the AFROC curve (A(z)) was significantly higher for either the combined interpretation of dynamic and hepatobiliary phase MR images (A(z) = 0.95) or dynamic MR images alone (0.91) than for CT images (0.77) (P = .01 for both comparisons). The mean sensitivity of combined interpretation of MR images (0.72) was significantly higher than those of dynamic MR images alone (0.63) and multidetector CT images (0.61) (P = .008 and .001, respectively). The mean positive predictive value was not significantly different among the three imaging sets. The combined interpretation of dynamic and hepatobiliary phase MR images improves diagnostic accuracy of gadobenate dimeglumine-enhanced MR imaging for the detection of HCC compared with either dynamic MR or multiphasic multidetector CT images alone.Radiology 05/2009; 251(1):85-95. · 5.73 Impact Factor -
Article: Detection of hepatocellular carcinoma in patients with cirrhosis: added value of coronal reformations from isotropic voxels with 64-MDCT.
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ABSTRACT: The purpose of our study was to prospectively assess the added value of isotropic coronal reformations of the liver when using 64-MDCT for the detection of hepatocellular carcinoma (HCC). Seventy-one consecutive patients (60 men, 11 women; mean age, 65 years) suspected of having HCC underwent 64-MDCT with coronal reformations. A multiphasic CT protocol that included unenhanced, hepatic arterial, portal venous, and equilibrium phases was performed. Three independent, blinded readers interpreted the transverse scan alone, the coronal scan alone, and the combined transverse and coronal scans for the presence of HCC. Sensitivity, positive predictive value, area under the receiver operating characteristic curve (A(z)), and interpretation time were calculated for each reading session. Seventy-six HCC nodules were confirmed in 48 patients using histopathologic analysis or follow-up with long-term CT, MRI, or both (mean follow-up time, 12 months; range, 12-15 months) as the reference standard. Mean sensitivity, positive predictive value, and A(z) value for HCC detection were, respectively, 84% (191/228 readings), 91% (191/210 readings), and 0.85 for the transverse scan alone; 83% (189/228 readings), 93% (189/203 readings), and 0.86 for the coronal scan alone; and 87% (198/228 readings), 93% (198/213 readings), and 0.87 for combined interpretation of transverse and coronal scans. No comparisons were statistically significant. Forty-eight false-positive interpretations were recorded (19 for the transverse, 14 for the coronal, and 15 for the combined interpretation sets). The reading session in which combined transverse and coronal scans were available for interpretation showed significantly superior reader confidence for HCC detection as well as longer interpretation times (p<0.05 for both comparisons). The average reading time for the combined interpretation of transverse and coronal image sets (mean, 12.1+/-0.8 minutes) was significantly longer than for the transverse image set (7.4+/-1.5 minutes) or the coronal image set (7.1+/-1.3 minutes) (p<0.01). With 64-MDCT, the addition of isotropic coronal reformations to transverse images significantly improved reader confidence for the detection of HCC, with no statistically significant improvement in sensitivity, positive predictive value, or diagnostic accuracy (as determined by the A(z) value). This improvement comes at the cost of a longer interpretation time.American Journal of Roentgenology 01/2009; 192(1):180-7. · 2.78 Impact Factor -
Article: Gadobenate dimeglumine-enhanced magnetic resonance imaging of primary leiomyoma of the liver.
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ABSTRACT: We report a case of histologically proven primary leiomyoma of the liver that was evaluated with multiphasic 64-section computed tomography (CT) and gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging. This lesion showed vivid enhancement during the arterial phase with sustained enhancement during the hepatic venous and equilibrium phases. During the liver-specific MR imaging phase (150 minutes after contrast injection), the same lesion demonstrated lack of contrast retention, thus appearing hypointense compared with the background liver. Because of this latter finding, the patient underwent partial resection of the liver. In primary hepatic leiomyoma, the absence of contrast uptake during the liver-specific phase of gadobenate dimeglumine-enhanced MR imaging may be inappropriately interpreted as a sign of malignancy, thus leading to unnecessary, aggressive management of such lesions.Journal of Magnetic Resonance Imaging 10/2008; 28(3):755-8. · 2.70 Impact Factor
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Institutions
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2008–2009
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Sapienza University of Rome
- Department of Radiological, Oncological and Pathological Sciences
Roma, Latium, Italy
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