Giancarlo Savino

Publications of Giancarlo Savino

• Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection.

  Authors: Antonio Moscariello, Richard A P Takx, U Joseph Schoepf, Matthias Renker, Peter L Zwerner, Terrence X O'Brien, Thomas Allmendinger, Sebastian Vogt, Bernhard Schmidt, Giancarlo Savino, Christian Fink, Lorenzo Bonomo, Thomas Henzler

  European radiology. 05/2011; 21(10):2130-8.

  To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) andTo compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) and to estimate the potential for radiation dose savings. Sixty five consecutive patients (48 men; 59.3 ± 7.7 years) prospectively underwent cCTA and coronary catheter angiography (CCA). Full radiation dose data, using all projections, were reconstructed with FBP. To simulate image acquisition at half the radiation dose, 50% of the projections were discarded from the raw data. The resulting half-dose data were reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Full-dose FBP and half-dose iterative reconstructions were compared with regard to image noise and image quality, and their respective accuracy for stenosis detection was compared against CCA. Compared with full-dose FBP, half-dose iterative reconstructions showed significantly (p = 0.001 - p = 0.025) lower image noise and slightly higher image quality. Iterative reconstruction improved the accuracy of stenosis detection compared with FBP (per-patient: accuracy 96.9% vs. 93.8%, sensitivity 100% vs. 100%, specificity 94.6% vs. 89.2%, NPV 100% vs. 100%, PPV 93.3% vs. 87.5%). Iterative reconstruction significantly reduces image noise without loss of diagnostic information and holds the potential for substantial radiation dose reduction from cCTA.

• Cardiac silhouette findings and mediastinal lines and stripes: radiograph and CT scan correlation.

  Authors: Riccardo Marano, Carlo Liguori, Giancarlo Savino, Biagio Merlino, Luigi Natale, Lorenzo Bonomo

  Chest. 05/2011; 139(5):1186-96.

  Despite the increased use of CT imaging, chest radiography remains a very important diagnostic modality in the evaluation of lung parenchymal and mediastinal diseases, providing a vast amount ofDespite the increased use of CT imaging, chest radiography remains a very important diagnostic modality in the evaluation of lung parenchymal and mediastinal diseases, providing a vast amount of useful information. This information is generally derived from the relationships among the normal anatomic structures of the mediastinum, pleura, and lungs, which represent the basis of the "cardiac silhouette" and "mediastinal lines-and-stripes" concepts that potentially play an important role in the establishment of a diagnosis or a spectrum of diagnoses before proceeding to CT imaging. The capability of recognizing an abnormal chest radiograph on the basis of the displacement, deformation, or obscuration of one of these structures when compared with those in normal findings is often mandatory prior to requesting a potentially useful CT scan examination. Therefore, radiologists, trainees, and physicians must be familiar with the anatomic basis of those findings to be able to recognize the normal and abnormal appearance of structures when developing an appropriate differential diagnosis. In this review, we briefly describe the cardiac silhouette concepts and the mediastinal lines-and-stripes configurations as they relate to the radiographic and CT scan appearance of structures for a spectrum of pathologic diseases and list the possible underlying causes of the displacement, deformation, or obscuration of the structures.

• New therapeutic horizons for the use of negative pressure wound therapy?

  Authors: Marzia Salgarello, Damiano Tambasco, Eugenio Farallo, Giancarlo Savino, Lorenzo Bonomo

  Injury. 04/2011; 42(11):1388-90.

• Pediatric cardiovascular CT angiography: radiation dose reduction using automatic anatomic tube current modulation.

  Authors: Christopher Herzog, Denise M Mulvihill, Shaun A Nguyen, Giancarlo Savino, Bernhard Schmidt, Philip Costello, Thomas J Vogl, U Joseph Schoepf

  AJR. American journal of roentgenology. 05/2008; 190(5):1232-40.

  OBJECTIVE: The purpose of this study was to assess the effect of weight-based scanning protocols and automatic tube current modulation on the tube current-time product and image quality at pediatricOBJECTIVE: The purpose of this study was to assess the effect of weight-based scanning protocols and automatic tube current modulation on the tube current-time product and image quality at pediatric cardiovascular 64-MDCT angiography. MATERIALS AND METHODS: Our pediatric cardiovascular 64-MDCT protocols use a weight-based algorithm to determine nominal tube voltage settings with 80, 100, and 120 kV. Automatic tube current modulation was used for each case. The mAs, volume CT dose index (CTDI(vol)), and dose-length product (DLP) values were recorded and the effective dose calculated. On the basis of the selected nominal tube current, the dose values that would have been delivered without tube current modulation were also calculated. Scans were compared with 16-MDCT using 120 kVp and 120 mAs. Two radiologists independently rated image quality on a 5-point scale. Image noise was objectively measured within four different regions of interest. Findings at CT were clinically correlated with results of cardiac sonography, angiography, or surgery. RESULTS: Thirty-eight 64-MDCT and 30 16-MDCT scans were evaluated. Mean diagnostic quality for 64-MDCT was rated at 3.6 +/- 0.4 and mean image noise was 8.9 +/- 4.5 H. Results with 16-MDCT were not significantly different: diagnostic quality (3.6 +/- 0.4; p = 0.97) and image noise (9.1 +/- 2.8 H; p = 0.31). Scanning with automatic tube current modulation significantly (p < 0.05) reduced the tube current time-product compared with scanning without automatic tube current modulation (-57.8%/54.1/128 mAs) or with 16-MDCT (-47.9%/54.1/104.37 mAs), respectively. The mAs values were significantly (p < 0.05) lower for 80 kVp than for 100 or 120 kVp scans, but image quality and image noise were not significantly (p = 0.24) different. Agreement between MDCT and clinical findings was excellent. CONCLUSION: Under simulated conditions, automatic tube current modulation combined with low tube voltage settings significantly reduced radiation exposure and thus appears preferable in pediatric cardiovascular 64-MDCT.

• Coronary artery bypass grafts and MDCT imaging: what to know and what to look for.

  Authors: Riccardo Marano, Carlo Liguori, Pierluigi Rinaldi, Maria Luigia Storto, Marco Angelo Politi, Giancarlo Savino, Lorenzo Bonomo

  European radiology. 01/2008; 17(12):3166-78.

  Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronaryMulti-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings.

• Significant coronary artery stenosis: comparison on per-patient and per-vessel or per-segment basis at 64-section CT angiography.

  Authors: Christopher Herzog, Peter L Zwerner, Josh R Doll, Christopher D Nielsen, Shaun A Nguyen, Giancarlo Savino, Thomas J Vogl, Philip Costello, U Joseph Schoepf

  Radiology. 08/2007; 244(1):112-20.

  PURPOSE: To prospectively evaluate the accuracy of 64-section computed tomographic (CT) coronary angiography for assessing significant stenosis on a global and segmental level, by using conventionalPURPOSE: To prospectively evaluate the accuracy of 64-section computed tomographic (CT) coronary angiography for assessing significant stenosis on a global and segmental level, by using conventional coronary artery angiography as the reference standard. MATERIALS AND METHODS: This study was HIPAA compliant and had local institutional review board approval. Patients gave informed consent. Patients suspected of having coronary artery disease (CAD) underwent both conventional coronary catheter angiography and contrast material-enhanced retrospectively electrocardiographically gated 64-section multi-detector row CT of the coronary arteries. Two experienced observers analyzed all CT scans for signs of CAD (stenosis of 0%, <or=49%, 50%-69%, 70%-99%, or 100%). Diagnostic accuracy of CT coronary angiography compared with that of conventional angiography was determined on a per-segment, per-vessel, and per-patient basis. No patients, vessels, or segments were excluded from analysis. Spearman correlation, cross tables, and a chi(2) test were used for statistical analysis. RESULTS: On a per-segment basis, 92.4% (762 of 825) of all segments could be clearly evaluated. In 7.6% of segments, image quality was compromised either by misregistration (16%), motion artifacts (30%), or small vessel size (54%). Correlation coefficients for detection and grading of stenosis were r=0.65 on a per-segment, r=0.83 on a per-vessel, and r=0.88 on a per-patient basis. Stenoses of 50% or greater were detected with accuracy, sensitivity, and specificity, respectively, of 96.1% (793 of 825), 82% (50 of 61), and 97.1% (743 of 765) on a per-segment basis, 90.9% (150 of 165), 89% (32 of 36), and 91.5% (118 of 129) on a per-vessel basis, and 89% (49 of 55), 100% (19 of 19), and 83% (30 of 36) on a per-patient basis. CONCLUSION: On a per-patient basis, 64-section multi-detector row CT coronary angiography enables the diagnosis of significant (>or=50%) stenosis in CAD with an accuracy of 89%. On a per-segment and per-vessel basis, diagnostic accuracy is still impaired, primarily by limited spatial resolution.

• Coronary CT angiography.

  Authors: U Joseph Schoepf, Peter L Zwerner, Giancarlo Savino, Christopher Herzog, J Matthias Kerl, Philip Costello

  Radiology. 08/2007; 244(1):48-63.

  Owing to ongoing technical refinements and intense scientific and clinical evaluations, computed tomography (CT) of the heart has left the research realm and matured into a clinical application thatOwing to ongoing technical refinements and intense scientific and clinical evaluations, computed tomography (CT) of the heart has left the research realm and matured into a clinical application that is about to fulfill its promise to replace invasive cardiac catheterization in selected patient populations. CT coronary angiography is technically more challenging than other CT applications owing to the nature of its target, the continuously moving heart. Rapid technical developments in this field require constant adaptation of acquisition protocols. These challenges, however, are in no way insurmountable for users with knowledge of the general CT technique. The intent of this communication is to provide those interested in and involved with coronary CT angiography with a step-by-step "manual" describing the authors' approach to performing coronary CT angiography. Included are considerations regarding appropriate patient selection, patient medication, radiation protection, contrast enhancement, acquisition and reconstruction parameters, image display and analysis techniques, and the radiology report. The recommendations are based on the authors' experience, which spans the evolution of multi-detector row CT for cardiac applications, from its beginning to the advent of the most current generations of 64-section and dual-source CT technologies, which they believe herald the entrance of this examination into routine clinical practice.

• Does two-segment image reconstruction at 64-section CT coronary angiography improve image quality and diagnostic accuracy?

  Authors: Christopher Herzog, Shaun A Nguyen, Giancarlo Savino, Peter L Zwerner, Josh Doll, Christopher D Nielsen, Thomas G Flohr, Thomas J Vogl, Philip Costello, U Joseph Schoepf

  Radiology. 07/2007; 244(1):121-9.

  PURPOSE: To prospectively evaluate the effect of single- versus two-segment image reconstruction on image quality and diagnostic accuracy at 64-section multidetector computed tomographic (CT)PURPOSE: To prospectively evaluate the effect of single- versus two-segment image reconstruction on image quality and diagnostic accuracy at 64-section multidetector computed tomographic (CT) coronary angiography by using conventional coronary angiography as the reference standard. MATERIALS AND METHODS: The study design was approved by a human research committee; patients gave informed consent. The study was HIPAA compliant. Forty consecutive patients (22 men, 18 women; mean age, 61 years +/- 8 [standard deviation]) underwent both 64-section multidetector CT coronary angiography and conventional angiography. All data sets were reconstructed by using single- and two-segment image reconstruction algorithms, with resulting temporal resolution of 82.5-165 msec. Two experienced observers independently evaluated image quality and signs of coronary artery disease. A five-level grading scheme was used to grade stenosis (0%, <50%, <70%, <99%, 100%) and image quality (1[unacceptable] to 5[excellent]). Interobserver correlation, Spearman correlation coefficients, and diagnostic accuracy were calculated. RESULTS: Six hundred coronary artery segments were visible on conventional angiograms, of which 560 (93.3%) were seen by using single-segment and 561 (93.5%) were seen by using two-segment image reconstruction (P=.35). Mean quality scores were not significantly different (P=.22) for single- (3.1 +/- 0.9) and two-segment (3.2 +/- 0.8) reconstruction. Significantly (P=.03) better image quality was observed for two-segment reconstruction only at heart rates of 80-82 beats per minute, at which temporal resolution was approximately 83 msec. For grading coronary artery stenosis, correlation was 0.64 for single- and 0.66 for two-segment reconstruction (P=.43). Significant stenosis (>50%) was detected on a per-segment basis with 77.1% sensitivity and 98.6% specificity by using single-segment and with 79.2% sensitivity and 99.1% specificity by using two-segment image reconstruction. CONCLUSION: At heart rates of more than 65 beats per minute, use of two-segment reconstruction improves image quality at multidetector CT coronary angiography but does not significantly affect overall diagnostic accuracy compared with single-segment reconstruction.

• CT of cardiac function.

  Authors: Giancarlo Savino, Peter Zwerner, Christopher Herzog, Marco Politi, Lorenzo Bonomo, Philip Costello, U Joseph Schoepf

  Journal of thoracic imaging. 03/2007; 22(1):86-100.

  Multidetector computed tomography (MDCT) can play a role in diagnosis of coronary artery disease and in the assessment of left ventricle (LV) and right ventricle global function, with initial goodMultidetector computed tomography (MDCT) can play a role in diagnosis of coronary artery disease and in the assessment of left ventricle (LV) and right ventricle global function, with initial good correlation results with standard modalities. With the latest scanners, regional LV contractility with both qualitative and quantitative assessment has become possible. MDCT function evaluation by specific postprocessing software can be performed considering simultaneously different parameters plus the subjective visual perception of anomalies on 2-dimensional and 3-dimensional cine-loop models. MDCT's ability to make high-resolution 3-dimensional reconstructions throughout the cardiac cycle allows this imaging modality to evaluate both coronary and LV anatomy and morphology, and also LV functional parameters. The ability to provide functional information of the right ventricle represents another important application of MDCT both in patients with acute pulmonary embolism and with congenital cardiovascular disease. Initial results on accuracy are promising and the clinical applicability of MDCT should rapidly increase.

• The Age of CT Pulmonary Angiography.

  Authors: U Joseph Schoepf, Giancarlo Savino, Douglas R Lake, James G Ravenel, Philip Costello

  Journal of thoracic imaging. 12/2005; 20(4):273-9.

  With the introduction of multi detector-row CT (MDCT), computed tomography (CT) has been firmly established as the de facto first line test for imaging patients with suspected pulmonary embolismWith the introduction of multi detector-row CT (MDCT), computed tomography (CT) has been firmly established as the de facto first line test for imaging patients with suspected pulmonary embolism (PE). However, remaining concerns regarding CT's accuracy for diagnosis of isolated peripheral emboli have prevented the unanimous acceptance of this test as the standard of reference for imaging PE. Consequently, many patients with a chest CT scan negative for PE undergo additional testing for a definitive rule-out of PE, increasing radiation burden, risk of complications, and health care cost. After a decade of uncertainty, there is now conclusive evidence that computed tomography (CT), if positive, provides reliable confirmation of the presence of PE and, more importantly, if negative effectively rules out clinically significant PE. Current endeavors to streamline and facilitate workflow for CT diagnosis of PE will further improve the acceptance, utility, and importance of this test. Thus, rather than seeking further confirmation for the accuracy of CT for PE diagnosis, future efforts ought to be directed at harnessing the unique strengths of this test. Examples include improvements in workflow, CT derivation of right ventricular function parameters for triage and prognostication of patients with acute PE, and the comprehensive assessment of patients with acute chest pain for PE, coronary disease, aortic disease, and pulmonary disease by means of a single, contrast enhanced, ECG-synchronized CT scan. At the same time, efforts must be directed at refining clinical pathways to ensure appropriate use and avoid overutilization of this test.

• Novel developments in cardiac computed tomography.

  Authors: James G Ravenel, Giancarlo Savino, U Joseph Schoepf

  The American heart hospital journal. 02/2005; 3(3):167-74.

  Recent advances in computed tomography have the potential to change the way imaging is performed in the detection of coronary artery disease. The current generation of scanners offers the ability toRecent advances in computed tomography have the potential to change the way imaging is performed in the detection of coronary artery disease. The current generation of scanners offers the ability to rapidly acquire thin sections in conjunction with the electrocardiogram, allowing for both anatomic and physiologic data to be obtained. These advancements hold the promise for a noninvasive means of directly evaluating the coronary arteries that can be applied in every day practice. This article reviews the advances in technology and their implications for imaging the heart.

• Diagnostic imaging of the diabetic foot. What the clinician expects to know from the radiologist....

  Authors: Adolfo Canadè, Giancarlo Savino, Alessandra Porcelli, Antonio Troia, Alessandro Cina, Alessandro Pedicelli, Paolo Campioni

  Rays. 28(4):433-42.

  A case of diabetic foot in a patient with advanced diabetes is presented. The correct diagnostic approach was analyzed based on the reasoned combination of available diagnostic imaging proceduresA case of diabetic foot in a patient with advanced diabetes is presented. The correct diagnostic approach was analyzed based on the reasoned combination of available diagnostic imaging procedures (color-Doppler US, CT-angiography, MR-angiography and digital subtraction angiography) and on the clinician's instances. Angiographic findings contraindicated intravascular treatment. Femorotibial surgical bypass was performed.

• Diagnostic imaging of the digestive tract. Reasoned approach to a duodenal filling defect.

  Authors: Adolfo Canadè, Giancarlo Savino, Giuseppe Macis, Angela Parrella, Paolo Campioni

  Rays. 28(4):395-9.

  A case of a patient with sideropenic anemia of suspected gastrointestinal origin is presented. A radiologic study of the upper digestive tract was performed. It documented a duodenal filling defectA case of a patient with sideropenic anemia of suspected gastrointestinal origin is presented. A radiologic study of the upper digestive tract was performed. It documented a duodenal filling defect giving rise to an analytic discussion throughout various perceptive-interpretative logical steps: the image reality, the formation of the filling defect image and its nature. The radiologist's conclusions supported the presence of a benign submucosal neoformation to be treated with surgical resection for its size and for the patient's clinical conditions.

• Multirow CT angiography of coronary arteries.

  Authors: Ornella Pantalone, Francesco Palladino, Rosa Maria Lotito, Massimiliano Missere, Giancarlo Savino, Giovanni Minella, Agostino Meduri, Luigi Natale, Pasquale Marano

  Rays. 28(1):13-9.

  The introduction of spiral multislice or multidetector CT (MSCT) has led to significant results in coronary diagnostic imaging. In fact with MSCT, isotropic (cubic voxel) three-dimensional imaging ofThe introduction of spiral multislice or multidetector CT (MSCT) has led to significant results in coronary diagnostic imaging. In fact with MSCT, isotropic (cubic voxel) three-dimensional imaging of large volumes (e.g. the entire cardiac volume) was possible in a single breath-hold. Moreover, with dedicated reconstruction algorithms, temporal resolution and scannable volume could be optimized, limiting the artifacts associated with the spiral technique. The quantification of calcium deposits in the coronary walls and, in particular, the morphologic study of these vessels represent an important challenge to this technique. Multislice CT with retrospective gating is now a relevant diagnostic instrument in coronary heart disease; however only most recent CT devices with 16 rows of detectors enable a real solution of problems of spatial (isotropic, submillimetric imaging) and temporal (< 0.5 s rotation time) required for correct identification of stenosis and plaque characterization, which are the two main goals of noninvasive coronary imaging.

• Lung metastases from rectal adenocarcinoma: about the best diagnostic strategy.

  Authors: Giancarlo Savino, Alessandra Di Veronica, Francesca Martina, Arianna Bellitti, Massimo Basile, Giuseppina Cozza, Paolo Campioni

  Rays. 29(2):167-74.

  A case of suspected lung metastases from colorectal adenocarcinoma is discussed. A diagnostic approach for follow-up of resected patients is proposed. It includes available diagnostic imaging for theA case of suspected lung metastases from colorectal adenocarcinoma is discussed. A diagnostic approach for follow-up of resected patients is proposed. It includes available diagnostic imaging for the characterization of metastatic pulmonary nodules together with methods for the differential diagnosis between primary malignant nodules and benign nodules.