Lorenzo Bonomo

Publications of Lorenzo Bonomo

• Hepatic veins in presurgical planning of hepatic resection: what a radiologist should know.

  Authors: Brunella Barbaro, Giovanna Soglia, Giuseppe Alvaro, Maria Vellone, Felice Giuliante, Gennaro Nuzzo, Lorenzo Bonomo

  Abdominal imaging. 05/2012;

  Hepatic resection is considered to be feasible when all malignant nodules can be technically excised. The goal of the surgical approach is to optimize the oncologic resection (negative margins),Hepatic resection is considered to be feasible when all malignant nodules can be technically excised. The goal of the surgical approach is to optimize the oncologic resection (negative margins), sparing the non-cancerous hepatic parenchyma. The outflowing hepatic vein (HV) of that particular liver remnant must be intact in order to preserve its function. The purpose of this article is to familiarize radiologists with anatomy and anatomical variants of HVs, with special emphasis on segmental venous drainage for presurgical planning of hepatic resections. We focus on information which radiologist should give to hepatic surgeon to choose proper surgical approach. Radiologist's familiarity with the anatomy and anatomical variants of HVs is essential for accurate surgical planning to avoid venous congestion as postoperative complication. Any clinically important hepatic vein variation detected on presurgical imaging should be carefully recorded in the radiology report.

• (18)F-Fluorodeoxyglucose positron emission tomography in evaluating treatment response to imatinib or other drugs in gastrointestinal stromal tumors: a systematic review.

  Authors: Giorgio Treglia, Paoletta Mirk, Antonella Stefanelli, Vittoria Rufini, Alessandro Giordano, Lorenzo Bonomo

  Clinical imaging. 05/2012; 36(3):167-75.

  To systematically review the role of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) in evaluating treatment response to imatinib or other drugs in gastrointestinal stromalTo systematically review the role of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) in evaluating treatment response to imatinib or other drugs in gastrointestinal stromal tumors (GIST). A comprehensive literature search of published studies through February 2011 in PubMed/MEDLINE and EMBASE databases was performed. We identified 19 studies including 628 patients with GIST. Main findings of included studies are presented. (18)F-FDG PET has a significant value in assessing treatment response to imatinib or other drugs in GIST patients. (18)F-FDG PET allows an early assessment of treatment response and is a strong predictor of clinical outcome.

• 18F-fluoro-deoxy-glucose focal uptake in very small pulmonary nodules: fact or artifact? Case reports.

  Authors: Maria Lucia Calcagni, Silvia Taralli, Fabio Maggi, Vittoria Rufini, Giorgio Treglia, Lucia Leccisotti, Lorenzo Bonomo, Alessandro Giordano

  World journal of surgical oncology. 04/2012; 10(1):71.

  ABSTRACT: BACKGROUND: F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolicABSTRACT: BACKGROUND: F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolic characterization of undetermined solid pulmonary nodules. The diagnostic performance of 18F-FDG is similar for nodules measuring at least 1 cm and for larger masses, but few data exist for nodules smaller than 1 cm. CASE PRESENTATION: We report five cases of oncologic patients showing focal lung 18F-FDG uptake on PET-CT in nodules smaller than 1 cm. We also discuss the most common causes of 18F-FDG false-positive and false-negative results in the pulmonary parenchyma. In patient 1, contrast-enhanced CT performed 10 days before PET-CT did not show any abnormality in the site of uptake; in patient 2, high-resolution CT performed 1 month after PET showed a bronchiole filled with dense material interpreted as a mucoid impaction; in patient 3, contrast-enhanced CT performed 15 days before PET-CT did not identify any nodules; in patients 4 and 5, contrast-enhanced CT revealed a nodule smaller than 1 cm which could not be characterized. The 18F-FDG uptake at follow-up confirmed the malignant nature of pulmonary nodules smaller than 1 cm which were undetectable, misinterpreted, not recognized or undetermined at contrast-enhanced CT. CONCLUSION: In all five oncologic patients, 18F-FDG was able to metabolically characterize as malignant those nodules smaller than 1 cm, underlining that: 18F-FDG uptake is not only a function of tumor size but it is strongly related to the tumor biology; functional alterations may precede morphologic abnormalities. In the oncologic population, especially in higher-risk patients, PET can be performed even when the nodules are smaller than 1 cm, because it might give an earlier characterization and, sometimes, could guide in the identification of alterations missed on CT.

• Clinical applications of (18)F-FDG PET in the management of hepatobiliary and pancreatic tumors.

  Authors: Anna Maria De Gaetano, Vittoria Rufini, Paola Castaldi, Anna Maria Gatto, Laura Filograna, Alessandro Giordano, Lorenzo Bonomo

  Abdominal imaging. 04/2012;

  The assessment of hepatobiliary and pancreatic tumors is commonly achieved by ultrasound, computed tomography (CT), and magnetic resonance. The 2-[fluorine-18]fluoro-2-deoxy-D: -glucose (FDG)The assessment of hepatobiliary and pancreatic tumors is commonly achieved by ultrasound, computed tomography (CT), and magnetic resonance. The 2-[fluorine-18]fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography (PET) detects increased glucose metabolism associated with neoplastic lesions, provides high accuracy in most cancer imaging applications and is now widely used in clinical practice. However, PET is not always useful and accurate knowledge of appropriate indications is essential for a proper clinical management. (18)F-FDG is transported into cells and phosphorylated by the enzyme hexokinase to (18)F-FDG-6-phosphate, which cannot proceed down the glycolytic pathway and therefore is accumulated in the malignant tissue. PET allows accurate quantification of FDG uptake in tissue, and previous studies have demonstrated that standardized uptake values provide highly reproducible parameters of tumor glucose use (Weber et al., J Nucl Med 40:1771-1777, 1999). The recent development and diffusion of hybrid PET-CT scanners allows functional and anatomic data to be obtained in a single examination, improving lesion localization and resulting in significant diagnostic improvement (Wahl, J Nucl Med 45:82S-95S, 2004). Moreover, CT can be performed diagnostically with the use of intravenous and oral contrast and simultaneous PET-contrast-enhanced CT scanning appears to be an efficient method in cancer evaluation. However, in most centers, a low-dose CT is routinely performed without contrast media infusion.Proper patient preparation, scanning protocol, combined assessment of PET and CT data, and the evaluation of conventional imaging findings are essential to define disease and to avoid diagnostic pitfalls. The role of PET and PET-CT in malignancies of the liver, biliary tract, and pancreas is here reviewed; normal patterns, representative cases, and common pitfalls are also presented.

• Role of PET/CT in the functional imaging of endocrine pancreatic tumors.

  Authors: Vittoria Rufini, Richard P Baum, Paola Castaldi, Giorgio Treglia, Anna Maria De Gaetano, Cecilia Carreras, Daniel Kaemmerer, Merten Hommann, Dieter Hörsch, Lorenzo Bonomo, Alessandro Giordano

  Abdominal imaging. 03/2012;

  Endocrine pancreatic tumors (EPTs) are a heterogeneous group of neoplasms with variable clinical and biological features and prognosis, ranging from very slow-growing tumors to highly aggressive andEndocrine pancreatic tumors (EPTs) are a heterogeneous group of neoplasms with variable clinical and biological features and prognosis, ranging from very slow-growing tumors to highly aggressive and very malignant ones. As other neuroendocrine tumors, EPTs are characterized by the presence of neuroamine uptake mechanisms and/or peptide receptors at the cell membrane and these features constitute the basis of the clinical use of specific radiolabeled ligands, both for imaging and therapy. The more widespread use of hybrid machines, i.e., positron emission tomography/computed tomography (PET/CT), allows to perform imaging with high resolution and high diagnostic accuracy especially for small lesions, and to correlate anatomic location with function. The recent WHO recommendations for classification and prognostic factors help the selection of tracers likely to show a positive image on PET; therefore, tracers exploiting specific metabolic patterns ((18)F-DOPA and (11)C-5-HTP) or specific receptor expression ((68)Ga-DOTA-peptides) are suited to well-differentiated tumors, while the use of (18)F-FDG is preferred for poorly-differentiated neoplasms with high proliferative activity and loss of neuroendocrine features. In differentiated EPTs, (11)C-5-HTP performs better than (18)F-DOPA even though its use is hampered by its complex production and limited availability and experience; (68)Ga-peptides are indicated for all type of gastroenteropancreatic (GEP) neuroendocrine tumors, regardless of their functional activity. In addition, (68)Ga-DOTA-peptides play a distinctive role in planning peptide receptor radionuclide therapy.

• Integrated imaging of non-small cell lung cancer recurrence: CT and PET-CT findings, possible pitfalls and risk of recurrence criteria.

  Authors: Andrea Caulo, Saeed Mirsadraee, Fabio Maggi, Lucia Leccisotti, Edwin J R van Beek, Lorenzo Bonomo

  European radiology. 03/2012; 22(3):588-606.

  To review the role of imaging in the diagnosis of recurrent disease in previously treated non-small cell lung cancer (NSCLC) and discuss the imaging pitfalls. A comprehensive review of publishedTo review the role of imaging in the diagnosis of recurrent disease in previously treated non-small cell lung cancer (NSCLC) and discuss the imaging pitfalls. A comprehensive review of published literature on CT and PET imaging of NSCLC recurrence was performed. Diagnostic and prognostic values are discussed. Representative imaging examples are illustrated. Up to 30% of NSCLC recurrences present as loco-regional, involving treated hemithorax and ipsilateral lymph nodes, while 70% present as metachronous distant metastases. CT and PET-CT play an important role in the early detection of recurrence; indications for imaging vary depending on pathological features. Imaging plays a central role in the identification of recurrence and may predict prognosis. Lung cancer recurs after surgery in 30% to 75% of patients. CT and PET-CT are crucial in identification of loco-regional recurrence. Knowledge of potential pitfalls is essential, especially for parenchymal or nodal recurrence. CT can diagnose metastases but further examinations (PET-CT, MRI) are often needed. Morphological and functional imaging criteria may help in predicting recurrence.

• Low-Dose Multidetector CT Angiography in the Evaluation of Infrarenal Aorta and Peripheral Arterial Occlusive Disease.

  Authors: Roberto Iezzi, Marco Santoro, Riccardo Marano, Carmine Di Stasi, Roberta Dattesi, Miles Kirchin, Giovanni Tinelli, Francesco Snider, Lorenzo Bonomo

  Radiology. 02/2012; 263(1):287-98.

  Purpose:To investigate the ionizing radiation dose, image quality, and diagnostic performance of computed tomographic (CT) angiography of the peripheral arteries with three different CT angiographicPurpose:To investigate the ionizing radiation dose, image quality, and diagnostic performance of computed tomographic (CT) angiography of the peripheral arteries with three different CT angiographic acquisition protocols, with use of pretreatment digital subtraction angiography (DSA) as the reference standard.Materials and Methods:The study was approved by the institutional review board and performed in agreement with the 1990 Declaration of Helsinki and subsequent amendments. Each patient provided informed consent before undergoing CT. The authors performed a prospective, single-center, randomized comparison of three different x-ray exposure CT acquisition protocols in 60 randomized patients with peripheral arterial occlusive disease referred for 64-section multidetector CT angiography of the lower limb (0.625-mm collimation, intravenous administration of 100 mL of iomeprol [400 mg iodine per milliliter] at 4 mL/sec). The acquisition protocols were performed with (a) 120 kVp and a noise index of 26 (moderate noise reduction [MNR]), referred to as the 120-kVp MNR group; (b) 80 kVp and a noise index of 26, referred to as the 80-kVp MNR group; and (c) 80 kVp and a noise index of 30 (high noise reduction [HNR]), referred to as the 80-kVp HNR group. Axial and three-dimensional (3D) images were qualitatively and quantitatively compared by using the overall F test and pairwise comparisons. The x(2) test was used to compare the three protocols in terms of diagnostic performance in patients who also underwent DSA before an interventional procedure.Results:Significantly higher attenuation values were obtained in the vessels with the 80-kVp MNR and 80-kVp HNR acquisition protocols. No significant differences were noted in terms of image quality with either axial source images or 3D reconstructions. Likewise, no significant differences were found among the three protocols in terms of noise throughout the peripheral vasculature. Finally, no significant differences were found among the three groups with regard to diagnostic performance. Overall dose reductions of 48% and 61% were obtained for the 80-kVp MNR and 80-kVp HNR protocols, respectively.Conclusion:Substantial reductions of radiation dose are achievable at multidetector CT angiography of the peripheral arteries without compromising image quality and diagnostic performance if acquisition protocols are modified appropriately and used in conjunction with a contrast material containing a high concentration of iodine.© RSNA, 2012Supplemental material:http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110700/-/DC1.

• Characterization of microvascular and myocardial damage within perfusion defect area at myocardial contrast echocardiography in the subacute phase of myocardial infarction.

  Authors: Leonarda Galiuto, Gabriella Locorotondo, Lazzaro Paraggio, Alberto R De Caterina, Antonio M Leone, Elisa Fedele, Sabrina Barchetta, Italo Porto, Luigi Natale, Antonio G Rebuzzi, Lorenzo Bonomo, Filippo Crea

  European heart journal cardiovascular Imaging. 02/2012; 13(2):174-80.

  The anatomical correlates of perfusion defect (PD) at myocardial contrast echocardiography (MCE) in the subacute phase of ST-elevation myocardial infarction (STEMI) are currently unknown. The studyThe anatomical correlates of perfusion defect (PD) at myocardial contrast echocardiography (MCE) in the subacute phase of ST-elevation myocardial infarction (STEMI) are currently unknown. The study aimed at assessing whether, in the subacute phase of STEMI, within MCE PD microvessels are anatomically damaged or if some vasodilation can be still elicited and if the PD correlates with the extent of myocardial necrosis. Twenty-two post-percutaneous coronary intervention (PCI) patients underwent MCE 7 ± 1 days after STEMI, at baseline and after adenosine (ADN) administration. An area of completely non-opacified myocardium, corresponding to the area of the PD, was quantitated by planimetry. The area of the PD on MCE was compared with biochemical and imaging measures of myocardial necrosis: cardiac Troponin T peak (cTnT peak) and hyperenhanced area at gadolinium-enhanced cardiac magnetic resonance (Gd-CMR), respectively. After vasodilator stimulus, the area of the PD remained significantly unchanged when compared with the baseline value (P = 0.09 vs. baseline). The MCE index correlated at baseline with cTnT peak and Gd-CMR assessments of myocardial necrosis (P < 0.001). Also after ADN infusion, correlations between PD and extent of myocardial necrosis were similar to that assessed at baseline. When assessed in the subacute phase of STEMI, the extent of the PD on MCE represents an area of both myocardial and microvascular necrosis.

• Ileal Crohn's disease: CEUS determination of activity.

  Authors: Antonio De Franco, Manuela Marzo, Carla Felice, Daniela Pugliese, Alessandra Di Veronica, Lorenzo Bonomo, Alessandro Armuzzi, Luisa Guidi

  Abdominal imaging. 01/2012;

  Transabdominal ultrasound is currently accepted as a clinical first-line tool in the assessment of Crohn's disease activity. During recent years, great improvements have been achieved in ultrasoundTransabdominal ultrasound is currently accepted as a clinical first-line tool in the assessment of Crohn's disease activity. During recent years, great improvements have been achieved in ultrasound examination with the introduction of high-frequency transducers, ultrasonographic microbubble contrast agents, and dedicated contrast-specific ultrasound software. Therefore, contrast-enhanced ultrasonography (CEUS) is emerging as one of the most important imaging techniques in the diagnosis and follow-up of patients with ileal Crohn's disease. It is non-invasive and non-ionizing, easily repeatable, well-tolerated by patients and has significant diagnostic accuracy. Moreover, the possibility to monitor response to therapies, describing, and quantifying contrast enhancement behavior by specific software, represents an interesting aspect of its utilization, considering the still open questions about the correct use of immunosuppressive and biological agents. The aim of our review is to provide an updated overview of the role of CEUS in the patients who have an ileal localization of Crohn's disease, defining its qualitative and quantitative features.

• Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity.

  Authors: Antonio De Franco, Alessandra Di Veronica, Alessandro Armuzzi, Italia Roberto, Manuela Marzo, Barbara De Pascalis, Italo De Vitis, Alfredo Papa, Enrico Bock, Francesco M Danza, Lorenzo Bonomo, Luisa Guidi

  Radiology. 12/2011; 262(2):680-8.

  To quantitatively assess microvascular activation in the thickened ileal walls of patients with Crohn disease (CD) by using contrast-enhanced ultrasonography (US) and evaluate its correlation withTo quantitatively assess microvascular activation in the thickened ileal walls of patients with Crohn disease (CD) by using contrast-enhanced ultrasonography (US) and evaluate its correlation with widely used indexes of CD activity. This prospective study was approved by the ethics committee, and written informed consent was obtained from all patients. The authors examined 54 consecutively enrolled patients (mean age, 35.29 years; age range, 18-69 years; 39 men, 15 women) with endoscopically confirmed CD of the terminal ileum. Ileal wall segments thicker than 3 mm were examined with low-mechanical-index contrast-enhanced US and a second-generation US contrast agent. The authors analyzed software-plotted time-enhancement intensity curves to determine the maximum peak intensity (MPI) and wash-in slope coefficient (β) and evaluated their correlation with (a) the composite index of CD activity (CICDA), (b) the CD activity index (CDAI), and (c) the simplified endoscopic score for CD (SES-CD, evaluated in 37 patients) for the terminal ileum. Statistical analysis was performed with the Mann-Whitney test, Spearman rank test, and receiver operating characteristic (ROC) analysis. MPI and β coefficients were significantly increased in the 36 patients with a CICDA indicative of active disease (P<.0001 for both), the 33 patients with a CDAI of at least 150 (P<.032 and P<.0074, respectively), and the 26 patients with an SES-CD of at least 1 (P<.0001 and P<.002, respectively). ROC analysis revealed accurate identification (compared with CICDA) of active CD with an MPI threshold of 24 video intensity (VI) (sensitivity, 97%; specificity, 83%) and a β coefficient of 4.5 VI/sec (sensitivity, 86%; specificity, 83%). Contrast-enhanced US of the ileal wall is a promising method for objective, reproducible assessment of disease activity in patients with ileal CD.

• Improvement of multislice oxygen-enhanced MRI of the lung by fully automatic non-rigid image registration.

  Authors: Francesco Molinari, Grzegorz Bauman, Guglielmo Paolantonio, Tobias Geisler, Bernhard Geiger, Lorenzo Bonomo, Hans-Ulrich Kauczor, Michael Puderbach

  European journal of radiology. 11/2011;

  PURPOSE: In oxygen-enhanced magnetic resonance imaging of the lung (O2-MRI), motion artifacts related to breathing hamper the quality of the parametric O2-maps. In this study, fully automaticPURPOSE: In oxygen-enhanced magnetic resonance imaging of the lung (O2-MRI), motion artifacts related to breathing hamper the quality of the parametric O2-maps. In this study, fully automatic non-rigid image registration was assessed as a post-processing method to improve the quality of O2-MRI. MATERIALS AND METHODS: Twenty healthy volunteers were investigated on a 1.5T MR system. O2-MRI was obtained in four coronal sections using an IR-HASTE sequence with TE/TI of 12/1200ms. Each section was repeatedly imaged during oxygen and room-air ventilation. Spatial differences among the images were corrected by fully automatic non-rigid registration. Signal variability, relative enhancement ratio between oxygen and room air images, and spatial heterogeneity of lung enhancement were assessed before and after image registration. RESULTS: Motion artifacts were corrected in 5-10s. Non-rigid registration reduced signal variability of the source images and heterogeneity of the O2-maps by 1.1±0.2% and 11.2±2.9%, respectively (p<0.0001). Registration did not influence O2 relative enhancement ratio (p=0.06). CONCLUSION: Fully automatic non-rigid image registration improves the quality of multislice oxygen-enhanced MRI of the lung.

• Diffusion-Weighted Magnetic Resonance Imaging in Monitoring Rectal Cancer Response to Neoadjuvant Chemoradiotherapy.

  Authors: Brunella Barbaro, Renata Vitale, Vincenzo Valentini, Sonia Illuminati, Fabio M Vecchio, Gianluca Rizzo, Maria Antonietta Gambacorta, Claudio Coco, Antonio Crucitti, Roberto Persiani, Luigi Sofo, Lorenzo Bonomo

  International journal of radiation oncology, biology, physics. 11/2011;

  PURPOSE: To prospectively monitor the response in patients with locally advanced nonmucinous rectal cancer after chemoradiotherapy (CRT) using diffusion-weighted magnetic resonance imaging. ThePURPOSE: To prospectively monitor the response in patients with locally advanced nonmucinous rectal cancer after chemoradiotherapy (CRT) using diffusion-weighted magnetic resonance imaging. The histopathologic finding was the reference standard. METHODS AND MATERIALS: The institutional review board approved the present study. A total of 62 patients (43 men and 19 women; mean age, 64 years; range, 28-83) provided informed consent. T(2)- and diffusion-weighted magnetic resonance imaging scans (b value, 0 and 1,000 mm(2)/s) were acquired before, during (mean 12 days), and 6-8 weeks after CRT. We compared the median apparent diffusion coefficients (ADCs) between responders and nonresponders and examined the associations with the Mandard tumor regression grade (TRG). The postoperative nodal status (ypN) was evaluated. The Mann-Whitney/Wilcoxon two-sample test was used to evaluate the relationships among the pretherapy ADCs, extramural vascular invasion, early percentage of increases in ADCs, and preoperative ADCs. RESULTS: Low pretreatment ADCs (<1.0 × 10(-3)mm(2)/s) were correlated with TRG 4 scores (p = .0011) and associated to extramural vascular invasion with ypN+ (85.7% positive predictive value for ypN+). During treatment, the mean percentage of increase in tumor ADC was significantly greater in the responders than in the nonresponders (p < .0001) and a >23% ADC increase had a 96.3% negative predictive value for TRG 4. In 9 of 16 complete responders, CRT-related tumor downsizing prevented ADC evaluations. The preoperative ADCs were significantly different (p = .0012) between the patients with and without downstaging (preoperative ADC ≥1.4 × 10(-3)mm(2)/s showed a positive and negative predictive value of 78.9% and 61.8%, respectively, for response assessment). The TRG 1 and TRG 2-4 groups were not significantly different. CONCLUSION: Diffusion-weighted magnetic resonance imaging seems to be a promising tool for monitoring the response to CRT.

• Diagnostic accuracy of ¹⁸F-FDG-PET and PET/CT in patients with Ewing sarcoma family tumours: a systematic review and a meta-analysis.

  Authors: Giorgio Treglia, Marco Salsano, Antonella Stefanelli, Maria Vittoria Mattoli, Alessandro Giordano, Lorenzo Bonomo

  Skeletal radiology. 11/2011; 41(3):249-56.

  To systematically review and meta-analyse literature data on the diagnostic performance of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) and positron emissionTo systematically review and meta-analyse literature data on the diagnostic performance of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) in patients with Ewing sarcoma family tumours (ESFT). PubMed/MEDLINE, Embase and Scopus databases were searched for articles that evaluated FDG-PET and PET/CT in patients with ESFT from inception to 31 May 2011. Studies that fulfilled the three following criteria were included in the systematic review: FDG-PET or PET/CT performed in patients with ESFT; articles about the diagnostic accuracy of FDG-PET and PET/CT; sample size of at least 10 patients with ESFT were included. Studies in which there were sufficient data to reassess sensitivity and specificity of FDG-PET or PET/CT in ESFT were included in the meta-analysis, excluding duplicate publications. Finally, pooled sensitivity, pooled specificity and area under the receiver operating characteristic (ROC) curve of FDG-PET or PET/CT in ESFT were calculated. We found 13 studies comprising a total of 342 patients with ESFT. The main findings of the studies included are presented. The meta-analysis of five selected studies provided these results about FDG-PET and PET/CT in ESFT: pooled sensitivity: 96% (95% confidence interval [CI] 91-99%); pooled specificity: 92% (95% CI 87-96%); area under the ROC curve: 0.97. With regard to the staging and restaging of patients with ESFT, the sensitivity, specificity and accuracy of FDG-PET and PET/CT are high; the combination of FDG-PET or PET/CT with conventional imaging is a valuable tool for the staging and restaging of ESFT and has a relevant impact on the treatment strategy plan.

• Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit.

  Authors: Alessandro Pedicelli, Tommaso Verdolotti, Angelo Pompucci, Flora Desiderio, Francesco D'Argento, Cesare Colosimo, Lorenzo Bonomo

  Skeletal radiology. 10/2011; 40(12):1595-601.

  The aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology duringThe aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology during percutaneous extra-vascular spinal procedures performed in the angiography suite. We used a 3D rotational angiographic unit with a flat panel detector. MPR images were obtained from a rotational acquisition of 8 s (240 images at 30 fps), tube rotation of 180° and after post-processing of 5 s by a local work-station. Multislice CT (MSCT) is the best guidance system for spinal approaches permitting direct tomographic visualization of each spinal structure. Many operators, however, are trained with fluoroscopy, it is less expensive, allows real-time guidance, and in many centers the angiography suite is more frequently available for percutaneous procedures. We present our 6-year experience in fluoroscopy-guided spinal procedures, which were performed under different conditions using MPR images. We illustrate cases of vertebroplasty, epidural injections, selective foraminal nerve root block, facet block, percutaneous treatment of disc herniation and spine biopsy, all performed with the help of MPR images for guidance and control in the event of difficult or anatomically complex access. The integrated use of "CT-like" MPR images allows the execution of spinal procedures under fluoroscopy guidance alone in all cases of dorso-lumbar access, with evident limitation of risks and complications, and without need for recourse to MSCT guidance, thus eliminating CT-room time (often bearing high diagnostic charges), and avoiding organizational problems for procedures that need, for example, combined use of a C-arm in the CT room.

• Atlantoepistrophic magnetic resonance imaging involvement in early rheumatoid arthritis: an aggressive tight control therapy not fully arresting the disease.

  Authors: Angelo Zoli, Silvia Bosello, Nicola Magarelli, Graziella D'Antona, Rosanna Amelia, Annalaura Fedele, Giusy Peluso, Lorenzo Bonomo, Gianfranco Ferraccioli

  Arthritis care & research. 09/2011; 63(11):1629-33.

  Rheumatoid arthritis (RA) is the most common inflammatory disorder affecting the cervical spine. The purpose of this study was to characterize the atloaxial involvement with magnetic resonanceRheumatoid arthritis (RA) is the most common inflammatory disorder affecting the cervical spine. The purpose of this study was to characterize the atloaxial involvement with magnetic resonance imaging (MRI) in patients with early RA at the moment of diagnosis and after 18 months of a tight control therapy. Twenty consecutive patients with early RA without cervical symptoms and 20 healthy controls were enrolled. The patients underwent unenhanced and enhanced gadolinium MRI study of the upper cervical spine at diagnosis and after 18 months of therapy. The presence of pannus tissue at MRI was considered active synovitis. Five (25%) of the 20 patients presented craniocervical involvement with active synovitis at MRI. At onset, patients with cervical involvement presented higher levels of erythrocyte sedimentation rate, a higher swollen joint count, and a higher Disease Activity Score in 44 joints level. All 5 patients (100%) with cervical involvement presented already peripheral erosions. After 18 months, 1 of 5 patients with atloepistrophic synovial involvement at baseline presented complete regression of the enhancement of synovial periodontoid process, and 1 presented a decrease of this enhancement. None of the patients developed erosive process at the odontoid. The only patient with complete regression of the enhancement presented a very early disease (<3 months). Our study demonstrates involvement of the atloaxial junction in 25% of early RA patients, in particular in patients with active and erosive arthritis. An early diagnosis and aggressive treatment with a combination therapy, aiming for remission, does not always reduce atlantoaxial synovitis.

• Diffusion-weighted imaging in evaluating the response to neoadjuvant breast cancer treatment.

  Authors: Paolo Belli, Melania Costantini, Carmine Ierardi, Enida Bufi, Daniele Amato, Antonino Mule, Luigia Nardone, Daniela Terribile, Lorenzo Bonomo

  The breast journal. 09/2011; 17(6):610-9.

  The aim of this study was to investigate the role of diffusion imaging in the evaluation of response to neoadjuvant breast cancer treatment by correlating apparent diffusion coefficient (ADC) valueThe aim of this study was to investigate the role of diffusion imaging in the evaluation of response to neoadjuvant breast cancer treatment by correlating apparent diffusion coefficient (ADC) value changes with pathological response. From June 2007 to June 2009, all consecutive patients with histopathologically confirmed breast cancer undergoing neoadjuvant chemotherapy were enrolled. All patients underwent magnetic resonance imaging (MRI) (including diffusion sequence) before and after neoadjuvant treatment. The ADC values obtained using two different methods of region of interest (ROI) placement before and after treatment were compared with MRI response (assessed using RECIST 1.1 criteria) and pathological response (assessed using Mandard's classification). Fifty-one women (mean age 48.41 years) were included in this study. Morphological MRI (RECIST classification) well evaluated the responder status after chemotherapy (TRG class; area-under-the-curve 0.865). Mean pretreatment ADC values obtained with the two different methods of ROI placement were 1.11 and 1.02 × 10(-3) mm(2) /seconds. Mean post-treatment ADC values were 1.40 and 1.35 × 10(-3) mm(2) /seconds, respectively. A significant inverse correlation between mean ADC increase and Mandard's classifications was observed for both the methods of ADC measurements. Diagnostic performance analysis revealed that the single ROI method has a superior diagnostic accuracy compared with the multiple ROIs method (accuracy: 82% versus 74%). The coupling of the diffusion imaging with the established morphological MRI provides superior evaluation of response to neoadjuvant chemotherapy treatment in breast cancer patients compared with morphological MRI alone. There is a potential in the future to optimize patient therapy on the basis of ADC value changes. Additional works are needed to determine whether these preliminary observed changes in tumor diffusion are a universal response to tumor cell death, and to more fully delineate the ability of ADC value changes in early recognizing responder from nonresponder patients.

• Usefulness of fluorine-18 fluorodeoxyglucose PET/computed tomography in diagnosis of aortitis and treatment response evaluation in a patient with aortic prosthesis.

  Authors: Giorgio Treglia, Fabio Maggi, Lorenzo Bonomo, Alessandro Giordano

  Journal of cardiovascular medicine (Hagerstown, Md.). 09/2011; 12(11):814-6.

  We report the case of an 82-year-old man with aortic prosthesis inflammation in whom fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography has been useful in theWe report the case of an 82-year-old man with aortic prosthesis inflammation in whom fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography has been useful in the detection of the cause of fever of unknown origin. We also describe the correlation between decrease of FDG uptake in the vascular prosthesis after treatment and clinical improvement with normalization of the serological levels of inflammatory markers.

• Sonographic assessment of abdominal vein dimensional and hemodynamic changes induced in human volunteers by a model of abdominal hypertension.

  Authors: Franco Cavaliere, Alessandro Cina, Daniele Biasucci, Roberta Costa, Maurizio Soave, Riccardo Gargaruti, Lorenzo Bonomo, Rodolfo Proietti

  Critical care medicine. 08/2011; 39(8):2017.

• Quantitative Blush Evaluator accurately quantifies microvascular dysfunction in patients with ST-elevation myocardial infarction: comparison with cardiovascular magnetic resonance.

  Authors: Italo Porto, Christian Hamilton-Craig, Giovanni Luigi De Maria, Rocco Vergallo, Giorgio Cautilli, Leonarda Galiuto, Francesco Burzotta, Antonio Maria Leone, Giampaolo Niccoli, Luigi Natale, Lorenzo Bonomo, Filippo Crea

  American heart journal. 08/2011; 162(2):372-381.e2.

  After ST-elevation myocardial infarction (STEMI), microvascular obstruction (MVO) can be assessed using semiquantitative angiographic "blush" scores subject to interoperator variability. QuantitativeAfter ST-elevation myocardial infarction (STEMI), microvascular obstruction (MVO) can be assessed using semiquantitative angiographic "blush" scores subject to interoperator variability. Quantitative Blush Evaluator (QuBE) is a free computer-calculated algorithm that evaluates myocardial blush on a continuous scale with improved reproducibility. We aimed to compare QuBE with cardiovascular magnetic resonance (CMR) in detecting MVO and its severity. Fifty-two STEMI treated with successful primary percutaneous coronary intervention were enrolled. Quantitative Blush Evaluator and electrocardiographic sum ST-segment resolution were blindly calculated. All patients underwent CMR 4 to 7 days after STEMI for assessment of infarct size (IS), myocardial salvage index, MVO (both as first-pass MVO and delayed-enhancement MVO [DE-MVO]), and presence of intramyocardial hemorrhage on T2-weighted sequences. Quantitative Blush Evaluator values were inversely related to IS (R = -0.4, P = .008), DE-MVO (R = -0.7, P < .001), and first-pass MVO (R = -0.4, P = .002) and positively related to myocardial salvage index (R = 0.4, P = .007). Moreover, patients with intramyocardial hemorrhage had significantly lower QuBE values (3.9, 3.5-8.0 vs 12.2, 8.2-16.0, P = .001) than those without. At receiver operating characteristic curve analysis, QuBE accounted for an area under the curve of 0.88 (95% CI 0.7-0.9, P = .001) for both DE-MVO and hemorrhage detection and performed significantly better than ST resolution. Quantitative Blush Evaluator score correlates with IS and microvascular dysfunction by CMR and can be considered as an accurate tool for the assessment of MVO in clinical practice. Quantitative Blush Evaluator is a useful quantitative angiographic technique for the assessment of myocardial reperfusion after STEMI.

• The timing of natural menopause after uterine fibroid embolization: a prospective cohort study.

  Authors: Giovanna Tropeano, Sonia Amoroso, Carmine di Stasi, Giuseppe Vizzielli, Lorenzo Bonomo, Giovanni Scambia

  Fertility and sterility. 07/2011; 96(4):980-4.

  To determine whether uterine fibroid embolization before the age of 45 years advances the timing of natural menopause. Prospective cohort study. University tertiary-care center. Forty-three regularlyTo determine whether uterine fibroid embolization before the age of 45 years advances the timing of natural menopause. Prospective cohort study. University tertiary-care center. Forty-three regularly cycling women aged 35-44 years who underwent embolization and 43 age-matched control subjects. Annual assessments of menopausal status using prospectively recorded menstrual diaries and hormonal (serum FSH and E(2)) and ultrasound measures (ovarian volume and antral follicle count). Women were followed for 7 years or until they reached menopause. Age at menopause as computed by subtracting the date of birth from the exact date of the last menstrual period. Over the study period, 9 patients (25%) and 12 control subjects (33%) became menopausal, 19 patients (53%) and 18 control subjects (50%) entered the menopausal transition (irregular cycles), and 8 patients (22%) and 6 control subjects (17%) continued to menstruate regularly. Mean menopausal age in the embolization group (48.94 ± 2.48 years) was not significantly different from that in the control group (49.52 ± 1.25 years). There was no significant difference of menopause occurrence between the groups. Longitudinal changes in hormonal and ultrasound measures were similar for the two groups. This long-term follow-up study found no evidence for fibroid embolization advancing the timing of menopause in women before the age of 45 years.