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ABSTRACT: Malignant pheochromocytomas respond to chemotherapy with a reduction in tumor size and catecholamine secretion. We investigated the usefulness of molecular imaging with meta-iodobenzylguanidine (MIBG) for evaluating the effects of chemotherapy in patients with malignant pheochromocytoma. Six patients were studied before and after 6 ± 4 months of combination chemotherapy with cyclophosphamide, vincristine, and dacarbazine. Urinary catecholamines, metanephrines, and vanillylmandelic acid (VMA) levels were measured before and after chemotherapy. [(131)I]MIBG uptake was calculated for each tumor lesion on images before and after chemotherapy. An intensity ratio (IR) of abnormal to normal tissue count density was used to evaluate the change in lesion activity with therapy. Urinary catecholamines, metanephrines, and VMA significantly decreased with chemotherapy. MIBG uptake decreased in most lesions and the reduction in overall IR correlated with the reduction in urinary VMA. However, the change in individual lesions was variable and MIBG IR did not change or increased in a number of lesions. In conclusion, MIBG imaging is useful in the evaluation of patients with malignant pheochromocytoma who are receiving chemotherapy. It can provide not only a measure of overall effectiveness of treatment but also allows a lesion-by-lesion evaluation of the heterogeneity of response to chemotherapy.
Cancer Imaging 01/2013; 13(2):155-161. · 1.50 Impact Factor
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The Breast Journal 10/2012; · 1.64 Impact Factor
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ABSTRACT: We compared metaiodobenzylguanidine (MIBG) uptake and magnetic resonance (MR) signal intensity ratio in differentiating benign and malignant disease in patients with pheochromocytoma or paraganglioma.
Eighteen patients (9 men, mean age 37 ± 8 years) with pheochromocytoma or paraganglioma underwent MR imaging and iodine-131 MIBG scintigraphy. MR signal intensity ratio was measured on T1 and T2-weighted images using region of interest analysis and intensity ratio of MIBG uptake was calculated for each tumor lesion on 48 h images.
A total of 28 tumor lesions was analyzed of which 12 were benign and 16 malignant. MIBG uptake intensity ratio was significantly higher in malignant lesions compared to benign (5.2 ± 2.4 and 2.9 ± 1.4, respectively, p < 0.01). On the contrary, no significant difference in tumor size and MR signal intensity ratio between malignant and benign tumor lesions was observed.
In patients with pheochromocytoma or paraganglioma, iodine-131 MIBG uptake is able to differentiate between benign and malignant disease, while MR imaging is not useful for this purpose. The higher MIBG uptake observed in malignant lesions could reflect major tumor storage of catecholamines compared to benign lesions.
Annals of Nuclear Medicine 07/2012; 26(8):670-5. · 1.50 Impact Factor
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Pier Paolo Mainenti,
Marcello Mancini,
Ciro Mainolfi,
Luigi Camera, Simone Maurea,
Antonietta Manchia,
Michela Tanga,
Francesco Persico,
Pietro Addeo,
Dario D’Antonio,
Antonio Speranza,
Luigi Bucci,
Giovanni Persico,
Leonardo Pace,
Marco Salvatore
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ABSTRACT: BackgroundTo compare contrast-enhanced US (CE-US), multidetector-CT (MDCT), 1.5 Tesla MR with extra-cellular (Gd-enhanced) and intracellular
(SPIO-enhanced) contrast agents and PET/CT, in the detection of hepatic metastases from colorectal cancer.
Materials and methodsA total of 34 patients with colo-rectal adenocarcinoma underwent preoperatively CE-US, MDCT, Gd- and SPIO-enhanced MR imaging
(MRI), and PET/CT. Each set of images was reviewed independently by two blinded observers. The ROC method was used to analyze
the results, which were correlated with surgical findings, intraoperative US, histopathology, and MDCT follow-up.
ResultsA total of 57 hepatic lesions were identified: 11 hemangiomas, 29 cysts, 1 focal fatty liver, 16 metastases (dimensional distribution:
5/16<5mm; 3/16 between 5mm and <10mm; 8/16≥10mm). Six of 34 patients were classified as positive for the presence
of at least one metastasis. Considering all the metastases and those ≥10mm, ROC areas showed no significant differences between
Gd- and SPIO-enhanced MRI, which performed significantly better than the other modalities (P<0.05). Considering the lesions <10mm, ROC areas showed no significant differences between all modalities; however MRI
presented a trend to perform better than the other techniques. Considering the patients, ROC areas showed no significant differences
between all the modalities; however PET/CT seemed to perform better than the others.
ConclusionsGd- and SPIO-enhanced MRI seem to be the most accurate modality in the identification of liver metastases from colo-rectal
carcinoma. PET/CT shows a trend to perform better than the other modalities in the identification of patients with liver metastases.
KeywordsUS-MDCT-MRI-PET/CT-Liver metastases-Colo-rectal carcinoma
Abdominal Imaging 04/2012; 35(5):511-521. · 1.73 Impact Factor
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ABSTRACT: Imaging characterization is a frequent topic in diagnostic evaluation of patients with pancreatic cystic lesions.
We present a patient with a true pancreatic cyst with internal septation in an adult female. The presence of the internal septum should be considered in the differential diagnosis, in fact in our case CT and MR imaging findings were incorrectly suggestive of mucinous cystadenoma.
True pancreatic cyst may show septate architecture and thus for imaging characterization this feature should be considered in the differential diagnosis of cystic pancreatic masses.
JOP: Journal of the pancreas 01/2012; 13(1):83-6.
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Journal of Digestive Diseases 06/2011; 12(3):223-5. · 1.59 Impact Factor
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ABSTRACT: Nodular fasciitis is a benign reactive proliferation that usually involves the deep fascia. The rapidly growing, the abundant cellularity, and the mitotic activity noted on histology can simulate an aggressive entity, such as sarcoma. We report an uncommon case of nodular fasciitis involved the chest wall of a thirteen boy and its management, emphasizing the need to consider this lesion in the differential diagnosis of pediatric soft tissue masses.
MUSCULOSKELETAL SURGERY 04/2011; 95(3):251-3.
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ABSTRACT: To compare norcholesterol uptake and magnetic resonance (MR) signal intensity ratios (SIRs) in characterizing adrenal adenomas to differentiate hypersecreting from nonhypersecreting lesions.
We studied 34 patients (14 males and 20 females, mean age: 47±15 years) with hypersecreting (n=19) or nonhypersecreting (n=15) adrenal adenomas; all patients underwent iodine-131 norcholesterol scintigraphy and MR studies. Pathology (n=26) or follow-up data (n=8) were obtained. Imaging studies were qualitatively evaluated to calculate diagnostic accuracy of each test; radionuclide studies were also semiquantitatively evaluated using a four-point score to measure norcholesterol uptake, whereas MR scans were quantitatively assessed for measuring SIRs of adrenal lesions. Imaging data were then compared between hypersecreting and nonhypersecreting adenomas.
The diagnostic accuracies of norcholesterol (100%) and MR (95%) scans to identify adrenal adenomas were similar; however, while a significantly (P=0.01) higher norcholesterol uptake was observed in hypersecreting (2.8±0.5 cm) adenomas compared with nonhypersecreting (2.28±0.6 cm) lesions, no significant differences in SIRs were found in this comparative analysis; in this regard, no significant difference in tumor size (centimeter) occurred between hypersecreting (2.7±0.5 cm) and nonhypersecreting (3.1±0.9 cm) adenomas.
Adrenal scintigraphy using norcholesterol and MR are both able to accurately identify cortical adenomas; however, while semiquantitative analysis of norcholesterol uptake is effective to differentiate between hypersecreting and nonhypersecreting adenomas, SIRs evaluation is not useful for this purpose; in particular, the lower norcholesterol uptake observed in nonhypersecreting adenomas might reflect the normal hormone synthesis status of these lesions and, thus, regular secretion; this finding could also reflect initial adrenal dysfunction responsible for subclinical disorders.
Nuclear Medicine Communications 03/2011; 32(6):535-41. · 1.40 Impact Factor
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ABSTRACT: Thanks to the wide use of diagnostic imaging modalities, multiple primary malignancies are being diagnosed more frequently and different associations of malignancies have been reported in this setting.
In this paper, we describe the case of a patient with non-functioning well-differentiated neuroendocrine carcinoma of the head of the pancreas associated with extra-hepatic cholangiocarcinoma, in which an early diagnosis using magnetic resonance imaging allowed a good outcome.
The simultaneous association of neuroendocrine pancreatic tumors and cholangiocarcinoma has not yet been described; however, this association should be considered and, due to the high contrast of magnetic resonance imaging, this technique is recommended in such patient in order to reach an accurate diagnosis.
JOP: Journal of the pancreas 01/2011; 12(3):255-8.
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ABSTRACT: Caroli's disease is a rare congenital disorder first described by Caroli in 1958. This abnormality consists of non-obstructive, saccular or fusiform dilation of the intrahepatic bile ducts resulting in cystic lesions; similar abnormalities may also occur in the kidneys and pancreas.
We illustrate the role of enhanced mangafodipir trisodium magnetic resonance imaging in a patient with sporadic non-hereditary Caroli's disease associated with pancreatic involvement in which mangafodipir trisodium magnetic resonance imaging characterized part of the cystic liver lesions as saccular dilations of the intrahepatic bile ducts of the left lobe, allowing diagnosis of the disease.
We strongly recommend hepatobiliary magnetic resonance imaging with mangafodipir trisodium in such patients.
JOP: Journal of the pancreas 01/2010; 11(5):460-3.
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ABSTRACT: Lymphoepithelial cyst of the pancreas is a rare benign lesion which often presents as an incidental radiological finding, but may cause symptoms, such as abdominal pain and nausea. It can occur at any location in the pancreas. The differential diagnosis includes primary splenic cysts, pseudocysts, mucinous cystic neoplasms of the pancreas, left adrenal cysts, duplication cysts and retroperitoneal cysts. Some of these diagnoses can be excluded by MRI; however, for the final diagnosis, fine needle aspiration or surgical resection may be necessary.
We report a rare case of a pancreatic lymphoepithelial cyst in an asymptomatic 63-year-old man, discovered in a clinical follow-up for colon cancer. In particular, we describe the unique "cheerios-like" appearance of the lesion which has never before been reported.
This particular finding could help in the differential diagnosis of this benign lesion from other pancreatic masses.
JOP: Journal of the pancreas 01/2010; 11(2):170-2.
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Marcello Mancini,
Anna Prinster,
Giovanni Annuzzi,
Raffaele Liuzzi,
Rosalba Giacco,
Carmela Medagli,
Matteo Cremone,
Gennaro Clemente, Simone Maurea,
Gabriele Riccardi,
Angela Albarosa Rivellese,
Marco Salvatore
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ABSTRACT: The aim of this study was to determine the diagnostic performance of ultrasound (US) in the quantitative assessment of steatosis by comparison with proton magnetic resonance spectroscopy ((1)H-MRS) as a reference standard. Three liver echo-intensity indices were derived: US hepatic mean gray level, hepatic-renal echo-intensity ratio (H/R), and hepatic-portal blood echo-intensity ratio. The (1)H-MRS degree of steatosis was determined as percentage fat by wet weight. Regression equations were used to estimate quantitatively hepatic fat content. The hepatic fat content by (1)H-MRS analysis ranged from 0.10% to 28.9% (median value, 4.8%). Ultrasound H/R was correlated with the degree of steatosis on (1)H-MRS (R(2)= 0.92; P < .0001), whereas no correlation with (1)H-MRS was found for hepatic mean gray level and hepatic-portal blood echo-intensity ratio. A receiver operating characteristic curve identified the H/R of 2.2 as the best cutoff point for the prediction of (1)H-MRS of at least 5%, yielding measures of sensitivity and specificity of 100% and 95%, respectively. In this pilot study, US H/R exhibits high sensitivity and specificity for detecting liver fatty changes. Our results indicate that quantitative evaluation of hepatic fat content can be performed using US H/R and could therefore be a valuable analytic tool in clinical investigation.
Metabolism: clinical and experimental 09/2009; 58(12):1724-30. · 2.59 Impact Factor
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ABSTRACT: To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation.
Eleven patients who underwent repair between 1982 and 2007 were identified. Five (Group 1) presented pseudoaneurysm at the anastomosis of the donor renal and native iliac arteries, and six (Group 2) presented iliac pseudoaneurysm following transplant nephrectomy. Intraoperative cultures and immunohistochemical examinations were obtained from all surgical cases to determine the existence of a relationship between infection or transplant rejection and pseudoaneurysm formation.
Endovascular repair (EVR) was used to treat three patients, while eight patients underwent open repair (OR). Transplant nephrectomy was needed in all cases but one after anastomotic pseudoaneurysm repair. After pseudoaneurysm excision, arterial reconstruction was performed in all cases, with a limb salvage rate of 100%. At 30 days, no patients died in the EVR subgroup. In the OR subgroup, one patient died of sepsis (12.5%). Cultures taken from the pseudoaneurysm wall and content grew Candida albicans and E. coli in two febrile patients. Pathologic evaluation of donor renal arteries revealed evidence of chronic rejection in three patients (60%) in Group 1, and in two (33.3%) in Group 2. No patients in either Group presented late infection, failure of vascular reconstruction nor pseudoaneurysm recurrence. The follow-up ranges from 20 to 89 months.
The etiology of pseudoaneurysms in this location is multifactorial, however, an association with chronic rejection must be considered. Though rare, the development of pseudoaneurysms at the donor renal-external iliac artery anastomosis results in high rates of transplant nephrectomy. Less invasive endovascular techniques offer a new therapeutic option in this challenging scenario notwithstanding the fact that they require further validation.
Interactive cardiovascular and thoracic surgery 04/2009; 8(6):654-60.
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Massimo Imbriaco,
Letizia Spinelli,
Alberto Cuocolo, Simone Maurea,
Giacomo Sica,
Mario Quarantelli,
Antonio Pisani,
Raffaele Liuzzi,
Bruno Cianciaruso,
Massimo Sabbatini,
Marco Salvatore
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ABSTRACT: OBJECTIVE: Fabry's disease is a multisystem X-linked disorder of lysosomal metabolism frequently associated with left ventricular (LV) hypertrophy. In this study, we aimed to assess whether myocardial T2 relaxation time determined by a black blood multiecho multishot MRI sequence could be used to evaluate cardiac involvement in patients with Fabry's disease. CONCLUSION: Myocardial T2 relaxation time is prolonged in patients with Fabry's disease compared with that of hypertrophic patients and healthy control subjects. MRI may be useful for the characterization of myocardial tissue in patients with Fabry's disease.
American Journal of Roentgenology 04/2007; 188(3):850-3. · 2.78 Impact Factor
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ABSTRACT: Technetium-99m tetrofosmin is a lipophilic phosphine used for myocardial perfusion imaging. Biodistribution studies have shown significant thyroid uptake of tetrofosmin and preliminary reports have suggested that tetrofosmin imaging may be of value in patients with thyroid cancer. In this study, tetrofosmin whole-body scintigraphy was performed in 35 patients with evidence of thyroid diseases. All patients underwent laboratory evaluation of thyroid function as well as99mTc pertechnetate scan, thallium-201 (n=16)99mTc-methoxyisobutylisonitrile (MIBI) (n=19) whole-body studies. Thyroid images were semi-quantitatively analysed by a 4-point score: O=no significant uptake; 1=uptake increased as compared to background activity, but inferior to normal thyroid tissue; 2=uptake equal to normal thyroid tissue; 3=uptake superior to normal thyroid tissue. Pathology examinations were obtained. A total of 41 thyroid nodules were detected, of which 15 were goitre nodules, 13 adenomas and 13 malignant lesions. In goitre nodules, concordant results of tetrofosmin and pertechnetate uptake (score 1 or 0) were observed in the majority of lesions (87%). In function adenomas (n=10), both tetrofosmin uptake and pertechnetate uptake were score 3. In non-function adenomas (n=3), tetrofosmin uptake was score 3, while pertechnetate uptake was score 0. In six malignant lesions, tetrofosmin uptake was score 3, while pertechnetate uptake was score 0; in the other seven lesions, where a prevalence of goitre abnormalities was observed, results of tetrofosmin and pertechnetate uptake were similar (score 0 or 1). In seven (70%) of the ten patients with malignant nodules, whole-body tetrofosmin images showed increased abnormal uptake in a total of 28 extra-thyroid tumour sites, as subsequently confirmed by other techniques. When tetrofosmin images were compared to 201T1 and99mTc-MIBI scans, concordant results were observed in all cases. In conclusion, tetrofosmin imaging may be particularly useful to characterize and stage patients with malignant thyroid nodules; it shows similar results to thallium but provides better image quality. Comparable findings were observed between tetrofosmin and MIBI studies. Thus, tetrofosmin may be an alternative to thallium and MIBI in the aforementioned patients.
European journal of nuclear medicine and molecular imaging 11/1996; 23(12):1568-1574. · 4.99 Impact Factor
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ABSTRACT: The results of resting planar ECG-gated technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) imaging were compared with those of thallium-201 (TI) reinjection after exercise-redistribution scintigraphy in 20 patients (19 men, 1 woman, mean age 5310 years) with angiographically proven coronary artery disease. Eight normal subjects (seven men, one woman, mean age 508 years) constituted the control group. In these subjects, only resting99mTc-MIBI imaging was performed. The standardized percent count increase from end-diastole to end-systole was calculated as an index of wall thickening in 13 segments for each study. Regional wall thickening index (WTI) and99mTc-MIBI uptake were significantly different (P99mTc-MIBI uptake were significantly higher (P50% of peak activity) than in Re- segments with severe reduction of TI uptake (PPP99mTc-MIBI regional wall thickening, myocardial perfusion and TI uptake after reinjection. The results of this study suggest that regional WTI decreased significantly as myocardial perfusion decreased. In addition, regional wall thickening was preserved in segments with exercise-induced ischaemia and enhanced TI uptake after re-injection.
European journal of nuclear medicine and molecular imaging 01/1995; 22(9):1017-1022. · 4.99 Impact Factor
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ABSTRACT: BackgroundWe compared rest-redistribution thallium 201 and resting technetium 99m methoxyisobutyl isonitrile (MIBI) cardiac imaging BackgroundWe compared rest-redistribution thallium 201 and resting technetium 99m methoxyisobutyl isonitrile (MIBI) cardiac imaging
in 29 men with angiographically proven coronary artery disease and regional ventricular dysfunction. Left ventricular ejection in 29 men with angiographically proven coronary artery disease and regional ventricular dysfunction. Left ventricular ejection
fraction at radionuclide angiography was 35%±9%. fraction at radionuclide angiography was 35%±9%.
Methods and ResultsRegional left ventricular wall motion was assessed on gated99mTc MIBI images according to a 3-point scale (0=normal, 1=hypokinetic, 2=akinetic or dyskinetic).201Tl and99mTc MIBI uptake values were analyzed quantitatively. A total of 435 myocardial segments were classified on the basis of wall Methods and ResultsRegional left ventricular wall motion was assessed on gated99mTc MIBI images according to a 3-point scale (0=normal, 1=hypokinetic, 2=akinetic or dyskinetic).201Tl and99mTc MIBI uptake values were analyzed quantitatively. A total of 435 myocardial segments were classified on the basis of wall
motion analysis into three groups: group 1 (normal wall motion;n=201), group 2 (hypokinetic;n=132), and group 3 (akinetic or dyskinetic;n=102).201Tl and99mTc MIBI uptake values were significantly higher in groups 1 and 2 compared with group 3 (p<0.05) and in group 1 compared with group 2 (p<0.05). When201Tl and99mTc MIBI uptake values were directly compared, no significant differences in groups 1 and 2 were observed. In group 3,99mTc MIBI uptake (67%±14%) was significantly lower (p<0.001) than initial (72%±11%) and delayed201Tl uptake (73%±12%). motion analysis into three groups: group 1 (normal wall motion;n=201), group 2 (hypokinetic;n=132), and group 3 (akinetic or dyskinetic;n=102).201Tl and99mTc MIBI uptake values were significantly higher in groups 1 and 2 compared with group 3 (p<0.05) and in group 1 compared with group 2 (p<0.05). When201Tl and99mTc MIBI uptake values were directly compared, no significant differences in groups 1 and 2 were observed. In group 3,99mTc MIBI uptake (67%±14%) was significantly lower (p<0.001) than initial (72%±11%) and delayed201Tl uptake (73%±12%).
ConclusionThus rest-redistribution201Tl and resting99mTc MIBI cardiac imaging reflect the severity of left ventricular dysfunction in coronary artery disease. However, in segments ConclusionThus rest-redistribution201Tl and resting99mTc MIBI cardiac imaging reflect the severity of left ventricular dysfunction in coronary artery disease. However, in segments
with severely impaired regional ventricular function,201Tl uptake is significantly higher than99mTc MIBI uptake. with severely impaired regional ventricular function,201Tl uptake is significantly higher than99mTc MIBI uptake.
Journal of Nuclear Cardiology 04/1994; 1(1):65-71. · 2.67 Impact Factor
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ABSTRACT: We studied 19 patients with angiographically proven coronary artery disease and left ventricular dysfunction (ejection fraction 33% 8%) by resting technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) and rest-redistribution thallium-201 cardiac imaging. Thallium and (99mTc-MIBI) studies were visually analysed. Of 285 segments, 203 (71%) had normal thallium uptake, 48 (17%) showed reversible thallium defects and 34 (12%) showed irreversible thallium defects. Of these 34 irreversible thallium defects, 19 (56%) were moderate and 15 (44%) were severe. Of the corresponding 285 segments, 200 (70%) had normal 99mTc-MIBI uptake, while 37 (13%) showed moderate and 48 (17%) showed severe reduction of 99 99mTc-MIBI uptake. Myocardial segmental agreement for regional uptake score between initial thallium and resting (99mTc-MIBI) images was 90% (=0.78). Segmental agreement between delayed thallium and resting 99Tc-MIBI images was 77% (=0.44). In particular, in 26 (9%) segments 99mTc-MIBI uptake was severely reduced while delayed thallium uptake was normal or only moderately reduced. These data suggest that although rest-redistribution thallium and resting (99mTc-MIBI) cardiac imaging provide concordant results in the majority of myocardial segments, some segments with severely reduced resting 99mTc-MIBI uptake may contain viable but hypoperfused myocardium. Thus, conclusions on myocardial viability based on 99mTc-MIBI uptake should be made with caution in chronic coronary artery disease.
European journal of nuclear medicine and molecular imaging 11/1993; 20(12):1186-1192. · 4.99 Impact Factor
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ABSTRACT: To compare rest-injected thallium-201 (Tl) redistribution and resting technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) myocardial uptake in chronic coronary artery disease (CAD), 15 patients with angiographically proven CAD and left ventricular (LV) dysfunction (ejection fraction 34%9%) were studied. All patients underwent rest-redistribution Tl and resting 99mTc-MIBI cardiac imaging. Gated 99mTc-MIBI images were also acquired to assess regional LV wall motion (WM). Myocardial segments (n=225) were divided into three groups on the basis of the degree of coronary artery stenosis: group 1 (total occlusion, n=82), group 2 (50%–99% of stenosis, n=84) and group 3 (<50% of stenosis, n=59). WM was significantly worse in groups 1 and 2 compared to group 3 (P<0.001), but no difference was observed between groups 1 and 2. TI and 99mTc-MIBI uptake were significantly lower in groups 1 and 2 compared to group 3 (P < 0.001), and in group 1 compared to group 2 (P<0.001). When TI and 99mTc-MIBI uptake were directly compared, TI uptake was higher than 99mTc-MIBI uptake in group 1 (P<0.001), while no significant difference was observed in groups 2 and 3. Thus, both rest-injected TI redistribution and resting 99mTc-MIBI uptake reflected the severity of coronary artery stenosis in CAD. However, in myocardial segments with total coronary occlusion T1 uptake was significantly higher than 99mTc-MIBI uptake. Our data suggest that rest-injected Tl redistribution cardiac imaging may identify, more accurately than resting 99mTc-MIBI imaging, the presence of viable myocardium in chronic CAD, particularly when the coronary blood flow is severely impaired.
European journal of nuclear medicine and molecular imaging 05/1993; 20(6):502-510. · 4.99 Impact Factor
