Paolo Baldassari

Sapienza University of Rome, Roma, Latium, Italy

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Publications (9)9.62 Total impact

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    ABSTRACT: To compare two regimens of reduced bowel preparation and faecal tagging for CT colonography.
    European radiology. 08/2014;
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    ABSTRACT: AIM: To retrospectively study the frequency and magnitude of complications associated with computed tomography (CT) colonography in clinical practice. METHODS: A questionnaire on complications of CT colonography was sent to Italian public radiology departments identified as practicing CT colonography with a reasonable level of training. The frequency of complications and possible risk factors were retrospectively determined. Responses were collated and row frequencies determined. A multivariate analysis of the factors causing adverse events was also performed. RESULTS: 40,121 examinations were performed in13 centers during the study period. No deaths were reported. Bowel perforations occurred in 0.02% (7 exams). All perforations were asymptomatic and occurred in patients undergoing manual insufflation. Five perforations (71%) occurred in procedures performed following a recent colonoscopy. There was no significant difference between perforations associated with rectal balloon (0.017%) and those that were not (0.02%). Complications related to vasovagal reaction (either with or without spasmolytic) occurred in 0.16% (63 exams). All vasovagal reactions resolved in less than 3h, without any sequelae. CONCLUSIONS: Perforation rate at CT colonography in Italy is comparable with elsewhere in the world, occurring regardless of the experience of radiology centers. Although the risk is very small, it may not be negligible when compared with the risk of diagnostic colonoscopy.
    Digestive and Liver Disease 05/2013; · 3.16 Impact Factor
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    ABSTRACT: A 55-year-old woman referred to Radiology Department, with abdominal mass and chronic indefinite and vague abdominal pain, most severe in right hypochondrium and accentuated during menstruation. A history of two cesarean sections was revealed. The patient underwent an ultrasound and Computed Tomography with intravenous contrast media revealing the presence of gallbladder and abdominal wall hyperenhancing masses. Finally, Magnetic Resonance study with intravenous administration of paramagnetic contrast media confirmed the involvement of gallbladder by a solid tissue and the presence of a solid nodule on the abdominal wall. Considering imaging features and the contrast enhancement of the nodules, the patient was sent to surgery. Surgical removal of both gallbladder and abdominal solid implant was performed and histology confirmed the diagnosis of gallbladder and abdominal wall endometriosis.
    Abdominal Imaging 03/2012; · 1.91 Impact Factor
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    ABSTRACT: PURPOSE To retrospectively evaluate the incidence of complication related to CTC performed in both symptomatic and asymptomatic patients undergoing CTC during the period ranging from 2000 and 2010. METHOD AND MATERIALS With a national survey, an e-mail questionnaire about serious adverse events of virtual colonoscopy with particular attention to large bowel perforation, was sent to all Italian Public Health Centers performing a daily CTC service. Technical parameters related to complications and kind of treatment needed for adverse events were also investigated. The questionnaire was completed by clinical director from all radiology departments. Responses were analyzed and raw frequencies were determined. RESULTS All Centers (13/13) interviewed, answered positively to the Survey. Among 13 centers, 40.121 CT colonography exams were performed. No deaths were reported. 39 (0.097%) patients experienced a complication during the procedure: 32 vasovagal self-limiting attack episodes (0.079%) and 7 perforations (0.017%). In 4 (57%) cases the site of perforation was within the rectum, in 3 (43%) cases within the sigmoid colon. No case of perforation were obsterved within transverse, ascending colon and caecum. Three patients had to undergo surgery. The remaining four patients had a conservative treatment. Four out of seven cases of perforation had a conventional colonoscopy in the past seven days prior to CTC and on the same day of the exam, respectively. CONCLUSION In summary, we found a low rate of colonic perforation (0.017) that were associated with CT colonography when it was used to investigate patients with symptoms of colorectal cancer or in those asymptomatic patients . The rate of occurrence of luminal perforation, however, was more than four times lower than were equivalent rates published for colonoscopy. CLINICAL RELEVANCE/APPLICATION CT Colonography is a safe technique that can be used for evaluation of symptomatic or asymptomatic patients. Perforation remains an infrequent complication of this imaging modality.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: PURPOSE The aim of this study was to compare a same day iodine bowel preparation for CT colonography using Iopamidol in asymptomatic and symptomatic patients undergoing CT Colonography. METHOD AND MATERIALS Fifty consecutive patients, ranging in aget between 41 and 87 y.o., underwent CT colonography for several reason. All patient underwent two days of low fiber diet and had ingested 2 tablets of Bisacodyl a night before examination followed by 2 tablets of Bisacodyl a day of examination with 400 ml of water mixed with 64.5 g of Macrogol and Simeticone and 70 ml of tagging agent,(Iopamidol,Gastromiro, Bracco,Italy). Per colonic segment measurements of residual stool attenuation and homogeneity were performed, and a subjective evaluation of tagging quality (grade 1-5) was done. Independently, two reviewers performed polyp and carcinoma detection.A Visual Analogue Scale (VAS) was administered to all patients in order to evaluate the exam tolerability feeled by the patients. Number of evacuation episodes as well as time to first evacuation occured was recorded for all patients.Mean waiting time after preparation was recorded.Number of CAD False Positive for both prone and supine series were annotated. RESULTS The mean tagging density was 572. The tagging quality was graded 5 (excellent) in 90% of all segment. Mean per-polyp sensitivity for lesions >or=10 mm was 92%. Mean number of evacuation episodes was 3, with the first evacuation occured in 85% of patients just 1 hour after ingestion of preparation.The mean waiting time after preparation was 1 hour and 45 minutes.The VAS evaluation showed a very high tolerabilty of the exam.Mean number of CAD FP's was 10 for prone and 12 for supine series. CONCLUSION Same-day preparation with Iopamidol results in a very high patient acceptability and has a comparable, excellent image quality and good diagnostic performance of our standard tagging protocol that included administration of 170 ml of Iodine Tagging agent a day before the examination. Tolerability of the exam was very in high in 90% of Patients. CLINICAL RELEVANCE/APPLICATION Same Day Tagged-Preparation using Bisacodyl, Macrogol and Iopamidol for CT Colonography is a feasible technique with high tolerability and high diagnostic performance.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: Peritoneal carcinomatosis is usually associated with a poor overall survival rate. Recently, introduction of more aggressive surgical treatment and intraperitoneal chemotherapy appears to significantly increase the overall survival rate for these patients. A detailed preoperative assessment of peritoneal carcinomatosis could be very challenging in the field of imaging, but a new aggressive surgical approach requires an accurate preoperative assessment of the disease. Cross-sectional imaging using CT and MRI with diffusion-weighted imaging (DWI) sequences is important for appropriate management of patients with peritoneal carcinomatosis. Appreciation of the spectrum of diagnostic patterns and pitfalls as well as different sites of involvement of peritoneal carcinomatosis using CT and DWI is crucial for appropriate surgical treatment.
    Abdominal Imaging 10/2011; 37(4):616-27. · 1.91 Impact Factor
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    ABSTRACT: To assess the positive predictive value (PPV) of CTC in the clinical routine of a dedicated referral centre. All consecutive patients referred for CTC between May 2009 and May 2010 were considered for inclusion in this study. All the patients who, following the diagnosis of a>6 mm polyp or mass at CTC, underwent a post-CTC colonoscopy within eight weeks from diagnosis were included. Per patient PPV for lesions, adenomas and advanced neoplasia was calculated. Chi-square test was used for statistical comparison, and a p value<0.05 was considered to be statistically significant. 516 patients were included in the study. Of them, 76 (14%) patients had at least one lesion≥6 mm on CTC. Overall, 59 (11%) patients were diagnosed at CTC with at least one polyp, 12 (2%) with a flat lesions, and 5 (1%) with a mass. Per-patient PPVs for any lesion>6 mm, neoplasia, and advanced neoplasia were 96% (95% CI: 92-100%), 68.4% (95% CI: 58-79%), and 30% (95% CI: 20-41%), respectively. PPV for neoplasia and advanced neoplasia was substantially higher for >10 mm lesions. In dedicated centers, CTC appears to be a highly specific procedure, characterized by a very low rate of false-positive results for >6 mm lesions.
    European journal of radiology 02/2011; 80(3):e289-92. · 2.65 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the utility of single-shot spin- echo echo-planar diffusion-weighted imaging (DWI) using a b value of 1000 s/mm2 for depicting peritoneal metastases.To retrospectively measure the diagnostic performance of 64 MDCT and DWI 3T MRI results in the detection of peritoneal metastases (PMs) in patients with advanced ovarian cancer undergoing peritonectomy and hypertermic intraperitoneal chemotherapy (HIPEC). METHOD AND MATERIALS In 68 patients with ovarian cancer who were undergoing cytoreductive surgery the presence of PM was prospectively rated as grade 0 (absent), grade 1 (equivocal), or grade 2 (present) on CT scans and 3T MRI using DW sequences after dividing abdomen into 14 different sites. First MDCT images (VCT, GE, Malvern US) with i.v. contrast along with isotropic reformatted coronal and sagittal images alone was reviewed, followed by MRI (Discovery MR750 3.0T, GE Malvern, US) including DWI. Results of HIPEC surgey and histopathologic evaluation were compared with DWI MRI and MDCT results. Sensitivity, specificity, and accuracy were calculated for DWI, MDCT, and combined DWI and MDCT for PMs depiction by two senior radiologists. RESULTS 952 sites of PMs were proven by surgical and histopathologic findings. The combination of DWI and MDCT was most sensitive and accurate for PMs, depicting 847 and 780 tumor sites for the two observers (sensitivity, 89%, 82%) compared with DWI alone, which depicted 704 and 694 tumor sites with sensitivity of 74%, 73%, and MDCT alone which depicted 809 and 761 tumor sites (sensitivity of 85%, 80%). PMs showed restricted diffusion on DWI and ascites was of low signal intensity, increasing tumor conspicuity. Treitz and mesentery represent the most difficult sites for detecting lesions. CONCLUSION 64-Section MDCT by using MPR reformatted images is a very useful technique in the detection of PMs of 0.5 cm in diameter or larger, although sensitivity decreases remarkably for lesions <0.5 cm in diameter. The crucial additional information provided by this exam is the precise location of implants that shows a satisfactory correlation with surgical findings. Adding DWI MRI to routine MDCT seems to improve the sensitivity and specificity for depicting PMs. CLINICAL RELEVANCE/APPLICATION Adding DWI to routine MDCT improves the sensitivity and specificity for depicting peritoneal metastases. The use of DWI it is crucial even in follow-up of patients with peritoneal carcinosis.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 12/2010
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    ABSTRACT: PURPOSE/AIM To underline the role of 64 MDCT and DWI 3T MRI in the evaluation of Peritoneal Metastases (PMs) from ovarian cancer in patients undergoing peritonectomy and hypertermic intraperitoneal chemotherapy (HIPEC). To correlate imaging findings with surgical and histopathological findings using Peritoneal Cancer Index (PCI) score. CONTENT ORGANIZATION Simultaneous use of 64 MDCT with I.V. contrast by using thin slice (.625 mm) and MPR reconstructions and DWI 3T MRI improve detection of PMs with good correlation with PCI. In this poster, we review different appearances, diagnostic patterns of peritoneal spread from advanced ovarian cancer after dividing abdomen into 9 anatomical regions and in 14 sites. Distinct patterns appear to predict the presence of either nodular or diffuse peritoneal pathology. SUMMARY 64 MDCT and DWI 3T MRI appear of crucial importance in surgical management of those patients affected by peritoneal carcinomatosis from advanced ovarian cancer that can be treated by HIPEC. It is important for radiologist to learn which abdominal areas are the most important and crucial to evaluate in order to exclude the presence of PMs for a right selection of patients that must be surgically treated by HIPEC.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting;