L Macarini

Università degli studi di Foggia, Foggia, Apulia, Italy

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Publications (123)141.68 Total impact

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    ABSTRACT: In patients with atrial fibrillation (AF), extensive atrial tissue fibrosis identified by delayed enhancement magnetic resonance imaging has been associated with early recurrence of AF after catheter ablation. We present a case of a patient with extensive atrial fibrosis and AF recurrence.The study of late gadolinium enhancement with cardiac magnetic resonance imaging in patients with AF could be a valuable noninvasive tool for the selection of patients suitable for successful catheter ablation.
    No preview · Article · Jan 2016 · Therapeutic Advances in Cardiovascular Disease
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    ABSTRACT: Aims: To evaluate the utility of a multiparametric 3T magnetic resonance imaging (MRI) study using diffusion-weighted images (DWI) for the assessment of prostate cancer before and after radiotherapy (RT). Methods: A total of 34 patients, who received a histologic diagnosis of prostate adenocarcinoma, underwent MRI examination before and after local RT for the assessment of response to treatment. Apparent diffusion coefficient (ADC) values were calculated and compared. Results: Before RT, DWI shows pathologic restriction of signal, while after RT pathologic restriction of signal was reduced or disappeared. The ADC values were significantly increased after therapy (p<0.05). Conclusions: The use of DWI with ADC measurements may be an imaging biomarker in the assessment of prostate cancer.
    Full-text · Article · Sep 2015
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    ABSTRACT: Purpose: To compare magnetic resonance spectroscopy (MRS) and diffusion weighted imaging (DWI) in the assessment of progression and regression of brain tumors in order to assess whether there is correlation between MRS and DWI in the monitoring of patients with primary tumors after therapy. Methods: Magnetic resonance imaging (MRI) has been performed in 80 patients, 48 affected by high grade gliomas (HGG) and 32 affected by low grade gliomas (LGG). The variation of apparent diffusion coefficient (ADC) value and metabolite ratios before and after treatment has been used to test DWI sequences and MRS as predictor to response to therapy. Comparison between post contrast-enhancement sequences, MRS and DWI has been done in terms of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover statistical correlation of ADC deviations with MRS metabolites variations before and after therapy have been studied. Results: In the case of HGG, MRS shows better sensitivity, specificity, PPV, NPV and accuracy compared to DWI, especially when considering the Choline/N-acetylaspartate (Cho/NAA) ratio. Regarding the LGG, the technique that better evaluates the response to treatment appears to be the DWI. A moderate correlation between ADC deviations and Cho, Lipide (Lip) and Lactate (Lac) has been found in LGG; while NAA revealed to be weakly correlated to ADC variation. Considering HGG, a weak correlation has been found between ADC deviations and MRS metabolites. Conclusion: Combination of DWI and MRS can help to characterize different changes related to treatment and to evaluate brain tumor response to treatment.
    No preview · Article · Sep 2015 · European journal of radiology
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    ABSTRACT: Several laparoscopic approaches to the adrenal gland have been described. We prefer the lateral transabdominal approach. The aim of this study is to evaluate prospectively the presence of any anatomical and dynamic changes in the spleen after laparoscopic transperitoneal left adrenalectomy (LTLA), which can cause an increased risk of early and late complications. We have evaluated 21 patients before and 6 months after surgery in order to verify the possible presence of a wandering spleen. A clinical and instrumental follow-up [ultrasound (US), magnetic resonance (MR)] were performed. During US protocol, in supine, right lateral, and orthostatic position, the longitudinal and anteroposterior diameter of the spleen and the resistive index within 3 cm of the origin of the splenic artery in three different measurements averaged were measured. MR protocol evaluated, in supine and right lateral position, the splenic volume and its distances from the diaphragm dome and the lateral margin of the costal arch. p Values calculated for each parameter were not statistically significant. Our results confirm the absence of any anatomical and dynamic changes in the spleen after LTLA. The most common complications after laparoscopic adrenalectomy are well known and widely described. Our experience does not exclude the occurrence of a wandering spleen, but allows us to state that a rightful mobilization of the pancreaticosplenic block can avoid this event, and in agreement with other authors, the presence of a wandering spleen remains an isolated complication.
    Full-text · Article · Jul 2015 · Surgical Endoscopy
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    Full-text · Article · May 2015 · Haemophilia
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    ABSTRACT: To evaluate the utility of diffusion-weighted-imaging (DWI) and apparent-diffusion-coefficient (ADC) in a 3T magnetic-resonance-imaging (MRI) study of breast cancer. In particular, the study aims to classify ADC-values according to histology either for benign or malignant lesions. 110 Breast MRI with MRI-DWI sequences and quantitative evaluation of the ADC were retrospectively reviewed. Results obtained with MRI-DWI and with biopsy were analyzed and ADC values were compared to histological results. MRI showed a 95.5% sensitivity and a 83.7% specificity. The mean ADC values of benign and malignant lesions were 2.06 ± 0.19 and 1.03 ± 0.07 mm(2)/s, respectively (p < .05). DWI and ADC-values could help distinguishing malignant and benign breast masses.
    No preview · Article · Apr 2015 · Cancer Investigation
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    ABSTRACT: Cardiac CT (CCT) is an imaging modality that is becoming a standard in clinical cardiology. We evaluated indications, safety, and impact on patient management of routine CCT in a multicenter national registry. During a period of 6 months, 47 centers in Italy enrolled 3,455 patients. CCT was performed mainly with 64-slice CT scanners (73.02 %). Contrast agents were administrated in 3,185 patients (92.5 %). Mean DLP changes with type of scanner and was lower in >64 row detector scanner. The most frequent indication for CCT was suspected CAD (44.8 %), followed by calcium scoring (9.6 %), post-angioplasty/stenting (8.3 %), post-CABGs (7.5 %), study of cardiac anatomy (4.22 %) and assessment in patients with known CAD (4.1 %) and acute chest pain (1.99 %). Most of the CCTs were performed in outpatient settings (2,549; 74 %) and a minority in inpatient settings (719, 20.8 %). Adverse clinical events (mild-moderate) occurred in 26 examinations (0.75 %). None of them was severe. In 45.3 % of the cases CCT findings impacted patient management. CCT is performed with different workloads in participating centers. It is a safe procedure and its results have a strong impact on patient management.
    Full-text · Article · Feb 2015 · La radiologia medica
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    Full-text · Article · Jan 2015 · American Journal of Emergency Medicine
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    Full-text · Article · Jan 2015
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    ABSTRACT: Takotsubo cardiomyopathy (TTC) is a transient form of acute heart failure triggered by stressful events and associated with a typical left ventricular ballooning. Cardiac magnetic resonance imaging may be helpful in the diagnosis of this syndrome, particularly when differential diagnosis with acute coronary syndrome (ACS) is not easy.We report 2 cases in which the distinction between TTC and ACS was required because of overlapping clinical presentation and presence of normal coronary angiography. Cardiac magnetic resonance imaging was therefore performed with the aim to distinguish the 2 clinical entities. The presence of localized edema in the midbasal segments of the lateral wall and the presence of subendocardial late enhancement in the basal segment of the inferolateral wall in case 1 were likely to be indicative of myocardial infarction in normal epicardial coronary arteries and microcirculation disease. The typical localization of edema to midapical segments of the left ventricle in the absence of late enhancement in case 2was indicative of TTC. The evaluationwith cardiacmagnetic resonance imaging of myocardial edema and myocardial scar/fibrosis allowed the prompt distinction between acute ischemic heart disease and TTC. Cardiac magnetic resonance imaging at admission may provide relevant functional and tissue information that might be useful in the diagnosis of TTC and in differential diagnosis with ACS.
    Full-text · Article · Dec 2014 · American Journal of Emergency Medicine
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    ABSTRACT: Penile paraffinoma is a well-known delayed complication of paraffin oil injection into the penis for penile girth augmentation but its MRI features have not been previously described. A 35-year-old Ukraine man presented with erectile dysfunction, voiding difficulty and an irregular, hard and painful penile mass that had progressively grown over the last year. He reported having received, seven years before, several penile injections of paraffin oil for penile girth augmentation. On physical examination, the mass was tender, poorly delimited, and involved the whole penile shaft and the cranial part of the scrotum. Preoperative MRI, performed to determine the extent of tissue to be removed and the possibilities of penile reconstruction, showed a newly-formed homogeneous tissue, compressing but not infiltrating Buck's fascia, iso-hypointense relative to muscle on T1-weighted sequences, and with a low signal intensity at T2-weighted sequences. On T1-weighted fat suppressed sequences, it did not enhance with contrast administration. MRI data were confirmed by surgical findings, as the newly-formed scar tissue did not infiltrate Buck's fascia. Pathology confirmed the diagnosis of penile paraffinoma. MRI seems to provide an adequate imaging of the histological events occurring after injection of paraffin oil in the subcutaneous tissues. Penile paraffinoma remains a clinical diagnosis, but MRI features may be helpful in planning an adequate surgical strategy and, in selected cases, establishing the differential diagnosis with other penile diseases, including cancer.
    Full-text · Article · Dec 2014 · BMC Medical Imaging
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    ABSTRACT: Purpose: We aimed to assess the correlation between pulmonary hemorrhage and pneumothorax in computed tomography (CT)-guided transthoracic fine needle aspiration (TTFNA), particularly its possible value as protection against the development of pneumotorax. Materials and methods: We reviewed the CT images of 538 patients (364 males and 174 females, mean age 70 years, range 36-90 years) who underwent CT-guided TTFNA of pulmonary nodules between January 2008 and September 2013. The following CT findings were assessed: pulmonary hemorrhage (type 1, along the needle track; type 2, perilesional; low-grade, ≤6 mm; high-grade, >6 mm), pneumothorax, distance between the target nodule and the pleural surface, and emphysema. Results: Pneumothorax occurred in 154 cases (28.6%) and pulmonary hemorrhage occurred in 144 cases (26.8%). The incidence of pneumothorax was lower in patients showing type 1 and high-grade pulmonary hemorrhage pattern. The incidence of pneumothorax in biopsies ≥30 mm from pleural surface was 26% (12/46) in cases showing this pattern, while it was 71.4% (30/42) when this pattern was not seen. Similarly, the incidence of pneumothorax in biopsies <30 mm from the pleural surface was 0% (0/28) in cases showing this hemorrhage pattern, while it was 19% (76/394) when this pattern was not seen. Conclusion: Pulmonary hemorrhage during TTFNA is a frequent event that protects against pneumothorax. A bleeding greater than 6 mm along the needle track is associated with lower incidence of pneumothorax, especially in biopsies deeper than 3 cm.
    Full-text · Article · Sep 2014 · Diagnostic and interventional radiology (Ankara, Turkey)
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    ABSTRACT: Background: There is a growing evidence that carotid intima media thickness (CIMT) is associated with coronary artery disease (CAD) and it should be used as a predictor of atherosclerotic burden of coronary arteries. However, these studies have been performed by using invasive coronary angiography (ICA) and in high-risk patients for CAD. The purpose of this study was to evaluate the correlation between CIMT by ultrasound and coronary atherosclerosis in symptomatic intermediate risk patients by coronary computed tomography angiography (CCTA). Methods: We enrolled 204 consecutive symptomatic patients (mean age: 61±10; men: 118) and intermediate risk for CAD. All patients underwent CIMT ultrasound evaluation and CCTA. Coronary artery calcium score (CACS), characteristics of plaques, severity of CAD, segment involvement score (SIS) and Gensini's score were assessed and compared with CIMT values. Results: CIMT has been proved as an independent predictor of a number of coronary artery plaques, overall number of mixed and remodeled plaques, presence of obstructive CAD, high SIS and Gensini's score (HR 1.2, CI 1.05-1.42, p 0.01; HR 1.2, CI 1.01-1.41, p 0.03; HR 9.0, CI 1.37-59.7, p 0.02; HR 21.0, CI 2.40-184, p<0.01; HR 1.2, CI 1.08-1.42, p<0.01; HR 1.2, CI 1.08-1.42, p<0.01, respectively). A cut-off value>1.3 was associated with a better positive and negative predictive value (100% and 69%) to predict the combined endpoint of presence and mixed and/or remodeled coronary artery plaques. Conclusions: CIMT is an independent predictor of coronary atherosclerotic burden as detected by CCTA in symptomatic intermediate risk patients.
    Full-text · Article · Aug 2014 · International Journal of Cardiology
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    Full-text · Article · Aug 2014 · International Journal of Cardiology
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    ABSTRACT: Percutaneous radiofrequency ablation (PRFA) of renal malignancies is currently a therapeutic option for patients who are not able to undergo surgery. Some authors consider PRFA as the therapeutic standard in the treatment of renal neoplasms in non-operable patients due to comorbid conditions and in patients with mild-moderate renal failure, to preserve residual renal functionality. The use of PRFA has become more and more widespread due to a rise in the incidental detection of renal cell carcinomas with the ever-increasing use of Imaging for the study of abdominal diseases. Clinical studies indicate that RF ablation is an effective therapy with a low level of risk of complications, which provides good results in selected patients over short and medium term periods of time, however up to now few long-term studies have been carried out which can confirm the effectiveness of PRFA.
    No preview · Article · Jul 2014 · La radiologia medica
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    ABSTRACT: We report a 33 year-old woman addicted to chronic unspecified solvents abuse with stupor, respiratory disorders, tetraplegia and severe metabolic acidosis. On admission an unenhanced cranial CT scan showed symmetrical hypodensities of both lentiform nuclei. MR imaging performed 12 hours after stupor demonstrates bilateral putaminal hemorrhagic necrosis, bilateral external capsule, corona radiata and deep cerebellar hyperintensities with right cingulate cortex involvement. DWI reflected bilateral putaminal hyperintensities with restricted water diffusion as to citotoxic edema and development of vasogenic edema in the external capsule recalling a fork. On day twenty, after specific treatments MRI demonstrated a bilateral putaminal marginal enhancement. Bilateral putaminal necrosis is a characteristic but non-specific radiological finding of methanol poisoning. Lentiform Fork sign is a rare MRI finding reported in literature in 22 patients with various conditions characterized by metabolic acidosis. Vasogenic edema may be due to the differences in metabolic vulnerability between neurons and astrocytes. We postulate that metabolic acidosis could have an important role to generate this sign.
    No preview · Article · Jun 2014
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    ABSTRACT: Purpose: Evaluate the role of diffusion-weighted-imaging (DWI) in the diagnosis and staging of gastric carcinoma. Materials and methods: A total of 31 patients with gastric adenocarcinoma, which underwent preoperative staging with 3Tesla Magnetic Resonance Imaging (MRI), were enrolled. Two radiologists evaluated the tumor staging in DWI. Results were compared to postsurgical pathologic findings. Results: The T factor accuracy of conventional MRI and DWI was 73% and 80% respectively; while the N staging accuracy of conventional MRI and DWI was 80% and 93%, respectively. Conclusion: DWI and apparent diffusion coefficient (ADC) values showed to be useful in preoperative staging of gastric cancer.
    No preview · Article · Mar 2014 · Cancer Investigation
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    ABSTRACT: The aim of this study is to demonstrate the effectiveness of 3-Dimensional Magnetic Resonance Imaging (3D MRI) using the ProSet technique in the diagnosis of lumbar radiculopathy and to compare morphological findings with clinical and neurophysiological data. 40 patients suffering from L5 or S1 mono-radiculopathy caused by a disc herniation were evaluated through preliminary clinical assessment and electromyography (EMG) technique. Both conventional spin-echo sequences and 3D coronal FFE with selective water excitation (ProSet imaging) were acquired. Indentation, swelling and tilt angle of the nerve root were assessed by means of a 3D MR radiculography. 3D ProSet multiplanar reconstructions (MPR) were used for quantitative measurements of L5 and S1 nerve root widths. Widths of the symptomatic nerve root were compared with those of the contralateral nerve. Data were processed using Epi Info 3.3 software (CDC, Atlanta, GA, USA) and were compared through a paired t-Student test. We observed an abnormal tilt angle in 22 patients (57,2 percent, P less than 0.05). Morphologic alterations such as monolateral swelling or indentation of the involved roots were found in 36 patients (90 percent, P less than0.01) using 3D MR radiculography. In 10 patients, EMG revealed more nerve roots involved, while 3D FFE with ProSet technique shows a single root involved. In 2 patients, alterations were demonstrated only through EMG technique. We suggest that 3D MR radiculography can provide more information than other techniques about symptomatic disc herniation, supporting the detection of morphological changes of all nerve segments. 3D FFE with ProSet technique demonstrates high sensibility to exactly identify the level of the root involved and can provide an extremely useful tool to lead a surgical planning.
    No preview · Article · Oct 2013 · Journal of biological regulators and homeostatic agents
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    ABSTRACT: Objectives: To correlate the apparent diffusion coefficient (ADC) of prostate cancer patients with pathological Gleason scores (GS). Methods: 40 patients with GS 2 + 3, 3 + 3, 3 + 4, or 4 + 4 were selected. The magnetic resonance imaging (MRI) study was performed adding axial diffusion-weighted imaging (DWI) sequences to the standard MRI protocol. ADC values obtained were correlated with the GS data. Results: Statistically significant differences of ADC (p < .05) were found among GS groups with a trend of decreasing ADC values with increasing GS. Conclusions: The ADC values may help clinicians to delineate prostate carcinoma, recognizing its high- or low-grade compartments.
    No preview · Article · Oct 2013 · Cancer Investigation
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    ABSTRACT: Ankle fractures account for 9 % of fractures (Clare in Foot Ankle Clin 13(4):593-610, 1) representing a significant portion of the trauma workload; proximal femoral fractures are the only lower limb fracture to present more frequently. Ankle fractures have a bimodal age distribution with peaks in younger males and older females (Arimoto and Forrester in AJR Am J Roentgenol 135(5):1057-1063, 2). There has been threefold increase in the incidence among elderly females over the past three decades (Haraguchi and Armiger in J Bone Joint Surg Am 91(4):821-829, 3). In 1950, Lauge-Hansen devised a classification of ankle fractures based on the position of the foot and the deforming force at the time of injury. This has been widely accepted by orthopedists, but is not in general use by radiologists. Identification of the fractures and classification of the type of injury allows diagnosis of the otherwise occult ligamentous injuries. Three radiographic views of the ankle (anteroposterior, mortise, and lateral) are necessary to classify an injury with the Lauge-Hansen system. Two additional criteria are also necessary: the position of the foot at the time of injury and the direction of the deforming force.
    Preview · Article · Aug 2013 · MUSCULOSKELETAL SURGERY

Publication Stats

567 Citations
141.68 Total Impact Points

Institutions

  • 2008-2015
    • Università degli studi di Foggia
      • Department of Medical and Surgical Sciences
      Foggia, Apulia, Italy
  • 1991-2004
    • Università degli Studi di Bari Aldo Moro
      • Dipartimento di Scienze Biomediche ed Oncologia Umana (DIMO)
      Bari, Apulia, Italy
  • 1989-2004
    • Policlinico di Bari
      Bari, Apulia, Italy