C Bartolozzi’s research while affiliated with University of Pisa and other places

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Publications (260)


ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents
  • Article
  • Full-text available

July 2015

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401 Reads

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136 Citations

European Radiology

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C Bartolozzi

To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach's statistics were used to rate levels of agreement and internal reliability of the consensus. Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. • Liver-specific contrast agents are recommended in MRI of the liver. • The hepatobiliary phase improves the detection and characterization of hepatocellular lesions. • Liver-specific contrast agents can improve the detection of HCC.

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Fig. 2: Normal coronary arteries (Volume Rendering views). 
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CT coronary angiography with iterative image reconstruction and low iodine (270mgI/mL) concentration: comparison of image quality and injection pressure with standard (320mgI/mL) iodine concentration

March 2015

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72 Reads


Figure 1. Axial CT image showing tiny contrast medium blush in the arterial phase in the pancreatoduodenal groove (arrows) as seen on the iPad (Apple Inc., Cupertino, CA) (a) and on the workstation (b), respectively. This finding was consistent with active arterial bleeding fed by pancreatoduodenal arteries, as subsequently confirmed by digital subtraction angiography. 
Figure 2. Axial CT image as displayed on the iPad (Apple Inc., Cupertino, CA) showing a small contrast medium blush (arrow) in the arterial phase inside the duodenal lumen. This finding was consistent with active arterial bleeding fed by pancreatoduodenal arteries and was not detected on the workstation. 
Table 2 . Time needed for completing review of CT angiography data sets and inter-reader agreement with the workstation and the iPad
Figure 3. Axial CT image as displayed on the iPad (Apple Inc., Cupertino, CA) showing tiny blush-like hyperdense spots (arrows) in the arterial phase inside the horizontal part of the duodenum. This finding was interpreted as active arterial bleeding only on the iPad but was not confirmed by digital subtraction angiography. 
iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience

February 2015

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176 Reads

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7 Citations

The British journal of radiology

Objective: To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding. Methods: 24 CTA examinations of patients with suspected acute gastrointestinal bleeding confirmed (19/24, 79.2%) or ruled out (5/24, 20.8%) by digital subtraction angiography (DSA) were retrospectively reviewed by three independent readers on a commercial picture archiving communication system (PACS) workstation and on an iPad with Retina Display® 64 GB (Apple Inc.). The time needed to complete reading of every CTA examination was recorded, as well as the rate of detection of arterial bleeding and identification of suspected bleeding arteries on both devices. Results: Overall, the area under the receiver operating characteristic curve, sensitivity, specificity, positive- and negative-predictive values for bleeding detection were not significantly different while using the iPad and workstation (0.774 vs 0.847, 0.947 vs 0.895, 0.6 vs 0.8, 0.9 vs 0.944 and 0.750 vs 0.667, respectively; p > 0.05). In DSA-positive cases, the iPad and workstation allowed correct identification of the bleeding source in 17/19 cases (89.5%) and 15/19 cases (78.9%), respectively (p > 0.05). Finally, the time needed to complete reading of every CTA study was significantly shorter using the iPad (169 ± 74 vs 222 ± 70 s, respectively; p < 0.01). Conclusion: Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster. Advances in knowledge: The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.




Figure 1: Summary flow chart of the study.
Figure 2: Local response of lesions treated. Abbreviations: CR=complete response; DC=disease control; OR=objective response.
Figure 3: Overall response of the entire liver according to mRECIST criteria. Abbreviations: CR=complete response; DC=disease control; OR=objective response.
Figure 4: Patient survival after cTACE (triangle plot) and DEB-TACE (square plot).
Baseline clinical and tumour characteristics of the study population randomised to receive cTACE or DEB-TACE
Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma

June 2014

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330 Reads

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563 Citations

British Journal of Cancer

Background: Transcatheter arterial chemoembolisation (TACE) is the treatment of choice for intermediate stage hepatocellular carcinoma (HCC). Doxorubicin-loaded drug-eluting beads (DEB)-TACE is expected to improve the performance of conventional TACE (cTACE). The aim of this study was to compare DEB-TACE with cTACE in terms of time-to-tumour progression (TTP), adverse events (AEs), and 2-year survival. Methods: Patients were randomised one-to-one to undergo cTACE or DEB-TACE and followed-up for at least 2 years or until death. Transcatheter arterial chemoembolisation was repeated 'on-demand'. Results: We enrolled 177 patients: 89 underwent DEB-TACE and 88 cTACE. The median number of procedures was 2 in each arm, and the in-hospital stay was 3 and 4 days, respectively (P=0.323). No differences were found in local and overall tumour response. The median TTP was 9 months in both arms. The AE incidence and severity did not differ between the arms, except for post-procedural pain, more frequent and severe after cTACE (P<0.001). The 1- and 2-year survival rates were 86.2% and 56.8% after DEB-TACE and 83.5% and 55.4% after cTACE (P=0.949). Eastern Cooperative Oncology Group (ECOG), serum albumin, and tumour number independently predicted survival (P<0.05). Conclusions: The DEB-TACE and the cTACE are equally effective and safe, with the only advantage of DEB-TACE being less post-procedural abdominal pain.






Citations (54)


... It has been reported that sorafenib demonstrated better antitumor effects when it was coadministered with 5fluorouracil (FU) in patients with advanced solid tumors. 15,16 Regorafenib (REG) is an analogue of SOR in terms of both molecular structures and pharmacological mechanisms. Replacing one hydrogen of SOR with fluorine leads to REG ( Figure 1). ...

Reference:

An Elusive Drug–Drug Cocrystal Prepared Using a Heteroseeding Strategy
A phase II (PhII) trial of sorafenib (S) in combination with 5-fluorouracil (5FU) continuous infusion (c.i.) in patients (pts) with advanced hepatocellular carcinoma (HCC): Preliminary data
  • Citing Article
  • May 2009

Journal of Clinical Oncology

... Seven RCTs compared RFA with PEI. 29,33,37,39,[43][44][45] RFA appeared to be more effective than PEI in most studies that reported OS (4/6 RCTs favoured RFA), event-or cancer-free survival (3/3 RCTs) and recurrence or local tumour progression (5/6 RCTs); all studies favouring RFA had a low RoB or some RoB concerns. However, some studies reported worse adverse events after treatment with RFA. ...

Percutaneous treatment of small hepatocellular carcinoma in cirrhosis: Radio-frequency thermal ablation versus ethanol injection - a prospective, randomized trial (final report)
  • Citing Article
  • January 2000

Radiology

... Magnetic resonance imaging (MRI) is a cornerstone in medical diagnostics, providing high-resolution images of soft tissues with unparalleled contrast. In abdominal imaging, MRI plays a crucial role in diagnosing and monitoring various abdominal conditions and anomalies such as liver cirrhosis, pancreatic tumors, and renal anomalies [5,7,9,10,18]. However, traditional MRI scans often produce anisotropic data, where the resolution differs across spatial dimensions, potentially limiting diagnostic accuracy and the ability to perform precise volumetric analysis [4,21]. ...

Clinical MRI of the abdomen: Why,how,when
  • Citing Book
  • January 2011

... A careful follow-up protocol is recommended after HCC ablation aiming to detect any recurrence of treated lesion and possible new lesions' development in other parts of the liver. A standard protocol for the follow-up should include at least a spiral CT or dynamic MR study of the liver every 4-6 months [48]. In the present work, triphasic CT was done every 3-6 months for the first 1.5 years after ablation. ...

Radiofrequency thermal ablation of liver tumors: State-of-the-art
  • Citing Article
  • January 2000

Cancer

... The standard MRI protocol contains the following sequences: axial T2, axial T1 in-phase and out-of-phase, fat-suppressed T2-weighted, diffusion weighted imaging (DWI) with corresponding apparent diffusion coefficient map, which includes both morphological and functional features of the lesion, and volumetric T1-weighted precontrast and dynamic volumetric post-extracellular contrast sequences, to contain at least an arterial and portal venous phase [25]. However, the European Society of Gastrointestinal and Abdominal Radiology has recommended use of liver-specific contrast agents, including gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA, Primovist®) [26]. Studies have found that gadoxetic acidenhanced MRI detected additional lesions, when compared to extracellular gadolinium-enhanced MRI scans [27 •, 28, 29]. ...

ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents

European Radiology

... Even though RFA has replaced PEI because of superior and predictable ablative results, the two methods are equally effective in small tumors (< 2 cm) [43, 104, 105]. PEI can be offered in small HCCs, mainly those for which RFA is not feasible due to tumor location (e. g. adjacent to the gallbladder, hepatic hilum, or large vessels) [106]. Another chemical ablation technique, percutaneous acetic acid injection (PAI), has not offered substantial advantages over PEI [107]. ...

Radiofrequency thermal ablation versus percutaneous ethanol injection for small hepatocellular carcinoma - Response
  • Citing Article
  • March 2004

Radiology

... In our previous studies, we found that angiotensin I production was transiently increased, peaking at approximately 2 weeks and returning to baseline levels after 6 weeks (Warner et al., 2012). A similar transient elevation of plasma angiotensin I production has been observed in human RAS (Garovic and Textor, 2005;Safian and Textor, 2001). It is likely that, as severe renal atrophy develops, the STK is less capable of activating the systemic renin-angiotensin system. ...

RENAL ARTERY STENOSIS
  • Citing Article
  • June 2000

Journal of Hypertension

... Some factors are hardly surprising, such as the time of day, the experience of the radiologist and the number of interruptions À others more puzzling, such as the size and luminescence of the screen, the use of key images in reporting, and the image order in the hanging protocol. (12)(13)(14)(15)(16)(17)(18) Given this complexity, it does not seem unreasonable to assume that the reading times when using AI can be differently affected in a clinical environment and a research environment. This seems supported by studies which find that CAD findings affect the reading times of individual radiologists differently. ...

iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience

The British journal of radiology

... Прежде всего, пациенту с ХАГ необходимо рекомендовать уменьшение потребления соли и включение в ежедневный рацион достаточного количества фруктов и овощей. Эпидемиологические исследования показывают, что употребление маринованных, ферментированных, обработанных или копченых продуктов с высоким содержанием нитритов и нитрозаминов [24], пищи, приготовленной методами с использованием высоких температур, такими как гриль или жарка, приводящими к высвобождению гетероциклического амина [25,26], а также диеты с повышенным содержанием гемового железа, красного мяса [27] или насыщенных жиров могут способствовать развитию и прогрессированию РЖ [28]. Курение табака и употребление алкоголя также являются дополнительными факторами риска РЖ и могут синергически взаимодействовать с факторами питания и инфекцией H. pylori. ...

N-Nitroso compounds in the diet
  • Citing Article
  • July 1999

Mutation Research/Genetic Toxicology and Environmental Mutagenesis