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1.  Non-invasive diagnostic imaging of colorectal liver metastases 
World Journal of Radiology  2015;7(7):157-169.
Colorectal cancer is one of the few malignant tumors in which synchronous or metachronous liver metastases [colorectal liver metastases (CRLMs)] may be treated with surgery. It has been demonstrated that resection of CRLMs improves the long-term prognosis. On the other hand, patients with un-resectable CRLMs may benefit from chemotherapy alone or in addition to liver-directed therapies. The choice of the most appropriate therapeutic management of CRLMs depends mostly on the diagnostic imaging. Nowadays, multiple non-invasive imaging modalities are available and those have a pivotal role in the workup of patients with CRLMs. Although extensive research has been performed with regards to the diagnostic performance of ultrasonography, computed tomography, positron emission tomography and magnetic resonance for the detection of CRLMs, the optimal imaging strategies for staging and follow up are still to be established. This largely due to the progressive technological and pharmacological advances which are constantly improving the accuracy of each imaging modality. This review describes the non-invasive imaging approaches of CRLMs reporting the technical features, the clinical indications, the advantages and the potential limitations of each modality, as well as including some information on the development of new imaging modalities, the role of new contrast media and the feasibility of using parametric image analysis as diagnostic marker of presence of CRLMs.
PMCID: PMC4506934  PMID: 26217455
Advances in imaging; Colorectal cancer; Liver metastases
2.  Poly Implant Prothèse (PIP) incidence of rupture: a retrospective MR analysis in 64 patients 
Aim of the study
The purpose of this retrospective study was to describe the magnetic resonance imaging (MRI) features of Poly Implant Prothèse (PIP) hydrogel implants in a group of 64 patients and to assess the incidence of rupture, compared to other clinical trials.
Material and methods
In this double-center study, we retrospectively reviewed the data sets of 64 consecutive patients (mean age, 43±9 years, age range, 27-65 years), who underwent breast MRI examinations, between January 2008 and October 2013, with suspected implant rupture on the basis of clinical assessment or after conventional imaging examination (either mammography or ultrasound). All patients had undergone breast operation with bilateral textured cohesive gel PIP implant insertion for aesthetic reasons. The mean time after operation was 8 years (range, 6-14 years). No patients reported history of direct trauma to their implants.
At the time of clinical examination, 41 patients were asymptomatic, 16 complained of breast tenderness and 7 had clinical evidence of rupture. Normal findings were observed in 15 patients. In 26 patients there were signs of mild collapse, with associated not significant peri-capsular fluid collections and no evidence of implant rupture; in 23 patients there was suggestion of implant rupture, according to breast MRI leading to an indication for surgery. In particular, 14 patients showed intra-capsular rupture, with associated evidence of the linguine sign in all cases; the keyhole sign and the droplet signs were observed in 6 cases. In 9 patients there was evidence of extra-capsular rupture, with presence of axillary collections (siliconomas) in 7 cases and peri-prosthetic and mediastinal cavity siliconomas, in 5 cases.
The results of this double center retrospective study, confirm the higher incidence (36%) of prosthesis rupture observed with the PIP implants, compared to other breast implants.
PMCID: PMC4256241  PMID: 25525578
Poly Implant Prothèse (PIP) implants; breast augmentation; implant rupture; magnetic resonance imaging (MRI)
3.  Diagnostic accuracy of MR imaging to identify and characterize focal liver lesions: comparison between gadolinium and superparamagnetic iron oxide contrast media 
To compare the diagnostic value of gadolinium (Gd) and ultrasmall superparamagnetic iron oxide (SPIO) contrast media for characterization of focal liver lesions (FLL), we retrospectively evaluated the results of magnetic resonance (MR) imaging in 68 patients (40 M, 28 F, age from 22 to 81 yrs) of which 36 with diagnosis of colo-rectal cancer, 26 with hepatic cirrhosis and 6 with incidental imaging detection of FLL. MR (Gyroscan Intera 1.5 T, Philips Medical Systems) study was performed using T1 and T2 fast-field-echo (FFE) and T2 turbo-spin-echo (TSE) sequences in axial and coronal views. Dynamic multi-phases gadolinium Gd-enhanced T1-FFE-Bh images were obtained in arterial, portal and equilibrium phases, followed by SPIO-enhanced T2-FFE scans. A qualitative analysis of pre- and post-contrast MR images to classify FLL as benign or malignant was performed using a 3-point scoring system: 0= benign; 1= suspicious for malignancy; 2= malignant. A total of 118 lesions were evaluated. In particular, histology (n=18), cytology (n=14) or clinical-imaging follow-up data (n=86) demonstrated 4 adenomas, 29 cysts, 3 focal steatosis, 25 hemangiomas, 1 focal vascular abnormality, 5 fibrotic lesions as well as 13 regenerative nodules, 6 dysplastic, 14 hepatocellular carcinomas (HCC), 17 metastasis and 1 cholangiocarcinoma. For MR imaging, diagnostic accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of Gd vs. SPIO images were respectively 83% vs. 92%, 79% vs. 74%, 85% vs. 99% (P=0.002), 68% vs. 96% (P=0.005) and 91% vs. 90%, respectively. The results suggest that SPIO-MR provides a diagnostic incremental value, as specificity and PPV, particularly to characterize FLL compared to Gd-MR; thus, we strongly recommend the use of SPIO when liver lesion characterization is requested and Gd images are uncertain.
PMCID: PMC4032916  PMID: 24914419
MR imaging; focal liver lesions (FLL); gadolinium; superparamagnetic iron oxide (SPIO); contrast media
4.  Xanthogranulomatous pyelonephritis mimicking a renal cell carcinoma: a unique and challenging case 
Acta Radiologica Short Reports  2014;3(1):2047981613513763.
We describe an unusual case of xanthogranulomatous pyelonephritis (XGPN) in a 73-year-old woman diagnosed after a blunt abdominal trauma. This case is unique because of the atypical presentation, with absence of symptoms, normal laboratory exams, and unusual computed tomography and magnetic resonance imaging findings. The patient underwent radical nephrectomy because a renal cystic tumor was suspected. Only the histopathological findings suggested the final diagnosis of XGPN.
PMCID: PMC4001428  PMID: 24778797
Computed tomography (CT); magnetic resonance imaging (MRI); ultrasound; kidney; pyelonephritis; urinary
5.  Idiopathic pulmonary fibrosis complicated by acute thromboembolic disease: chest X-ray, HRCT and multi-detector row CT angiographic findings 
Journal of Thoracic Disease  2013;5(1):82-86.
Idiopathic pulmonary fibrosis (IPF) is a chronic diffuse interstitial disease characterized by a predominant reticular pattern of involvement of the lung parenchyma which can be well documented by High Resolution Computed Tomography (HRCT). While almost half of the patients with IPF may develop pulmonary arterial hypertension, the occurrence of superimposed acute thrombo-embolic disease is rare.
We describe a case of an 87 yrs old female who was found to have IPF complicated by acute pulmonary thrombo-embolism during the clinical and radiological investigation of a rapidly worsening dyspnea. While chest x-ray findings were initially considered consistent with a congestive heart failure, a bed side echocardiography revealed findings suggestive of pulmonary arterial hypertension and right ventricular failure with enlargement of both right cavities and associated valvular regurgitations. An acute thrombo-embolic disease was initially ruled out by a perfusion lung scintigraphy and subsequently confirmed by contrast-enhanced multi-detector CT which showed an embolus at the emergency of the right inter-lobar artery with associated signs of chronic pulmonary hypertension. However, unenhanced scans performed with both conventional and high resolution techniques also depicted a reticular pattern of involvement of lung parenchyma considered suggestive of IPF despite a atypical upper lobe predominance. IPF was later confirmed by further clinical, serological and instrumental follow-up.
PMCID: PMC3548011  PMID: 23372953
Idiopathic pulmonary fibrosis; high resolution computed tomography; pulmonary thrombo-embolism; multidetector row CT angiography
6.  Primary signet ring cell carcinoma of the appendix mimicking acute appendicitis 
Acta Radiologica Short Reports  2012;1(9):arsr.2012.120017.
Primary signet ring cell carcinoma of the appendix is a very rare neoplasm that usually presents with signs and symptoms of acute appendicitis and in particular with a right lower abdominal pain. Preoperative imaging detection of appendiceal adenocarcinoma has an important value because it may result in an appropriate surgical procedure. We report a rare case of primary signet ring cell carcinoma of the vermiform appendix in an 80-year-old man who was misdiagnosed on computed tomography (CT) scan as acute appendicitis.
PMCID: PMC3738361  PMID: 23986852
Appendix; neoplasms – primary; inflammation; CT
7.  A classical phenotype of Anderson-Fabry disease in a female patient with intronic mutations of the GLA gene: a case report 
Fabry disease (FD) is a hereditary metabolic disorder caused by the partial or total inactivation of a lysosomal hydrolase, the enzyme α-galactosidase A (GLA). This inactivation is responsible for the storage of undegraded glycosphingolipids in the lysosomes with subsequent cellular and microvascular dysfunction. The incidence of disease is estimated at 1:40,000 in the general population, although neonatal screening initiatives have found an unexpectedly high prevalence of genetic alterations, up to 1:3,100, in newborns in Italy, and have identified a surprisingly high frequency of newborn males with genetic alterations (about 1:1,500) in Taiwan.
Case presentation
We describe the case of a 40-year-old female patient who presented with transient ischemic attack (TIA), discomfort in her hands, intolerance to cold and heat, severe angina and palpitations, chronic kidney disease. Clinical, biochemical and molecular studies were performed.
Reported symptoms, peculiar findings in a renal biopsy – the evidence of occasional lamellar inclusions in podocytes and mesangial cells – and left ventricular (LV) hypertrophy, which are considered to be specific features of FD, as well as molecular evaluations, suggested the diagnosis of a classical form of FD.
We detected four mutations in the GLA gene of the patient: -10C>T (g.1170C>T), c.370-77_-81del (g.7188-7192del5), c.640-16A>G (g.10115A>G), c.1000-22C>T (g.10956C>T). These mutations, located in promoter and intronic regulatory regions, have been observed in several patients with manifestations of FD. In our patient clinical picture showed a multisystemic involvement with early onset of symptoms, thus suggesting that these intronic mutations can be found even in patients with classical form of FD.
PMCID: PMC3425126  PMID: 22682330
Fabry disease; α-galactosidase A; GLA; Globotriaosylceramide; High resolution melting
8.  Magnetic resonance assessment of left ventricular volumes and mass using a single-breath-hold 3D k-t BLAST cine b-SSFP in comparison with multiple-breath-hold 2D cine b-SSFP 
Insights into Imaging  2010;2(1):39-45.
To assess the feasibility of single-breath-hold three-dimensional cine b-SSFP (balanced steady-state free precession gradient echo) sequence (3D-cine), accelerated with k-t BLAST (broad-use linear acquisition speed-up technique), compared with multiple-breath-hold 2D cine b-SSFP (2D-cine) sequence for assessment of left ventricular (LV) function.
Imaging was performed using 1.5-T MRI (Achieva, Philips, The Netherlands) in 46 patients with different cardiac diseases. Global functional parameters, LV mass, imaging time and reporting time were evaluated and compared in each patient.
Functional parameters and mass were significantly different in the two sequences [3D end-diastolic volume (EDV) = 129 ± 44 ml vs 2D EDV = 134 ± 49 ml; 3D end-systolic volume (ESV) = 77 ± 44 ml vs 2D ESV = 73 ± 50 ml; 3D ejection fraction (EF) = 43 ± 15% vs 2D EF = 48 ± 15%; p < 0.05], although an excellent correlation was found for LV EF (r = 0.99). Bland-Altman analysis showed small confidence intervals with no interactions on volumes (EF limits of agreement = 2.7; 7.6; mean bias 5%). Imaging time was significantly lower for 3D-cine sequence (18 ± 1 s vs 95 ± 23 s; p < 0.05), although reporting time was significantly longer for the 3D-cine sequence (29 ± 7 min vs 8 ± 3 min; p < 0.05).
A 3D-cine sequence can be advocated as an alternative to 2D-cine sequence for LV EF assessment in patients for whom shorter imaging time is desirable.
PMCID: PMC3288975  PMID: 22865424
Magnetic resonance imaging; Cardiac MRI; 2D b-SSFP; 3D b-SSFP; k-t BLAST; Left ventricle; Volumetric quantification; Ejection fraction
9.  64-Slice Multidetector Computed Tomographic Evaluation of Arterial Conduit Patency after Off-Pump Coronary Artery Bypass Grafting 
Texas Heart Institute Journal  2009;36(5):409-415.
We set out to evaluate the accuracy of 64-slice multidetector row computed tomography (MDCT) in the evaluation of graft patency in 25 unselected patients who underwent off-pump revascularization with arterial conduits. A total of 73 coronary artery bypass grafts were examined by means of 64-slice MDCT. Postoperative clinical outcomes were also evaluated as indicators of early coronary bypass malfunction. Serial data from cardiac-specific biomarkers and from hemodynamic results were obtained in all patients. Two radiologists analyzed the MDCT images and reached consensus.
No patients had evidence of postoperative acute myocardial infarction. Transient postoperative reduction of 5% to 8% in left ventricular ejection fraction was detected in 4 patients, independently of elevated biomarker serum levels. A total of 73 conduits were available for the analysis. Two grafts were judged not evaluable because of poor visualization due to irregular heartbeat. The image quality was excellent in all other scanned grafts and anastomoses.
We conclude that 64-slice MDCT technology enables accurate and reliable visualization of coronary bypass grafts with arterial conduits. We believe that it can be performed in large populations of postoperative bypass patients as a realistic alternative to coronary angiography.
PMCID: PMC2763475  PMID: 19876416
Coronary angiography; graft occlusion, vascular/radiography; myocardial revascularization; tomography, spiral computed; vascular patency
10.  A case of multiple intra-abdominal splenosis with computed tomography and magnetic resonance imaging correlative findings 
Hepatic splenosis refers to heterotopic auto-transplantation and implantation of splenic tissue resulting from the spillage of cells from the spleen after splenic trauma or splenectomy. The true incidence of splenosis is unknown, because this entity is usually an incidental finding at surgery. Splenic implants are usually multiple, and can be localized anywhere in the peritoneal cavity. Splenic implants in the peritoneal cavity may be confused with renal tumors, abdominal lymphomas and endometriosis. We describe computed tomography (CT) and magnetic resonance imaging (MRI) findings in a rare case of multiple intra-abdominal splenosis located along the hepatic surface and adjacent to the upper pole of the right kidney, mimicking a renal neoplasm.
PMCID: PMC2693699  PMID: 18322965
Abdomen; Computed tomography; Magnetic resonance imaging; Liver; Spleen

Results 1-10 (10)