Andrea Stagnitti

Value of MRI of the hand and the wrist in evaluation of bone age: preliminary results.

To evaluate bone age determination using MRI of the hand and wrist.

High positive predictive value of CT colonography in a referral centre.

AIM To assess the positive predictive value (PPV) of CTC in the clinical routine of a dedicated referral centre. MATERIAL AND METHODS 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. RESULTS 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. CONCLUSION 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.

Portrait of a polyp: the CTC dilemma

Portrait of a polyp: the CTC dilemma Franco Iafrate, Cesare Hassan, Perry J. Pickhardt, Alessandro Pichi, Andrea Stagnitti, Angelo Zullo, Emilio Di Giulio, Andrea Laghi Department of Radiological Sciences, ‘‘Sapienza’’ University of Rome, Viale Regina Elena 324, Rome 00161, Italy Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy Department of Radiology, University of Wisconsin Medical School, Madison, WI, USA Digestive and Liver Disease Unit, Sant’Andrea Hospital, ‘‘Sapienza’’ University of Rome, Rome, Italy Department of Radiological Sciences, ‘‘Sapienza’’ University of Rome Polo Pontino, Latina, Italy

MR enterography: Relationship between intestinal fold pattern and the clinical presentation of adult celiac disease

To correlate the clinical presentation of adult celiac disease with various intestinal fold patterns using MR‐enterography.

Nuclear Medicine in the Imaging and Management of Breast Cancer

Axillary nodal status is the most important prognostic factor for patients with breast cancer. Clinical assessment and imaging modalities are not always reliable. Surgical removal and histopathological examination of axillary lymph nodes remain essential methods of staging the axilla and planning breast cancer therapy (Chu et al, 2010; Perry, 2001) But whether axillary lymph node dissection improves survival remains controversial. Historically, nodal involvement was determined by conventional axillary dissection. (Gill, 2009) Till 1990s conventional axillary dissection was performed in all women with breast cancer with great incidence of morbidities such as pain, numbness, shoulder joint stiffness, scarring, infection and long term lymphoedema. (Mansel et al, 2006) Sentinel lymph node biopsy has recently been introduced in the treatment of women with breast cancer. The American Society of Clinical Oncology in 2005 (Lyman, 2005), and more recently the British Association of Surgical Oncology (Association of Breast Surgery, 2009) endorsed sentinel lymph node biopsy (SLNB) as the recommended method of staging early breast cancer in clinically node negative patients. The sentinel lymph node hypothesis is that the sentinel lymph nodes are the first nodes draining a tumor and that focused histological analysis of sentinel lymph nodes is predictive of the status of the regional nodes thus accurately staging the breast disease with lower incidence of complications. (Krag et al, 1998; Morton et al, 1992) Giuliano et al (Giuliano et al, 1994) demonstrated that the status of sentinel nodes, with respect to the presence of metastases, accurately reflected the metastatic content of the local nodal basin. Early works support the feasibility and accuracy of sentinel lymph node biopsy. However, the optimal management of the axilla remains uncertain as axillary lymph node dissection, sentinel lymph node biopsy and lymphoscintigraphy have been described as reliable alternative procedures. By combining preoperative lymphatic mapping with intraoperative gamma probe detection nuclear medicine procedures are increasingly used to identify and detect the sentinel node in breast cancer, and in other malignancies.

Preparazione del paziente e altri aspetti pratici

La preparazione del paziente per effettuare un esame di colonscopia virtuale (CV) e estremamente semplice, poiche non e necessaria alcuna pre-medicazione ne sedazione e l’unico farmaco che viene in genere somministrato e un agente spasmolitico. E richiesto solo il digiuno il giorno dello studio, nel caso in cui si dovesse iniettare per via endovenosa un mezzo di contrasto (mdc); ma questa non e la regola, dal momento che l’uso dell’mdc e limitato solo ad alcune situazioni cliniche.