Antonio Giulio Gennari

Value of percent change in tumoral volume measured at T2-weighted and diffusion-weighted MRI to identify responders after neoadjuvant chemoradiation therapy in patients with locally advanced rectal carcinoma

To evaluate the percent change in tumoral volume measured at T2‐weighted magnetic resonance imaging (T2WMRI) and diffusion‐weighted (DWI) as a method to identify responders after chemo‐ and radiation therapy (CRT) in patients with locally advanced rectal carcinoma.

Biochemical Markers and MR Imaging Findings as Predictors of Crohn Disease Activity in Patients Scanned by Contrast-enhanced MR Enterography

RATIONALE AND OBJECTIVES To define the best independent predictors for active inflammation in patients with Crohn disease (CD) examined by contrast-enhanced magnetic resonance (MR) enterography. MATERIALS AND METHODS Ninety-one patients (47 men and 44 women; aged 39.58 ± 17.1 years) with a diagnosis of CD; CD activity index (CDAI) ≥ 150 (n = 19 patients) or <150 (n = 72) underwent MR enterography including T2-weighted half-Fourier acquisition single-shot turbo spin-echo, T2-weighted spectral fat presaturation with inversion recovery, T1-weighted balanced steady-state free precession, and T1-weighted breath-hold resolution isotropic high volume three-dimensional MR imaging sequences before and after administration of gadobenate dimeglumine during arterial (30 seconds), portal venous (70 seconds), and delayed phase (3 and 5 minutes from contrast injection). Two readers analyzed the MR images in consensus. Reference standard was the Crohns Disease Endoscopic Index of Severity (CDEIS) with deep mucosal biopsy or the histologic analysis of the surgical specimen in those patients (n = 30) who underwent elective small-bowel resection. Univariate and multivariate logistic regression analyses were performed to assess CDAI, biochemical markers (C-reactive protein and fecal calprotectin levels) and MR imaging findings as potential predictors of inflammatory CD activity. RESULTS Patients revealed prevalently active (n = 47 patients) or quiescent CD with mural fibrosis (n = 44 patients). The bowel wall T2 hyperintensity (odds ratio [OR], 9.20; 95% confidence interval [CI], 2.71-31.19) and total length of disease (OR, 1.29; 95% CI, 1.11-1.49) were found as the best independent predictors of active CD. CDAI, C-reactive protein, and fecal calprotectin were not found independent predictors of active CD. CONCLUSIONS The bowel wall T2 hyperintensity and the length of the involved bowel tract were predictors of active inflammation in patients with CD examined by contrast-enhanced MR enterography.

Impact of gadolinium-based contrast agent in the assessment of Crohn's disease activity: Is contrast agent injection necessary?

To determine whether magnetic resonance enterography (MRE) performed without intravenous contrast injection is diagnostically noninferior to conventional contrast‐enhanced MRE (CE‐MRE) in patients with Crohns disease (CD).

Predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine-enhanced magnetic resonance imaging: diagnostic accuracy and confidence

OBJECTIVE To identify predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging. METHODS Fifty cirrhotic patients with 120 nodules, including 10 mass-forming intrahepatic cholangiocarcinomas and two combined hepatocellular carcinoma-cholangiocarcinomas, were scanned by Gd-BOPTA-enhanced MR imaging. RESULTS T1 hypointensity [odds ratio (OR), 20.12], peripheral hyperintense rim at hepatic arterial phase (OR, 13.5), and iso-hyperintensity at hepatobiliary phase (OR 21.32) were found to be independent predictors of intrahepatic cholangiocarcinoma. CONCLUSIONS T1 hypointensity, peripheral hyperintense rim at hepatic arterial phase, and iso-hyperintensity at hepatobiliary phase are independent predictors of intrahepatic cholangiocarcinoma diagnosis in patients with liver cirrhosis.

Predictors of mesorectal fascia invasion after gadolinium injection in rectal carcinoma after neoadjuvant therapy

OBJECTIVE To assess spectral presaturation inversion-recovery MRI sequence with gadolinium to identify predictors of mesorectal fascia (MRF) invasion in patients with locally advanced rectal carcinoma after neoadjuvant therapy. MATERIALS AND METHODS Sixty-five patients underwent neoadjuvant concomitant radiation and chemotherapy and surgery. Magnetic resonance images were assessed by two radiologists. RESULTS Linear (odds ratio, 95% confidence intervals: 19.33, 1.98-188.6) and reticular strands (odds ratio, 95% confidence intervals: 9.75, 1.45-67.77) reaching the MRF are predictors of MRF invasion. CONCLUSION Linear or reticular mesorectal strands reaching the MRF detected at contrast-enhanced MRI represent a predictor of MRF invasion.

Differentiation of Inflammatory From Fibrotic Ileal Strictures among Patients with Crohn's Disease Based on Visual Analysis: Feasibility Study Combining Conventional B-Mode Ultrasound, Contrast-Enhanced Ultrasound and Strain Elastography

The aim of this pilot study was to assess prospectively the feasibility of conventional B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) combined with real-time strain elastography (SE) in the differentiation of inflammatory from fibrotic ileal strictures among patients with Crohns disease (CD) based on visual analysis. Twenty non-consecutive patients (15 male and 5 female; mean age ± standard deviation, 40.2 ± 10.22 y) with CD and stricture of the terminal ileal loop were scanned by conventional B-mode US and CEUS and, subsequently, by real-time SE. Two independent readers visually classified each bowel stricture as fibrotic or inflammatory based on conventional B-mode US, CEUS, SE, individually and then for all techniques combined. All techniques combined had a higher (p <0.05) sensitivity (reader 1, 9/20 [45%]; reader 2, 7/20 [35%]), specificity (reader 1, 5/20 [25%]; reader 2, 8/20 [40%]) and diagnostic accuracy (reader 1, 14/20 [70%]; reader 2, 15/20 [75%]) and higher (p <0.05) area under the receiver operating characteristic curve (reader 1, 0.953; reader 2, 0.921) than individual techniques. Inter-reader agreement was fair for conventional B-mode US (k = 0.46) and CEUS (k = 0.39), moderate for SE (k = 0.6) and fair for all techniques combined (k = 0.38). Conventional B-mode US and CEUS, in combination with SE, may improve differentiation of inflammatory from fibrotic ileal strictures among patients with CD based on visual analysis.

Bolus versus continuous infusion of microbubble contrast agent for liver ultrasound by using an automatic power injector in humans: A pilot study

To evaluate the feasibility of using continuous infusion, in comparison with bolus injection, of a sulfur hexafluoride–microbubble contrast agent to prolong the duration of hepatic parenchymal enhancement in humans during sonographic examination.

Imaging characteristics of pleural tumours

AbstractMalignant mesothelioma is doubtless the more known pleural tumour. However, according to the morphology code of the International Classification of Diseases for Oncology (ICD-O), there are several histological types of pleural neoplasms, divided into mesothelial, mesenchymal and lymphoproliferative tumours, that may be misdiagnosed. In this paper we summarise and illustrate the incidence aspects and the clinical, pathological and radiological features of these neoplasms.Teaching Points• According to the ICD-O, there are 11 different histological types of pleural neoplasm. • Imaging, clinical and histopathological aspects of these neoplasms may be overlapping. • Knowledge of different pleural tumours plays an important role for diagnosis orientation.

Ultrasound of Upper Urinary Tract Infections

Urinary tract infection (UTI) is the most common bacterial infection. It accounts for 8.6 million visits in the ambulatory care setting in the United States. Women are at higher risk for UTI, with a self-reported annual incidence of 12%, and by the age of 32, half of them have suffered at least one UTI. Moreover UTI recurrence is high. Luckily acute pyelonephritis is much less common than cystitis, with a peak annual incidence of 25 cases per 10,000 women 15–34 years of age [1]. Infection is initiated when potential pathogens migrate from the bowel lumen to urethra and ascend to the kidneys. Accurate differentiation between uncomplicated UTI (episodes of acute cystitis and pyelonephritis in healthy premenopausal, non-pregnant woman, with no history suggesting abnormalities of urinary tract) and complicated UTI (all the other cases) is mandatory. Imaging helps in disease detection, definition its extent, reveal predisposing conditions and complications. Ultrasound is iexpensive, immediate, painless, widely available and radiation-free, so it should represents he first line imaging modality in the majority of patients. However uncomplicated UTI usually do not require imaging for diagnosis and treatment.

Ultrasound of Lower Urinary Tract Infections

Contrary to upper urinary tract infections (UTI), which affect almost exclusively the kidneys, lower UTI are a more complex entity, affecting several different portions of the genitourinary tract. They consist of a wide spectrum of manifestations, ranging from acute cystitis, which is the most common infection of all the urinary tract counting 0.70 episodes per person-year in young women and 0.07 episodes per person-year in postmenopausal women, to infrequent entities as schistosomiasis or life threatening disease such as Fournier’s gangrene. Enteric flora organisms like Escherichia Coli, Klebsiella Pneumoniae and Enterococcus species are the cause of disease in the vast majority of patients. The role of imaging techniques is strictly related to the severity of presentation varying between either end of possibilities: not required and mandatory. Ultrasound (US) is the technique of choice in most cases, however plain film and computer tomography (CT) may help the diagnostic workup in selected cases demonstrating peculiar findings.