Biagio Merlino

Malignant pleural disease

The vast majority of pleural neoplasms invade the pleura secondarily and can be seen in patients with bronchogenic carcinoma, breast cancer, lymphoma, and ovarian or gastric carcinoma. Primary pleural neoplasms are less common, although they have developed notoriety since the up-surge of malignant mesothelioma and the knowledge of its connection to asbestos exposure. Other malignant primary tumors include localized fibrous tumor and pleural liposarcoma. In most patients with diffuse malignant pleural disease the chest radiograph shows pleural effusion with or without pleural thickening. Computed tomography (CT) usually provides precise localization and extent of the disease and may be of value in assessing chest wall and mediastinal involvement. In specific situations, magnetic resonance (MR) may be useful as a problem-solving tool when CT findings of chest wall or diaphragmatic invasion are equivocal or in patients with contraindication to intravenous administration of ionic contrast material.

Bronchioloalveolar carcinoma of the lung.

Abstract. Bronchioloalveolar carcinoma is a histologically distinct form of pulmonary adenocarcinoma representing an estimated 2–10 % of all primary lung cancers. Its varied appearances include focal masses, nodular patterns, and pneumonic and diffuse forms so that bronchioloalveolar carcinoma should be considered in the differential diagnosis of solitary or multiple pulmonary nodules and acute or chronic alveolar diseases. In this article we describe the different radiographic manifestations of bronchioloalveolar carcinoma with particular emphasis on CT findings and those signs that may help in identifying the lesion as bronchioloalveolar carcinoma.

Gastric wall thickness in normal and neoplastic subjects: a prospective study performed by abdominal ultrasound

Gastric wall thickness (body-antrum) was blind measured prospectively by real-time ultrasound in 58 patients (30 with gastric cancer and 28 healthy) who had previously undergone endoscopy.Gastric wall thickness on the average measured 15.933±4.471 mm in the neoplastic patients and 5.107±1.100 mm in the normal subjects. Seven millimeters was the highest value found in the normal subjects (4 cases) and the minimum value found in the neoplastic patients (1 case).Knowing the normal gastric wall thickness value on a standard ultrasound examination of the upper abdomen is useful, as ultrasound is often performed as a screening or first-step procedure, in order to address the patients with higher values toward more specific techniques.

Staging of thoracic lymphoma by radiological imaging

Abstract Thoracic lymphomas, which are very common especially in Hodgkins disease patients, are characterised by enlargement of mediastinal lymph nodes, parenchymal abnormalities, and pleural, pericardial and chest wall involvement. The use of several imaging techniques has been proposed in order to assess the extent of the disease correctly and to plan therapy. The most relevant results in this field, especially those using computed tomography (CT), magnetic resonance imaging (MRI) and gallium scanning, are summarised in this review. Presently CT is widely and successfully used in staging patients, whereas MRI seems to be preferable, as a second-step technique, if pericardial, pleural and chest wall involvement are suspected. The role of gallium scanning is limited in the staging, although it could be relevant in the follow-up of treated patients.

Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremity arteries: a retrospective review study.

PurposeTo assess the frequency and clinical impact of extravascular incidental findings on routine CT angiography of abdominal aorta or lower extremity arteries.Materials and methodsFrom January 2002 to July 2004, a total of 692 patients underwent CT angiography of abdominal aorta and lower extremity arteries. Two radiologists retrospectively reviewed by consensus cross-sectional images for the presence and clinical impact definition of extravascular findings. The revision of hospital charts, medical records, and all procedures’ reports performed before and after CT angiography represented the standard of reference (SOR).ResultsOnly 373 out of 605 patients in whom extravascular findings were found had a SOR; in these patients CT angiography obtained a true-positive incidental rate of 98.9% (369/373). For the clinical impact definition of CT-angiography incidental findings, a concordance with SOR was obtained in 56.3% of patients, whereas a subsequent investigation was required in 183 patients (183/369, 49.6%). Among clinically relevant incidental findings, a total of 35 malignancies (35/894, 3.9%) were detected in 20 patients (20/423, 4.7%); in 15 patients (15/423, 3.5%) malignancy was unknown before CT-angiography exam.ConclusionsA careful observation of cross-sectional images, even if “time consuming”, is mandatory not only to assess vascular findings but also to avoid a misdiagnosis of clinical relevant extravascular findings.

Neoplastic extension across pulmonary fissures: value of spiral computed tomography and multiplanar reformations.

To assess the value of spiral computed tomography (CT) with multiplanar reformations for detection of neoplastic extension across pulmonary fissures, 51 patients with a lung neoplasm near a fissure underwent spiral CT, followed by multiplanar reformations, and spaced thin-section CT scans through the area of contact between tumor and fissure. The CT studies were evaluated for visibility of fissures and their relationship to the tumor. Imaging findings were compared with surgical results in 31 patients who underwent thoracotomy. Visibility of fissures on multiplanar reformations was either good or acceptable in 47 (92.2%) patients, and poor in four. Surgical findings of neoplastic extension across the major or the minor fissure were present in seven and eight patients, respectively. Thin-section CT scans were 83.3% sensitive in assessing neoplastic involvement of the major fissure, axial CT scans were 57.1% sensitive, and spiral CT multiplanar images were 100% sensitive. In the evaluation of the minor fissure, thin-section CT and axial spiral CT scans were considered inconclusive in six patients whereas multiplanar reformations enabled correct assessment of the fissure/neoplasm relationship in all but one patient. Spiral CT multiplanar images are accurate for detection of transfissural neoplastic extension, and are superior to axial CT scans for evaluation of tumors near the minor fissure.

A Pictorial Review of Coronary Artery Bypass Grafts at Multidetector Row CT

Multidetector row CT scanners with submillimeter spatial resolution and high temporal resolution are now available and are increasingly used for noninvasive assessment of vascular disease including coronary arteries and grafts. The entire heart and graft course can be scanned within a single breath-hold, and contrast-enhanced images are reconstructed through retrospective ECG gating. In this pictorial review, we describe the CT findings of the most commonly used coronary artery bypass grafts on both axial images and two-dimensional and three-dimensional images providing a correlation with conventional coronary angiography.

Beat-to-beat estimate of fetal cardiac time intervals using magnetocardiography: longitudinal charts of normality ranges and individual trends

Background.  Fetal magnetocardiography (fMCG) records fetal cardiac electro‐physiological activity during the second half of gestation. We aimed at assessing normality values, related variability, and trends of fetal cardiac time intervals (fCTI) evaluated longitudinally from beat‐to‐beat fMCG analysis in uncomplicated pregnancies.

Osteoblastoma of the sacrum: report of 18 cases and analysis of the literature

Study Design. Retrospective case series. Objective. (1) To analyze clinical and radiographical characteristics, treatment, and outcome in patients with sacral osteoblastoma, (2) to evaluate progression-free survival and local recurrence rate, and (3) to identify prognostic factors. Summary of Background Data. Osteoblastoma is a rare tumor that has been reported to affect the sacrum from 7% to 17%. Symptoms are various and the diagnosis is often delayed. Methods. From 1980 to 2010, 18 patients with sacral osteoblastoma (16 males and 2 females) were treated at Rizzoli Institute. Lesion involved S1 (2 cases), S1–S2 (3 cases), S2 (1 case), S2–S3 (1 case), S2–S4 (1 case), S3 (2 cases), S3–S4 (5 cases), S4 (1 case), and almost the entire sacrum in 2 cases. According to Enneking classification for benign bone tumors, 13 (72%) were diagnosed at stage 2 and 5 (28%) at stage 3. Mean tumor volume was 64 cm3 (range, 2–441 cm3). Nine patients had preoperative magnetic resonance imaging. Five patients had a previous inadequate intralesional surgery elsewhere. Treatment consisted in intralesional surgery (16 cases), intralesional surgery and radiotherapy (1 case), and wide resection (1 case). Local adjuvants used were phenol (7 patients), cryocoagulation with “iceball” technique (1 case). Embolizations were performed in 7 patients. Results. At a mean of 8.4 years (range, 1–28 yr), 15 patients (83%) remained continuously disease free, whereas 3 patients had local recurrence (17%). Progression-free survival was 87% at 5 years and 74% at 10 years. No statistical difference was found between patients who received or not local adjuvants (P = 1.254), older or younger than 20 years (P = 0.970), at stage 2 or 3 (P = 0.826), evaluated preoperatively with or without magnetic resonance imaging (P = 0.160), primarily treated versus patients with previous intralesional surgery elsewhere (P = 0.131). Conclusion. In our series, curettage was successful in most of the patients. Local adjuvants did not seem to reduce the risk of local recurrence when combined with intralesional surgery. Level of Evidence: 4

Multi-slice CT (MSCT) angiography for assessment of traumatic lesions of lower limbs peripheral arteries

AimThe aim of this study was to evaluate the feasibility and effectiveness of multi-slice computed tomography (MSCT) angiography for the assessment of traumatic lesions involving the arteries of the lower limbs.Materials and methodsForty-seven patients with suspected arterial post-traumatic lesions of lower limbs underwent MSCT angiography (4 × 2.5-mm collimation, 3-mm slice width). The standards of reference were: digital subtraction angiography (DSA; patients with inconclusive/doubtful or positive MSCT angiography indicating a need for intravascular treatment), surgical findings (patients with positive MSCT angiography indicating a need for surgery), or clinical/investigational follow-up (patients with negative MSCT angiography and no need for further diagnostic procedures or surgery).ResultsAll CT exams were technically adequate. Sensitivity, specificity, and overall diagnostic accuracy of MSCT angiography were 96.3, 90, and 93.6%, respectively, relative to the reference of standard findings. In 44 out of 47 patients, MSCT angiography allowed a correct continuation of the diagnostic work-up.ConclusionMSCT angiography is a reliable fast tool for diagnosing traumatic vascular lesions, providing results comparable to DSA.