Gianluca Valeri

Comparative study of breast implant rupture using mammography, sonography, and magnetic resonance imaging: correlation with surgical findings.

Abstract:  Purpose of this study was to evaluate the accuracy of mammography, ultrasonography, and magnetic resonance imaging (MRI), in the detection of breast implant rupture and to make a correlation with findings at explantation. The study population consisted of 63 women with 82 implants, undergoing surgical explantation. Implant rupture status was blindly determined obtaining diagnosis of rupture, possible rupture, or intact implant. Strictly predetermined rupture criteria were applied and compared with findings at surgery, which were considered the gold standard. False‐positives and false‐negatives were retrospectively evaluated to identify pitfalls in the investigation. All associations between imaging signs and surgical findings were evaluated by using chi‐square test. The respective sensitivity and specificity of investigations are reported. Our experience suggests that MRI is the more accurate method for identification of breast implant rupture, even if it should be performed following the diagnostic algorithm proposed.

Magnetic resonance cholangiopancreatography in primary sclerosing cholangitis in children.

Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown aetiology. Diagnosis is based on clinical and laboratory data in conjunction with imaging of the biliary tree using endoscopic retrograde cholangiopancreatography (ERCP). Objective: To evaluate the clinical usefulness of MR cholangiopancreatography (MRCP) in the diagnosis of PSC in children. Materials and methods: Twenty-one children with clinical and laboratory suspicion of PSC were enrolled. MRCP was performed using a superconductive system with a phased-array coil. Rapid acquisition with relaxation enhancement (RARE) T2-weighted and half-Fourier single-shot turbo-spin-echo (HASTE) sequences were used. The distribution and extent of biliary tree changes were evaluated and classified according to Majoies classification. A comparison between MRCP and ERCP was performed blind in all cases to evaluate the usefulness of MRI. Results: In 13 cases (62%), MRCP showed abnormalities of the biliary tree which were considered positive for PSC, while in 8 cases there were no signs of PSC. Both MRCP and ERCP correctly identified changes in 13 cases and excluded abnormalities in 5. MRCP had a sensitivity of 81%, specificity of 100%, negative predictive value of 62%, positive predictive value of 100% and an accuracy of 85%. Conclusions: MRCP can be proposed as the preliminary non-invasive imaging modality for the diagnosis of PSC in children.

CARDIAC IRON AND CARDIAC DISEASE IN MALES AND FEMALES WITH TRANSFUSION-DEPENDENT THALASSEMIA MAJOR: A T2* MAGNETIC RESONANCE IMAGING STUDY

Background It has been repeatedly reported that female patients with thalassemia major survive longer than males and that the difference is due to a lower rate of cardiac disease in females. Design and Methods We compared the cardiac iron load as measured by T2* magnetic resonance imaging in 776 patients (370 males) examined at the National Research Council as part of an Italian cooperative study. We also established normal left ventricular ejection fraction values for our population. Results The prevalence of cardiac disease was higher in males than in females (105 males versus 69 females; P<0.0001). Cardiac T2* was significantly lower in patients with heart dysfunction (P<0.0001), but no difference was observed according to sex. Twenty males and five females had a history of cardiac arrhythmias. Their cardiac T2* was not significantly lower than that of patients without arrhythmias (24 ms versus 26 ms; P=0.381), nor was there a difference between sexes. Liver T2* was significantly lower in males and females with heart dysfunction compared to those without. Ferritin levels were higher in patients of both sexes with heart dysfunction without significant differences between males and females. Conclusions Males and females are at the same risk of accumulating iron in their hearts, but females tolerate iron toxicity better, possibly as an effect of reduced sensitivity to chronic oxidative stress.

Single region of interest versus multislice T2* MRI approach for the quantification of hepatic iron overload

To evaluate the effectiveness of the single ROI approach for the detection of hepatic iron burden in thalassemia major (TM) patients in respect to a whole liver measurement.

Tendon involvement in rheumatoid arthritis of the wrist: MRI findings.

Abstract Objective. To evaluate the distribution and extent of wrist tendon alterations in patients with active rheumatoid arthritis (RA) using magnetic resonance imaging (MRI). Design and patients. Forty-three clinically active RA patients with an illness duration of less than 4 years and no clinical evidence of tendons tears were enrolled in the study. There were 10 men and 33 women, with an average age of 52 years (range 33– 63 years). MRI of both wrists, with one exception, was performed at 1.0 T using T1- and T2-weighted sequences (slice thickness 3 mm). Twelve healthy subjects (8 women, 4 men; mean age 31 years) were also evaluated as a control group. Two radiologists reviewed each of four schematic anatomical regions (volar, dorsal, ulnar, radial) for the degree of tendon and tendon sheath alterations using two progressive scales. Results. In the control group all tendons had homogeneous low signal intensity on all sequences. A small amount of fluid was found in six subjects but the diameter was always less than 1 mm. In the patient group minimal fluid (<2 mm) was found in 35 (41%) wrists, grade 2 fluid (<2>5 mm) in 26 (31%) and grade 3 fluid (>5 mm) in 24 (28%). Fifty-nine (69%) of the grade 1 changes were in the volar compartment but grade 2 involvement was evenly distributed. Grade 3 changes were most common in the dorsal compartment and combined grade 2 and 3 in the dorsal and ulnar compartments were 32 (38%) and 25 (30%) compared with 16 (18%) and 17 (20%) respectively in the volar and radial compartments. The tendons were normal (grade 0) in 47 (46%) wrists. A maximum tendon signal change (grade 1) was demonstrated in 28 wrists (32%). When associated with other individual tendons grades this grade was demonstrated in the dorsal compartment in 30 (35%) wrists, in the volar compartment in 12 (14%), in the radial compartment in 17 (20%) and in the ulnar compartment in 26 (30%). A partial tear (grade 2) was detected in 7 (8%) wrists, all involving the dorsal and ulnar compartments; five underwent surgical repair and one proved to have a complete rupture of extensor digitorum. Three (3%) had a grade 3 complete tendon tear: all of these were in extensor tendons. Surgical repair was successful in one case but two ruptured again within 3 months. Conclusions. Low grades of peritendinous effusion were more common in the volar compartment whereas moderate and high degrees of tendon sheath fluid collection and/or pannus and signs of tendonitis were more frequent in the dorsal and ulnar tendon sheaths.

Indications for breast magnetic resonance imaging. Consensus document “Attualità in senologia”, Florence 2007

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.RiassuntoLa RM mammaria è in fase di crescente utilizzo clinico, soprattutto per le applicazioni che richiedono la somministrazione di mezzo di contrasto (MdC) paramagnetico. Il presente documento propone una codificazione sintetica delle indicazioni accettabili con potenziale vantaggio per le donne, secondo la valutazione delle evidenze presenti in letteratura e l’opinione del gruppo di esperti estensori del documento. In generale si raccomanda che l’indagine sia eseguita presso centri che siano in grado di combinare l’esperienza senologica relativa all’imaging convenzionale e ai prelievi agobioptici con quella specifica in RM mammaria e che garantiscano l’esecuzione del second look ecografico per i reperti non rilevati all’imaging convenzionale pre-RM. Non si ritiene che vi siano evidenze in favore dell’utilizzo della RM quale approccio diagnostico nella caratterizzazione di reperti equivoci all’imaging convenzionale in tutte le situazioni nelle quali sia praticabile il prelievo agobioptico sotto guida ecografica o stereotassica né in favore dello studio di donne non ad alto rischio asintomatiche e con imaging convenzionale negativo. Sono qui definiti i requisiti tecnici e metodologici di esecuzione dell’indagine e indicazioni e limiti relativi a: sorveglianza delle donne ad alto rischio di tumore mammario; stadiazione locale pretrattamento chirurgico; valutazione dell’effetto della chemioterapia neoadiuvante; mammella trattata per carcinoma; carcinoma unknown primary syndrome; mammella secernente; protesi mammarie.

Open source software in a practical approach for post processing of radiologic images

PurposeThe purpose of this paper is to evaluate the use of open source software (OSS) to process DICOM images.Materials and methodsWe selected 23 programs for Windows and 20 programs for Mac from 150 possible OSS programs including DICOM viewers and various tools (converters, DICOM header editors, etc.). The programs selected all meet the basic requirements such as free availability, stand-alone application, presence of graphical user interface, ease of installation and advanced features beyond simple display monitor. Capabilities of data import, data export, metadata, 2D viewer, 3D viewer, support platform and usability of each selected program were evaluated on a scale ranging from 1 to 10 points.ResultsTwelve programs received a score higher than or equal to eight. Among them, five obtained a score of 9: 3D Slicer, MedINRIA, MITK 3M3, VolView, VR Render; while OsiriX received 10.ConclusionsOsiriX appears to be the only program able to perform all the operations taken into consideration, similar to a workstation equipped with proprietary software, allowing the analysis and interpretation of images in a simple and intuitive way. OsiriX is a DICOM PACS workstation for medical imaging and software for image processing for medical research, functional imaging, 3D imaging, confocal microscopy and molecular imaging. This application is also a good tool for teaching activities because it facilitates the attainment of learning objectives among students and other specialists.

Chromium Exposure and Germinal Embryonal Carcinoma: First Two Cases and Review of the Literature

The aim of the study was to determine the potential role of occupational exposures to chromium (Cr) in the onset of extragonadal germinal embryonal carcinoma. The first two cases of workers in a company with Cr exposure are reported. The published scientific literature regarding the topic in peer-reviewed journals including MEDLINE and CancerLit databases was extensively reviewed. Two young patients who were coworkers in the same company, exposed to Cr, developed extragonadal germinal embryonal carcinomas. One of them also developed angiosarcoma of the mediastinum. To the best of our knowledge these are the first two cases of germinal embryonal carcinoma in patients with occupational exposure to Cr.

Multiparametric Cardiac Magnetic Resonance Survey in Children With Thalassemia Major: A Multicenter Study.

Background—Cardiovascular magnetic resonance (CMR) plays a key role in the management of thalassemia major patients, but few data are available in pediatric population. This study aims at a retrospective multiparametric CMR assessment of myocardial iron overload, function, and fibrosis in a cohort of pediatric thalassemia major patients. Methods and Results—We studied 107 pediatric thalassemia major patients (61 boys, median age 14.4 years). Myocardial and liver iron overload were measured by T2* multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Late gadolinium enhancement images were acquired to detect myocardial fibrosis. All scans were performed without sedation. The 21.4% of the patients showed a significant myocardial iron overload correlated with lower compliance to chelation therapy (P<0.013). Serum ferritin ≥2000 ng/mL and liver iron concentration ≥14 mg/g/dw were detected as the best threshold for predicting cardiac iron overload (P=0.001 and P<0.0001, respectively). A homogeneous pattern of myocardial iron overload was associated with a negative cardiac remodeling and significant higher liver iron concentration (P<0.0001). Myocardial fibrosis by late gadolinium enhancement was detected in 15.8% of the patients (youngest children 13 years old). It was correlated with significant lower heart T2* values (P=0.022) and negative cardiac remodeling indexes. A pathological magnetic resonance imaging liver iron concentration was found in the 77.6% of the patients. Conclusions—Cardiac damage detectable by a multiparametric CMR approach can occur early in thalassemia major patients. So, the first T2* CMR assessment should be performed as early as feasible without sedation to tailor the chelation treatment. Conversely, late gadolinium enhancement CMR should be postponed in the teenager age.

Pancreatic iron overload by T2* MRI in a large cohort of well treated thalassemia major patients: can it tell us heart iron distribution and function?

Conflict of interest: The authors have no conflicts of interest to report. *Correspondence to: Michaela Cada, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail: michaela.cada@sickkids.ca Received for publication: 20 February 2015; Revised: 20 May 2015; Accepted: 27 May 2015 Published online: 4 June 2015 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/ajh.24078