Giovanni Foti

Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging.

BackgroundThe purpose of the study was to compare the accuracy of double-contrast barium enema (DCBE) and magnetic resonance imaging (MRI) in the diagnosis of intestinal endometriosis using the histological examination on resected specimen as comparative standard.MethodsEighty-three consecutive patients with suspected intestinal endometriosis, resected between 2005 and 2007, were prospectively evaluated. All of the women underwent preoperative DCBE and MRI on the same day. We evaluated number, site (rectum, sigmoid, cecum), and size of the lesions. The imaging findings were correlated with those resulting at pathology.ResultsAmong the 65 women who underwent surgery, 50/65 (76.9%) were found to have bowel endometriosis, with 9/50 (18%) patients presenting two lesions; DCBE allowed to detect 50/59 (84.7%) lesions. MRI allowed to detect 42/59 (71.1%) lesions. DCBE showed sensibility, specificity, PPV, NPV, and accuracy of respectively 84.7, 93.7, 98.0, 62.5, and 86.6%, MRI of 71.1, 83.3, 93.3, 46.8, and 74.6%.ConclusionDCBE is more accurate than unenhanced MRI in the diagnosis of bowel endometriosis, and should be preferred in the preoperative management of this disease, since it usually enables a proper surgical planning.

Contrast-enhanced ultrasonography (CEUS) vs. MRI of the small bowel in the evaluation of Crohn’s disease activity

PurposeThe presence of disease activity in Crohn’s disease (CD) is one of the main parameters used to establish whether optimal therapy should be drug therapy or surgery. However, a major problem in monitoring CD is the common mismatch between the patient’s symptoms and imaging objective signs of disease activity. Bowel ultrasonography (US) has emerged as a low-cost, noninvasive technique in the diagnosis and follow-up of patients with CD. Accordingly, the use of contrastenhanced US (CEUS) has made possible an evaluation of the vascular enhancement pattern, similar to the use of magnetic resonance imaging (MRI). The aim of our study was to evaluate the role of CEUS in comparison with small-bowel MRI for assessing Crohn’s disease activity.Materials and methodsWe prospectively enrolled 30 consecutive patients with known CD. Clinical and laboratory data were compared with imaging findings obtained from MRI and CEUS of the small bowel. MRI was performed with a 1.5-T system using phased-array coils and biphasic orally administered contrast agent prior to and after gadolinium chelate administration. We performed US with a 7.5-MHz linear-array probe and a second-generation contrast agent. The parameters analysed in both techniques were the following: lesion length, wall thickness, layered wall appearance, comb sign, fibroadipose proliferation, presence of enlarged lymph nodes and stenosis. We classified parietal enhancement curves into two types in relation to the contrast pattern obtained with the time-intensity curves at MRI and CEUS: (1) quick washin, quick washout, (2) slow washin, plateau with a slow washout.ResultsComparison between Crohn’s disease activity index (CDAI) and MRI showed a low correlation, with an rho=0.398; correlation between CDAI-laboratory data and CEUS activity was low, with rho=0.354; correlation between MRI activity and CEUS activity was good, with rho = 0.791; high correlation was found between CEUS and MRI of the small bowel when assessing wallthickness, lymph nodes and comb sign; good correlation was fund when assessing layered wall appearance, disease extension and fibroadipose proliferation. At MRI, timeintensity curves for 12/30 patients were active, compared with for 14/30 patients at CEUS; therefore there was a poor correlation between curve on CEUS and curve on MRI (r=0.167; p=0.36).ConclusionsThe use of CEUS can be recommended if there is a discrepancy between MRI and clinical/laboratory parameters. MRI of the small bowel remains the most accurate method for evaluating disease activity.RiassuntoObiettivoLa presenza di attività di malattia (CDAI) nel morbo di Crohn (MC) rappresenta un parametro fondamentale per stabilire la strategia medica o chirurgica nel trattamento, tuttavia una delle maggiori difficoltà nel monitoraggio del MC è costituito dalla non concordanza tra sintomatologia e rilievi imaging di attività di malattia. L’ecografia dell’intestino tenue emerge come tecnica a basso costo non invasiva nella diagnosi e nel follow-up dei pazienti con MC, e inoltre lo studio mediante mezzo di contrasto (CEUS) ha reso possibile la valutazione dell’enhancement parietale similmente alla enteroclisi in risonanza magnetica (RM). Lo scopo del nostro studio è valutare il ruolo del CEUS in confronto con RM nella valutazione di attività di malattia nei pazienti con MC.Materiali e metodiAbbiamo selezionato prospetticamente 30 pazienti consecutivi affetti da MC noto. I dati clinici e laboratoristici sono stati confrontati con i rilievi imaging alla RM e al CEUS dell’intestino tenue. L’enteroclisi-RM è stata effettuata con apparecchiatura da 1,5 T con bobine phased-array e mezzo di contrasto (MdC) orale bifasico prima e dopo la somministrazione di chelati del gadolinio endovena. L’ecografia è stata effettuata con soda lineare da 7,5 MHz e MdC ecografico di seconda generazione. I parametri analizzati per entrambe le metodiche sono: lunghezza della lesione, spessore parietale, aspetto striato di parete, segno del pettine, proliferazione fibroadiposa, linfoadenomegalie, stenosi. Abbiamo classificato l’impregnazione di parete post contrasto grafica in due tipi a seconda delle curve intensità tempo ottenute per entrambe le metodiche in: (1) rapida impregnazione e rapida dismissione del MdC; (2) lenta impregnazione e plateau con lenta dismissione del MdC.RisultatiLa correlazione tra CDAI e RM si è dimostrata scarsa con un coefficiente di correlazione Spearman’s (rho)=0,398; la correlazione tra CDAI e dati di laboratorio e attività CEUS si è dimostrata scarsa con un coefficiente di correlazione Spearman’s (rho)=0,354; la correlazione tra attività RM e attività CEUS si è dimostrata buona con un coefficiente di correlazione Spearman’s (rho)=0,791; ottima correlazione tra CEUS e enteroclisi-RM nella valutazione dello spessore parietale, dei linfonodi e segno del pettine; buona correlazione nella valutazione dell’aspetto striato della parete, dell’estensione di malattia e della proliferazione fibro-adiposa. In RM le curve intensità tempo sono risultate essere attive in 12/30 pazienti, in CEUS in 14/30 pazienti, con correlazione curva CEUS / curva RM scarsa (r=0,167 p=0,36).ConclusioniL’uso della CEUS può essere raccomandato in caso di discrepanza tra RM e dati di laboratorio e clinici. L’enteroclisi RM rimane tuttora la metodica imaging non invasiva più accurata per la stima di attività di malattia.

Incidental adrenal lesions: Accuracy of quadriphasic contrast enhanced computed tomography in distinguishing adenomas from nonadenomas

PURPOSE To evaluate the accuracy in distinguishing adrenal adenomas from nonadenomas by means of quadriphasic CT exam, including unenhanced (UE), arterial enhanced (AE), portal enhanced (PE) and 5-min delayed enhanced (DE) CT scans. METHODS This retrospective study had institutional review board approval; the need for informed consent was waived. From September 2007 to September 2009, 104 adrenal masses were evaluated in 87 patients (49 M, 38 F, mean age 58.4 years) undergoing UE, AE (35-s delay), PE (80-s delay) and DE (5-min delay) CT scans. The mean adrenal attenuation during all imaging phases was measured by two readers. The accuracy values of absolute unenhanced attenuation (UE), absolute wash-out (AWO), relative percentage wash-out (RPWO) and percentage enhancement wash-out (PEW) were assessed by using receiver operator curves (ROC) analysis. The overall accuracy of the quadriphasic protocol and other triphasic protocols were evaluated. A value of p≤0.05 was considered significant. RESULTS The accuracy in characterizing adrenal lesions was 86.5% (90/104) for UE attenuation (≤10 HU threshold), 90.1% (82/91) for RPWO (≥30% threshold), 85.7% (78/91) for AWO (≥12 HU threshold) and 83.5% (76/91) for PEW (≥30% threshold), respectively. Quadriphasic CT (accuracy 97.1%, 101/104) performed better than triphasic CT including only AE scan (efficiency 90.0%, 94/104; p=0.011) and triphasic CT including only PE scan (efficiency 96.1%, 100/104; p=0.025). CONCLUSION Quadriphasic CT protocol including 5-min DE scan may be used to characterize incidentally detected adrenal masses. RPWO represented the best wash-out parameter for characterizing adrenal lesions.

Preoperative assessment of nonfunctioning pancreatic endocrine tumours: role of MDCT and MRI

PurposeThis study was done to compare the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative assessment of nonfunctioning pancreatic endocrine tumours (NFPET).Materials and methodsFifty-one patients (25 men, 26 women; mean age, 52 years), preoperatively investigated by both MDCT and MRI and subsequently operated on with a histological diagnosis of NFPET, were included in this study. MDCT and MRI accuracy in evaluating location, size, margins, baseline density/signal intensity, structure, pattern of enhancement, peak enhancement phase, involvement of main pancreatic duct, involvement of adjacent organs, infiltration of peritumoural vessels, involvement of locoregional lymph nodes, and liver metastases was compared using Pearson correlation, Mann-Whitney and chi-square tests. A value of p<0.05 was considered statistically significant.ResultsMDCT and MRI had similar accuracy in assessing size, margins, baseline density/signal intensity, structure, pattern of enhancement, peak enhancement phase, involvement of main pancreatic duct, involvement of adjacent organs, involvement of locoregional lymph nodes, and liver metastases (p>0.05). MDCT was superior to MRI in evaluating the infiltration of peritumoural vessels (p=0.025).ConclusionsMDCT performed better than MRI in assessing vascular involvement and should be considered the best imaging tool for preoperative evaluation of NFPET.RiassuntoObiettivoScopo del presente lavoro è stato confrontare l’accuratezza diagnostica della tomografia computerizzata multidetettore (TCMD) e della risonanza magnetica (RM) nella valutazione preoperatoria dei tumori endocrini non funzionanti (TENF) del pancreas.Materiali e metodiSono stati inclusi nello studio 51 pazienti (25 uomini, 26 donne, età media 52 anni) studiati nel preoperatorio mediante TCMD e RM e sottoposti a chirurgia con diagnosi istologica di TENF. L’accuratezza diagnostica di TCMD e RM nel valutare sede della lesione, dimensioni, margini, densità/intensità di segnale pre-contrastografica, struttura della lesione, pattern di enhancement, fase di massima impregnazione, coinvolgimento del dotto pancreatico principale, infiltrazione di organi viciniori, infiltrazione delle strutture vascolari peritumorali, coinvolgimento dei linfonodi locoregionali, metastasi epatiche, è stata comparata mediante test di Pearson, Mann-Whitney e chi-square test. I valori statistici sono stati considerati significativi per p<0,05.RisultatiTCMD e RM hanno mostrato simile accuratezza nel valutare dimensioni tumorali, margini lesionali, densità/intensità di segnale pre-contrastografica, struttura lesionale, pattern di impregnazione, coinvolgimento del dotto pancreatico principale, infiltrazione degli organi contigui, linfonodi peripancreatici, metastasi epatiche (p>0,05). La TCMD è stata superiore alla RM nel valutare l’infiltrazione vascolare (p=0,025).ConclusioniLa TCMD è stata superiore alla RM nel valutare il coinvolgimento vascolare e dovrebbe essere considerata l’indagine di prima scelta per la valutazione preoperatoria dei TENF pancreatici.

Evaluation of relative wash-in ratio of adrenal lesions at early biphasic CT.

OBJECTIVE The purpose of this study was to retrospectively evaluate the accuracy of unenhanced attenuation and relative percentage wash-in ratio in early, that is, arterial and portal venous phase, biphasic CT in differentiating adrenal adenomas from metastatic lesions. MATERIALS AND METHODS One hundred seven adrenal masses in 86 consecutively registered patients (45 men, 41 women; mean age, 56 years) were evaluated. Diagnosis was achieved with percutaneous biopsy (n = 6), surgery (n = 13), and at least 1 year of imaging follow-up (n = 88). Unenhanced, arterial phase, and portal phase scans were obtained. Diameter and absolute attenuation values in each phase of CT were measured in a region of interest covering one to two thirds of a lesion. Relative percentage wash-in ratio was calculated. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in differentiation of adenomas from metastatic lesions were calculated for unenhanced attenuation and for wash-in ratio. A value of p < 0.05 was considered significant. RESULTS The final diagnosis was metastasis in 51 cases and adenoma in 56 cases. A significant difference was found between benign and malignant lesions in regard to diameter (p = 0.001), unenhanced CT attenuation (p = 0.001), and relative percentage wash-in ratio from the arterial to the portal venous scan (p = 0.014). In the differentiation of benign from malignant lesions, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of unenhanced CT attenuation (at an 11-HU threshold) were 98%, 86%, 86%, 98%, and 92%, and those of relative percentage wash-in ratio from the arterial to the portal venous phase were 94%, 77%, 79%, 93%, and 85%. CONCLUSION Relative percentage wash-in ratio may help in differentiating adenoma from metastasis and in guiding the decision to perform CT directed at the adrenal glands when unenhanced CT is not available.

Role of echocardiography and cardiac MRI in depicting morphological and functional imaging findings useful for diagnosing hypertrophic cardiomyopathy

PurposeHypertrophic cardiomyopathy (HCM) is a hereditary disease characterised by primary hypertrophy of the left and/or right ventricle. The reference standard for imaging diagnosis is echocardiography. The aim of our study was to prospectively compare the diagnostic accuracy of echocardiography and cardiac magnetic resonance (MR) imaging in patients with HCM.Materials and methodsTwenty-two consecutive patients with a known diagnosis of HCM were prospectively evaluated, with echocardiography and cardiac MR imaging performed within 2 weeks of each other (mean interval 7 days, range 2–14 days). Two experienced radiologists blinded to the previous clinical and imaging findings separately reviewed the images. The following parameters were calculated for both techniques: myocardial mass, wall thickness, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), systolic anterior motion (SAM) of the mitral valve and degree of myocardial fibrosis (based on the ultrasonic reflectivity at echocardiography and degree of late enhancement at cardiac MR imaging). The statistical correlation was calculated with Student’s t test, Spearman coefficient and Fisher’s exact test. A value of p<0.05 was considered significant.ResultsThe diagnosis of HCM was confirmed in all patients with both techniques, with absolute agreement in terms of the site of disease. The mean value of myocardial mass presented a statistically significant difference between the two techniques (114 g, p<0.001). In contrast, a nonsignificant difference between echocardiography and cardiac MR imaging was found for EDV (102 ml vs 111 ml; p=0.31), ESV (30 ml vs 38 ml; p=0.1), EF (74% vs 68%, p=0.5), SAM (p=0.1) and myocardial fibrosis (p=0.15).ConclusionsCardiac MR imaging correlates well with echocardiography in defining the morphological and functional parameters useful for the imaging diagnosis of HCM and therefore, in selected cases (poor acoustic window, doubtful echocardiography findings), it may be a valid alternative to echocardiography.RiassuntoObiettivoLa cardiomiopatia ipertrofica (CMI) è una malattia ereditaria caratterizzata dalla primitiva ipertrofia del ventricolo sinistro e/o destro. Lo standard di riferimento per la diagnosi strumentale è rappresentato dall’eco-cardiografia. Il nostro scopo è confrontare prospetticamente l’accuratezza diagnostica di ecocardiografia e risonanza magnetica cardiaca (cardio-RM) in pazienti con CMI.Materiali e metodiVentidue pazienti consecutivi con diagnosi nota di CMI sono stati prospetticamente valutati mediante eco-cardiografia e cardio-RM eseguite entro 2 settimane (scarto medio 7 giorni, range 2–14 giorni). Due operatori esperti, non a conoscenza dei precedenti dati clinici e strumentali dei pazienti arruolati, hanno revisionato separatamente le immagini. Per entrambe le tecniche sono stati calcolati massa cardiaca, spessori di parete, volume telediastolico (VTD) e telesistolico (VTS), frazione di eiezione (FE), spostamento anteriore del lembo mitralico (SAM), grado di fibrosi parietale (basato sul valore di eco-rinfrangenza all’eco-cardiografia e sull’entità di impregnazione tardiva alla cardio-RM). La correlazione statistica è stata calcolata mediante test t di Student, R di Spearman e test di Fisher. Un valore di p<0,05 è stato considerato significativo.RisultatiLa diagnosi di CMI è stata confermata in tutti i pazienti con entrambe le metodiche, con concordanza assoluta per quanto riguarda la sede. Il valore medio della massa cardiaca ha presentato una differenza statisticamente significativa tra le due metodiche (114 g, p<0,001). Al contrario, una differenza non significativa fra eco-cardiografia e cardio-RM è stata riscontrata per i valori di VTD (102 ml vs 111 ml; p=0,31), VTS (30 ml vs 38 ml; p=0,1), frazione d’eiezione (74% vs 68%, p=0,5), SAM (p=0,1), fibrosi parietale (p=0,15).ConclusioniLa cardio-RM correla bene con l’ecocardiografia nella definizione dei parametri morfologici e funzionali utili per la diagnosi strumentale di CMI e può pertanto rappresentare, in casi selezionati (scarsa finestra acustica, rilievi eco-cardiografici dubbi), una valida alternativa all’eco-cardiografia.

Evaluation of a method of computer-aided detection (CAD) of pulmonary nodules at computed tomography

PurposeThe authors sought to compare the sensitivity and reading time obtained using computer-aided detection (CAD) software as second reader (SR) or concurrent reader (CR) in the identification of pulmonary nodules.Materials and methodsUnenhanced CT scans of 100 consecutive cancer patients were retrospectively reviewed by four readers to identify all solid, noncalcified pulmonary nodules ranging from 3 to 30 mm in diameter. The sensitivity and reading time of each reader and of CAD alone were calculated at 3-mm and 5-mm thresholds with respect to the reference standard, consisting of a consensus reading by the four radiologists involved in the study. The McNemar test was used to compare the sensitivities obtained by reading without CAD (readers 1 and 2), with CAD as SR (readers 1 and 2 with a 2-month delay), and with CAD as CR (readers 3 and 4). The paired Student’s t test was used to compare reading times. A value of p<0.05 was considered statistically significant.ResultsA total of 258 and 224 nodules were identified at 3-mm and 5-mm thresholds, respectively. The sensitivity of CAD alone was 62.79% and 67.41% at the 3-mm and 5-mm threshold values respectively, with 4.15 and 2.96 false-positive findings per examination. CAD as SR produced a significant increase in sensitivity (p<0.001) in nodule detection with respect to reading without CAD both at 3 mm (12.01%) and 5 mm (10.04%); the average increase in sensitivity obtained when comparing CAD as SR to CAD as CR was statistically significant (p<0.025) both at the 3-mm (5.35%) and 5-mm (4.68%) thresholds. CAD as CR produced a nonsignificant increase in sensitivity compared with reading without CAD (p>0.05). Mean reading time using CAD as SR (330 s) was significantly longer than reading without CAD (135 s, p<0.001) and reading with CAD as CR (195 s, p<0.025).ConclusionsThe use of CAD as CR, without any significant increase in reading time, produces no significant increase in sensitivity in pulmonary nodule detection when compared with reading without CAD (p>0.05); CAD as SR, at the cost of longer reading times, increases sensitivity when compared with reading without CAD (p<0.001) or with CAD as CR (p<0.025).RiassuntoObiettivoScopo del nostro lavoro è stato confrontare la sensibilità ed i tempi di lettura ottenuti mediante il sistema diagnosi computer-assistita (CAD) della nostra apparecchiatura per la tomografia computerizzata multistrato (TCMS) in qualità di secondo lettore (SL) e di lettore concorrente (LC) nella identificazione dei noduli polmonari.Materiale e metodiLe TCMS non contrastografiche di 100 pazienti oncologici consecutivi sono state retrospettivamente analizzate da 4 lettori alla ricerca di noduli non calcifici di diametro compreso tra 3 e 30 mm. Utilizzando come standard di riferimento la lettura in consenso effettuata da 4 radiologi, sono stati calcolati sensibilità e tempi di lettura di ogni lettore e del CAD da solo, ai valori soglia dei noduli di 3 e 5 mm. È stato utilizzato il test di McNemar per confrontare i valori di sensibilità ottenuti dalla lettura senza CAD (lettori 1 e 2), con CAD come SL (lettori 1 e 2 dopo 2 mesi), con CAD come LC (lettori 3 e 4). Il test t di Student è stato utilizzato per confrontare i tempi di lettura. I valori statistici sono stati considerati significativi per p<0,05.RisultatiSono stati identificati 258 e 224 noduli rispettivamente alla soglia di 3 e 5 mm. Il CAD da solo ha presentato una sensibilità del 62,79% e 67,41% ai valori soglia di 3 e 5 mm, rispettivamente con 4,15 e 2,96 falsi positivi per esame. L’utilizzo del CAD come SL ha favorito un significativo aumento della sensibilità (p<0,001) nell’identificazione dei noduli polmonari rispetto alla lettura senza CAD sia alla soglia di 3 mm (12,01%) che a quella di 5 mm (10,04%); l’aumento medio di sensibilità ottenuto dal confronto della lettura con CAD come SL e CAD come LC è stata statisticamente significativa (p<0,025) sia alla soglia di 3 mm (5,35%) che di 5 mm (4,68%). Il CAD come LC ha favorito un aumento statisticamente non significativo della sensibilità se confrontato alla lettura senza CAD (p>0,05). I tempi di lettura utilizzando il CAD come SL (330 secondi) sono stati significativamente più lunghi rispetto alla lettura senza CAD (135 secondi, p<0,001) e alla lettura con CAD come LC (195 secondi, p<0,025).ConclusioniL’utilizzo del CAD come LC, senza un significativo aumento dei tempi di lettura, non comporta un aumento significativo della sensibilità nell’identificazione dei noduli polmonari rispetto alla lettura senza CAD (p>0,05); l’utilizzo del CAD come SL, a prezzo di un allungamento dei tempi di lettura, garantisce un significativo aumento della sensibilità rispetto alla lettura senza CAD (p<0,001) e con CAD come LC (p<0,025).

A simplified approach to virtual colonoscopy using different intestinal preparations: preliminary experience with regard to quality, accuracy and patient acceptability

PurposeThe authors assessed the quality, diagnostic accuracy and patient acceptability of computed tomography (CT) colonography performed using a simplified bowel preparation and software for post-processing digital elimination of stool and fluid data from images compared with the examination obtained with conventional preparation.Materials and methodsTwo groups of 40 consecutive asymptomatic patients aged between 48 and 72 years underwent CT colonography. In group A, the CT scan was performed with conventional bowel preparation (a full cathartic dose and oral contrast medium to tag any residue in the 3 days preceding the study). In the second group, CT colonography was performed after a reduced bowel preparation, with the oral contrast medium for residue tagging being administered only on the day of the investigation. Examination quality, diagnostic performance and patient acceptability (rated with a self-completed questionnaire) in the two groups of patients were compared by using the McNemar test.ResultsNo significant difference was obtained with regard to examination quality (180 vs. 165 segments free from stools and fluid, p>0.05) and overall diagnostic accuracy (16/17 colonic polyps detected in group A and 12/13 in group B, p>0.05). The questionnaires revealed a greater acceptability of the reduced bowel preparation compared with the standard procedure (p=0.01).ConclusionsIn asymptomatic patients, the use of software for post-processing digital elimination of residue from images in conjunction with reduced bowel preparation does not reduce examination quality or diagnostic performance when compared with the conventional CT colonography technique and is more acceptable to and better tolerated by the patient.RiassuntoObiettivoScopo del nostro lavoro è stato valutare qualità d’esame, performance diagnostica ed accettabilità da parte del paziente della colonscopia virtuale con tomografia computerizzata (colon-TC) dopo preparazione intestinale semplificata, mediante utilizzo del software di sottrazione dei residui colici, a confronto con l’esame ottenuto mediante preparazione convenzionale.Materiali e metodiDue gruppi di 40 pazienti asintomatici consecutivi, di età fra i 48 ed i 72 anni, sono stati sottoposti a colon-TC: nel gruppo A l’esame TC è stato eseguito con preparazione intestinale convenzionale (catartico a piena dose e mezzo di contrasto orale per la marcatura dei residui nei 3 giorni precedenti l’indagine); il secondo gruppo ha eseguito la colon-TC dopo preparazione intestinale ridotta con somministrazione orale di contrasto per la marcatura dei residui solo il giorno dell’indagine. Mediante il test di McNemar sono state confrontate qualità d’esame, performance diagnostica ed accettabilità (mediante questionario autocompilativo) degli esami nei due gruppi di pazienti.RisultatiSi è ottenuta una differenza non significativa per quanto concerne qualità d’esame (180 vs. 165 segmenti liberi da feci e liquidi, p>0,05) e performance diagnostica globale (16/17 polipi nel gruppo A; 12/13 nel gruppo B, p>0,05). Dai questionari è emersa una maggiore accettabilità della preparazione intestinale parziale rispetto a quella standard (p=0,01).ConclusioniIn pazienti asintomatici, l’utilizzo di un software per la sottrazione di liquidi in concomitanza ad una ridotta preparazione intestinale, non comporta una riduzione di qualità e performance diagnostica rispetto alla tecnica colon-TC tradizionale, mentre risulta più accettabile e meglio tollerato da parte del paziente.

CEUS versus CT Angiography in the follow-up of abdominal aortic endoprostheses: diagnostic accuracy and activity-based cost analysis

PurposeTo evaluate diagnostic accuracy and to perform an activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) compared to computed tomography (CT) during annual surveillance after abdominal aortic aneurysm repair with endovascular procedure (EVAR).Materials and methodsThis retrospective study included 137 patients in post-EVAR follow-up over a 6-year period (average post-operatory follow-up without aneurysm sac volumetric reduction). Sensitivity, specificity, positive predictive values, negative predictive values and accuracy were considered for CEUS using CT angiography (CTA) as reference standard. An activity-based cost analysis was performed to evaluate potential savings due to the introduction of CEUS as an alternative to CT, after the first year of postoperative negative controls.ResultsCEUS reported accuracy, sensitivity, specificity, positive predictive values, negative predictive values of 97.4, 96, 100, 100 and 93.1% in the detection and characterization of endoleaks. CEUS cost was € 84.7, and CTA cost was € 157.77, with a differential cost of € 73.07; using CEUS as an alternative to CT allowed a potential saving of 50.052,95 € during follow-up.ConclusionsCEUS is an accurate and cheap imaging method in post-EVAR follow-up patients, and it could be considered as a valid alternative to CTA, after the first year of negative controls, reducing the number of unnecessary CT examinations.

Preoperative assessment of nonfunctioning pancreatic endocrine tumours: role of MDCT and MRI@@@Ruolo della TCMD e della RM nella valutazione preoperatoria dei tumori endocrini non funzionanti del pancreas

PurposeThis study was done to compare the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative assessment of nonfunctioning pancreatic endocrine tumours (NFPET).Materials and methodsFifty-one patients (25 men, 26 women; mean age, 52 years), preoperatively investigated by both MDCT and MRI and subsequently operated on with a histological diagnosis of NFPET, were included in this study. MDCT and MRI accuracy in evaluating location, size, margins, baseline density/signal intensity, structure, pattern of enhancement, peak enhancement phase, involvement of main pancreatic duct, involvement of adjacent organs, infiltration of peritumoural vessels, involvement of locoregional lymph nodes, and liver metastases was compared using Pearson correlation, Mann-Whitney and chi-square tests. A value of p<0.05 was considered statistically significant.ResultsMDCT and MRI had similar accuracy in assessing size, margins, baseline density/signal intensity, structure, pattern of enhancement, peak enhancement phase, involvement of main pancreatic duct, involvement of adjacent organs, involvement of locoregional lymph nodes, and liver metastases (p>0.05). MDCT was superior to MRI in evaluating the infiltration of peritumoural vessels (p=0.025).ConclusionsMDCT performed better than MRI in assessing vascular involvement and should be considered the best imaging tool for preoperative evaluation of NFPET.RiassuntoObiettivoScopo del presente lavoro è stato confrontare l’accuratezza diagnostica della tomografia computerizzata multidetettore (TCMD) e della risonanza magnetica (RM) nella valutazione preoperatoria dei tumori endocrini non funzionanti (TENF) del pancreas.Materiali e metodiSono stati inclusi nello studio 51 pazienti (25 uomini, 26 donne, età media 52 anni) studiati nel preoperatorio mediante TCMD e RM e sottoposti a chirurgia con diagnosi istologica di TENF. L’accuratezza diagnostica di TCMD e RM nel valutare sede della lesione, dimensioni, margini, densità/intensità di segnale pre-contrastografica, struttura della lesione, pattern di enhancement, fase di massima impregnazione, coinvolgimento del dotto pancreatico principale, infiltrazione di organi viciniori, infiltrazione delle strutture vascolari peritumorali, coinvolgimento dei linfonodi locoregionali, metastasi epatiche, è stata comparata mediante test di Pearson, Mann-Whitney e chi-square test. I valori statistici sono stati considerati significativi per p<0,05.RisultatiTCMD e RM hanno mostrato simile accuratezza nel valutare dimensioni tumorali, margini lesionali, densità/intensità di segnale pre-contrastografica, struttura lesionale, pattern di impregnazione, coinvolgimento del dotto pancreatico principale, infiltrazione degli organi contigui, linfonodi peripancreatici, metastasi epatiche (p>0,05). La TCMD è stata superiore alla RM nel valutare l’infiltrazione vascolare (p=0,025).ConclusioniLa TCMD è stata superiore alla RM nel valutare il coinvolgimento vascolare e dovrebbe essere considerata l’indagine di prima scelta per la valutazione preoperatoria dei TENF pancreatici.