Giuseppe Franceschelli

Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn's disease.

AIM To evaluate the diagnostic ability of contrast-enhanced Magnetic Resonance Imaging (MRI) in assessment of the activity of perianal fistulas in Crohns disease (CD) patients, compared to clinical data. MATERIALS AND METHODS Fifty CD patients (25 men; mean[SD] age: 40.4[12.6] years) with known or suspected perianal fistulas underwent perianal space MRI. Radiological activity of disease was measured as the percentage increase (PI) of ROI values of fistulas in relation to ROI values of healthy local fat, after contrast administration. Clinical activity of disease was defined according to Perianal Disease Activity Index (PDAI) and Fistula Drainage Assessment (FDA). RESULTS Forty-two patients presented perianal disease at MRI (55 fistulas identified). An association between both fistulas PI and PDAI (Pearsons coefficient 0.512, p<0.0001) and between PI and FDA (p=0.003) was demonstrated. Areas under ROC curves of PI values in relation to PDAI and FDA were respectively 0.876 [95%CI=(0.743-1.00), p<0.001] and 0.784 [95%CI=(0.588-0.980), p=0.003]. A cut-off value of PI, calculated on these preliminary data, correctly classified more than 90% of fistulas. CONCLUSIONS Contrast-enhanced MRI with PI calculation offered practical information about activity of perianal fistulas and might be helpful in providing a comprehensive evaluation of CD perianal disease.

Magnetic resonance imaging in the preoperative assessment of Mayer-Rokitansky-Kuster-Hauser syndrome

PurposeWe evaluated the accuracy of magnetic resonance imaging (MRI) in young women with primary amenorrhoea with suspected Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (congenital absence of both vagina and uterus and presence of normal ovaries).Materials and methodsFifty-eight women (age range 14–30 years, mean 20.9) with primary amenorrhea were studied with MRI performed with a 1.0-T superconducting magnet (Philips NT Intera). All patients were examined in the supine position using a phased-array coil (four channels). Turbo spin-echo T2-weighted images were acquired in the sagittal, axial and coronal planes with the following parameters: TR 4,750–6,686, TE 100–120, FOV 350–375, 4- to 5-mm sections with a 0.4- to 0.5-mm intersection gap and NSA 6. T1-weighted images were acquired in the axial and coronal planes (TR 470, TE 15, FOV 350, 4-mm sections with a 0.6-mm intersection gap, NSA 3). Two experienced radiologists evaluated all the examinations in consensus to assess the presence, position and morphology of vagina, uterus, ovaries and kidneys and any pelvic abnormalities. MRI results were judged on the basis of laparoscopic findings in 41 patients.ResultsMRKH syndrome was confirmed in 56 patients with 100% sensitivity and specificity. MRI identified bilateral Müllerian buds in 34/56 (61%) and unilateral in 10/56 (18%) patients. MRI sensitivity was 81.42%, and there was good agreement with laparoscopy (k=0.55) and full agreement in the identification of cavitation between MRI and intraoperative sonography. Both ovaries were visualised in 54 patients, with regular morphology in 46 (82.1%), polycystic in 10 (17.8%), pelvic in 47 (83.6%) and extrapelvic in eight (14.5%). We found associated abnormalities of the upper urinary tract in six patients (solitary kidney in four and ptosis in two).ConclusionsMRI is a useful diagnostic tool in the preoperative evaluation of MRKH syndrome and is less expensive and invasive than laparoscopy. Strong cooperation between radiologists and surgeons is highly recommended.AbstractObiettivoValutare l’accuratezza della RM in donne con amenorrea primaria, con sospetta sindrome Mayer-Rokitansky-Kuster-Hauser (MRKH) (assenza congenita di vagina e utero con presenza di ovaie normali).Materiali e metodiCinquantotto donne (14–30 anni, media 20,9), con amenorrea primaria, sono state studiate con RM mediante magnete superconduttivo 1,0 T. Tutte le pazienti sono state esaminate in posizione supina con bobina multicanale (4 canali). Immagini turbo spin-echo T2 pesate sono state acquisite sui piani sagittale, assiale e coronale con i seguenti parametri: TR 4750–6686, TE 100–120, FOV 350–375, sezioni di 4–5 mm con interspazio di 0,4–0,5 mm i, NSA 6. Immagini T1 pesate sono state acquisite sui piani assiale e coronale (TR 470, TE 15, FOV 350, sezioni di 4 mm di spessore con interspazio di 0,6 mm, NSA 3). Due radiologi esperti hanno valutato gli esami in consenso per stabilire la presenza, sede e morfologia di vagina, utero, ovaie, reni ed eventuali ulteriori malformazioni pelviche. I risultati della RM sono stati confrontati con quelli laparoscopici in 41 pazienti.RisultatiLa sindrome MKRH è stata confermata in 56 pazienti con sensibilità e specificità del 100%. La RM ha identificato residui mülleriani in 34/56 (61%) e monolaterali in 10/56 (18%) pazienti. La sensibilità della RM è stata dell’81,42% e c’è stato un buon accordo con la laparoscopia (k Cohen 0,55) e un completo accordo nella identificazione delle cavitazione dei residui tra RM e ecografia intraoperatoria. Gli annessi bilaterali sono stati visualizzati in 54 pazienti, con regolare morfologia in 46 (82,1%), policistica in 10 (17,8%); sede pelvica in 47 (83,6%), extrapelvica in 8 (14,5%). Abbiamo riscontrato anomalie dell’apparato urinario superiore in 6 pazienti (monorene in 4, ptosico in 2).ConclusioniLa RM si è dimostrata utile metodica nella valutazione prechirurgica della sindrome MRKH ed è meno costosa ed invasive della laparoscopia. Una forte cooperazione tra radiologo e chirurgo è fortemente raccomandata.

Common carotid artery pseudoaneurysm after neck dissection: colour Doppler ultrasound and multidetector computed tomography findings.

Common carotid artery pseudoaneurysm is a rare disease, which has been previously unreported in association with neck dissection. We describe the Doppler ultrasound and multidetector computed tomography (CT) findings of a case of carotid pseudoaneurysm, one month after pharyngolaryngectomy with bilateral neck dissection. Multidetector CT confirmed the diagnosis made on the basis of Doppler ultrasound; the high image quality of axial and three-dimensional reconstructions avoided the need for pre-operative conventional angiography. In the presence of a pulsatile cervical mass after neck surgery, pseudoaneurysm of the carotid artery should be included in the differential diagnosis, and multidetector CT can be the sole pre-operative diagnostic imaging modality.

The role of interventional radiology in the treatment of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy after hepatocellular carcinoma. Complete surgical resection remains the only potentially curative option for patients with ICC. However, until now, early diagnosis with potential surgical intervention has been the exception rather than the rule with only 30% of patients qualifying for attempted surgical cure. Many patients are unresectable because of disease stage, anatomic conditions, medical comorbidities, and small future remnant liver. Interventional radiology procedures are available for these types of patients with intra-arterial therapies and/or ablative treatments both for curative and for palliative treatment. The goals of interventional therapy are to control local tumor growth, to relieve symptoms, and to improve and preserve quality of life. The choice of treatment depends largely on tumor extent and patient performance. No randomized studies exist to compare treatments. The present review describes the current evidence of the interventional treatments in the management of the ICC. Moreover, interventional procedures available to increase the future liver reserve before surgery were analyzed.

The role of interventional radiology in the treatment of epiphora

Epiphora is a relatively common ophthalmologic affection representing almost 5% of clinical consultations in ophthalmology and it consists in the complete or partial obstruction of nasolacrimal duct, leading to insufficient drainage of tears. The traditional treatment is represented by surgery namely, external dacryocystorhinostomy (DCR). Despite the high success rate DCR has many disadvantages and limitations since it requires general anesthesia, it may arise in a permanent facial scar and it is often affected by the reobstruction of the anastomotic tract by fibrotic scars and osteogenic activity. Fluoroscopically guided interventional procedures are a therapeutic alternative to surgery for lacrimal duct system obstructions that can consist either in balloon dacryocystoplasty or in nasolacrimal stent placement. In both cases, a pre-operative imaging characterization of the occlusion is needed for a correct treatment planning. In this review, we propose to highlight the role of interventional radiology in the treatment of epiphora and the role of computed tomography dacryocystography (CTD) in depiction and the pre-interventional planning.

DEB-TACE: a standard review

Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a relative new endovascular treatment based on the use of microspheres to release chemotherapeutic agents within a target lesion with controlled pharmacokinetics. This aspect justifies the immediate success of DEB-TACE, that nowadays represents one of the most used treatments for unresectable hepatocellular carcinoma. However, there is no consensus about the choice of the best embolotherapy technique. In this review, we describe the available microspheres and report the results of the main comparative studies, to clarify the role of DEB-TACE in the hepatocellular carcinoma management. We underline that there is no evidence about the superiority of DEB-TACE over conventional TACE in terms of efficacy, but there may be some benefits with respect to safety especially with the improvement of new technologies.