Maria Cristina Martina

Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer

CONTEXT Computed tomographic (CT) colonography has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk individuals, but less information is available on its performance in individuals at increased risk of CRC. OBJECTIVE To assess the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using unblinded colonoscopy as the reference standard. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, cross-sectional study. Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited in 11 Italian centers and 1 Belgian center between December 2004 and May 2007. Each participant underwent CT colonography followed by colonoscopy on the same day. MAIN OUTCOME MEASURES Sensitivity and specificity of CT colonography in detecting individuals with advanced neoplasia (ie, advanced adenoma or CRC) 6 mm or larger. RESULTS Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%; 95% confidence interval [CI], 79.0%-90.0%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%; 95% CI, 85.2%-90.0%). The positive and negative predictive values were 61.9% (95% CI, 55.4%-68.0%) and 96.3% (95% CI, 94.6%-97.5%), respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%; 95% CI, 76.2%-91.3%; P < .001). CONCLUSIONS In a group of persons at increased risk for CRC, CT colonography compared with colonoscopy resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%.

Effect of Preoperative Radiological Treatment of Hepatocellular Carcinoma Before Liver Transplantation: A Retrospective Study

AbstractPurpose: To assess the results of radiological treatment of patients with hepatocellular carcinoma (HCC) performed before orthotopic liver transplantation (OLT). Methods: Sixty-two transplanted patients with a total of 89 HCC nodules were studied; 50 lesions in 38 patients had been treated prior to OLT with transcatheter arterial chemoembolization (TACE: n=29), percutaneous ethanol injection (PEI; n=10), or combined therapy (TACE+PEI; n=11). The induced necrosis was pathologically evaluated. The recurrence rate after OLT in the treated group of patients (n=38) was compared with that in the non-treated group (n=24). Results: After TACE, necrosis was complete in 7 of 29 lesions (24.1%), partial in 11 of 29 (37.9%), and absent in 11 of 29 (37.9%). After PEI, necrosis was complete in 8 of 10 lesions (80%), and partial in 2 of 10 (20%). Using combined therapy, necrosis was complete in 11 of 11 lesions (100%). Four of 24 untreated and 4 of 38 treated patients did not survive OLT from causes not related to the HCC; 3 of 20 non-treated patients (15%) and 4 of 34 treated patients (11.8%) had post-OLT recurrence (these last four patients had undergone only TACE and did not have tumor necrosis at pathological examination). Conclusion: TACE of HCC prior to OLT had no influence on the recurrence rate. PEI and combined therapy (TACE + PEI) may be recommended in patients awaiting OLT.

Scenes from the past: multidetector CT study of gallbladder stones in a wrapped Egyptian mummy.

A whole-body examination was performed with multidetector computed tomography (CT) of a completely wrapped Egyptian mummy from the collection at the Egyptian Museum in Turin, Italy. The mummy dates from the Eighteenth Dynasty. Although embalmment of the deceased man should have included evisceration in accordance with his social rank, no canopic jars containing internal organs had been found at the discovery of his tomb, and at CT, all the organs were found to have desiccated inside the body. Numerous calcified stones that were incidentally identified in the gallbladder had attenuation characteristics indicative of a predominant bile pigment content. This case demonstrates the superior capabilities of multidetector CT for the noninvasive study of embalmed bodies. The intrinsic capacity of CT for depicting the density of materials allowed not only the identification of the gallbladder stones but also their characterization.

Comparing CT colonography and flexible sigmoidoscopy: a randomised trial within a population-based screening programme

Importance and aims The role of CT colonography (CTC) as a colorectal cancer (CRC) screening test is uncertain. The aim of our trial was to compare participation and detection rate (DR) with sigmoidoscopy (flexible sigmoidoscopy (FS)) and CTC in a screening setting. Design setting and participants We conducted two randomised clinical trials (RCTs). (1) Participation RCT: individuals, aged 58 years, living in Turin (Italy), were randomly assigned to be invited to FS or CTC screening; (2) detection RCT: residents in northern Italy, aged 58–60, giving their consent to recruitment, were randomly allocated to CTC or FS. Polyps ≥6 mm at CTC, or ‘high-risk’ distal lesions at FS, were referred for colonoscopy (TC). Main outcome measures Participation rate (proportion of invitees examined); DR of advanced adenomas or CRC (advanced neoplasia (AN)). Results Participation was 30.4% (298/980) for CTC and 27.4% (267/976) for FS (relative risk (RR) 1.1; 95% CI 0.98 to 1.29). Among men, participation was higher with CTC than with FS (34.1% vs 26.5%, p=0.011). In the detection RCT, 2673 subjects had FS and 2595 had CTC: the AN DR was 4.8% (127/2673, including 9 CRCs) with FS and 5.1% (133/2595, including 10 CRCs) with CTC (RR 1.08; 95% CI 0.85 to 1.37). Distal AN DR was 3.9% (109/2673) with FS and 2.9% (76/2595) with CTC (RR 0.72; 95% CI 0.54 to 0.96); proximal AN DR was 1.2% (34/2595) for FS vs 2.7% (69/2595) for CTC (RR 2.06; 95% CI 1.37 to 3.10). Conclusions and relevance Participation and DR for FS and CTC were comparable. AN DR was twice as high in the proximal colon and lower in the distal colon with CTC than with FS. Men were more likely to participate in CTC screening. Trial registration number NCT01739608; Pre-results.

Neural tube defect in a 4000-year-old Egyptian infant mummy: A case of meningocele from the museum of anthropology and ethnography of Turin (Italy)

This paper reports a paleopathological study of a severe neural tube defect in an ancient mummy, more specifically, a meningocele in an Egyptian infant from the XI dynasty (2100-1955B.C.). This is one of the most ancient cases of meningocele in mummified human remains described in paleopathological literature. Prehistoric and early historic examples of severe congenital defects of the vertebral column and neural tube are rare, because of the precarious preservation conditions of ancient human remains. Further, since the majority are only the skeletal remains, paleopathological and paleoepidemiological analysis based on the observation of bones is even more difficult. Hence, it is not easy to investigate this disease in the past in all its complexities and true diffusion. The case presented here is peculiar, since it concerns a mummy with almost all soft tissues preserved, thus allowing us to describe the defect in an infant. Only targeted, minimally invasive examinations were performed. An anthropological investigation with helical CT scan and histological analysis was used to diagnose the defect and identify post-mortem transformation processes. The analyses confirmed the diagnosis of meningocele in an approximately six-month-old infant.

Multidetector CT of an Antillean Zemi Idol

Volumetric multidetector computed tomography (CT) was performed on an anthropomorphic cotton zemi idol from the Taino culture, which flourished in the Antilles between the 13th and 15th centuries ad. The zemi belongs to the permanent collection of the Museum of Anthropology and Ethnography at the University of Torino in Italy. According to some researchers of Taino culture, this is the only known cotton figure functioning as a reliquary that contains a partially preserved human skull. Postprocessing consisted of multiplanar and three-dimensional reformation of the axial CT scans. The built-in capacity of CT to measure the density of materials allowed detailed characterization of the structure of the zemi, which includes vegetable fibers, wood, stone, shells, and bone-in particular, the anterior part of a human skull. The results of this multidisciplinary study involving radiologists and physical anthropologists confirm the importance of multidetector CT in the noninvasive study of delicate museum objects and have awakened anthropologic interest in the form of multidisciplinary studies that are currently underway to better identify the social meaning of the object. These studies will undoubtedly provide new information about Taino culture.

Petamenophis (Padiamenemipet), an Egyptian Child Mummy Protected for Eternity: Revelation by Multidetector Computed Tomography

Objective The objective of our work was to report the most recent findings obtained with multidetector computed tomography of a child mummy from the Roman period (119–123 CE) housed at the Egyptian Museum in Turin, Italy. Methods Multidetector computed tomography and postprocessing were applied to understand the embalming techniques, the nature of a foreign object, and anthropometrical values. The information was compared with that from other mummies that were buried in the same tomb, but today housed in different museums. Results New information regarding the embalming technique was revealed. Multidetector computed tomography allowed the identification of a knife-like metallic object, probably an amulet for the childs protection in the afterlife. Conclusions Multidetector computed tomography and image postprocessing confirm their valuable role in noninvasive studies in ancient mummies and provided evidence of a unique cultural practice in the late history of Ancient Egypt such as placing a knife possibly as an amulet.