Pasquale Pedote

Prognostic value of multidetector computed tomography in bowel infarction

PurposeThis study aimed to correlate computed tomography (CT) findings and outcomes in patients affected by bowel infarction.Materials and methodsTwenty-seven patients with bowel infarction due to vascular obstruction were evaluated with multidetector CT (MDCT) to establish the prognostic value of CT findings and their correlation with the origin of the ischaemia. The chi-square test was used to analyse the results (p≤0.05).ResultsMDCT images allowed recognition of the nature of ischaemia in all cases. In particular, arterial occlusion was found in 67% of patients and venous obstruction in 33%. The overall mortality rate was 63%. Outcome closely correlated with the kind of vascular obstruction, with a mortality rate of 89% in arterial forms and 11% in venous forms. Bowel-wall hyperdensity (2/9 venous occlusions), loss of wall enhancement (1/9 venous occlusions, 2/18 arterial occlusions) and wall thickening (8/9 venous obstructions, 2/18 arterial occlusions) were predictive of good outcome. Bowel-loop dilatation (4/9 venous occlusions, 13/18 arterial occlusions), intramural pneumatosis (1/9 venous occlusions, 17/18 arterial occlusions), mesenteric venous gas (2/9 venous occlusions, 11/18 arterial occlusions), portal venous gas (1/9 venous occlusions, 4/18 arterial occlusions), pneumoperitoneum (8/18 arterial occlusions) and pneumoretroperitoneum (1/18 arterial occlusions) were predictive of poor outcome. Ascites (6/9 venous occlusions, 12/18 arterial occlusions) did not add any prognostic information.ConclusionsMDCT is able to detect the nature of bowel ischaemia and provide important prognostic information.RiassuntoObiettivoRicercare eventuali correlazioni tra informazioni ottenute con tomografia computerizzata (TC) e prognosi nell’infarto intestinale.Materiali e metodiSono state valutate le immagini TC multidetettore (TCMD) di 27 pazienti con infarto intestinale da occlusione vascolare e sono state ricercate: significatività prognostica delle alterazioni evidenziate, correlazioni con la natura dell’ischemia. È stato applicato il test statistico del χ2 (p≤0,05).RisultatiLa TCMD ha riconosciuto sempre la natura dell’ischemia, secondaria ad occlusione arteriosa nel 67% dei casi e venosa nel 33%. Il tasso di mortalità complessivo è stato del 63%. L’eziologia della patologia in rapporto alla prognosi è risultata altamente significativa, con mortalità del 89% nelle forme arteriose e del 11% in quelle venose. L’iperdensità parietale (2/9 occlusioni venose), l’assenza di enhancement (1/9 occlusioni venose, 2/18 occlusioni arteriose), l’ispessimento di parete (8/9 occlusioni venose, 2/18 occlusioni arteriose) sono risultati significativi di evoluzione benigna, mentre la dilatazione delle anse (4/9 occlusioni venose, 13/18 occlusioni arteriose), la pneumatosi parietale (1/9 occlusioni venose, 17/18 occlusioni arteriose), l’aria nelle vene mesenteriche (2/9 occlusioni venose, 11/18 occlusioni arteriose), l’aria nei rami portali (1/9 occlusioni venose, 4/18 occlusioni arteriose), lo pneumoperitoneo (8/18 occlusioni arteriose) e il retropneumoperitoneo (1/18 occlusioni arteriose) sono risultati indici prognostici sfavorevoli. L’ascite (6/9 occlusioni venose, 12/18 occlusioni arteriose) non ha fornito indicazioni di tipo prognostico.ConclusioniLa TCMD consente di definire la natura dell’ischemia intestinale e fornisce importanti valutazioni prognostiche.

Preoperative local staging of colosigmoideal cancer: air versus water multidetector-row CT colonography

PurposeThe authors sought to evaluate the diagnostic accuracy of multidetector-row computed tomography (MDCT) performed with two different hypodense endoluminal contrast agents for the preoperative staging of colosigmoideal cancer.Materials and methodsSeventy consecutive patients with an endoscopically and histologically proven diagnosis of colosigmoideal cancer underwent MDCT examination. Thirty-five patients were evaluated with water MDCT colonography and the remaining 35 with air MDCT colonography. Patients were randomly assigned to the air or water groups for staging. Transverse images and multiplanar reconstructions (MPR) were retrospectively examined by two blinded expert radiologists in order to assess T and N parameters, and the results were compared with histological findings.ResultsThe overall diagnostic accuracy of MDCT was 68.6% for water and 62.8% for air colonography. In the evaluation of the T parameter, the accuracy values were 88.6% for water and 80% for air colonography. In staging of the N parameter, the accuracy values were 77.1% and 74.3% for water and air MDCT colonography, respectively.ConclusionsMDCT examination can be proposed for the local staging of colosigmoideal cancer. Water is more accurate than air in evaluation of the T parameter, whereas the kind of endoluminal contrast material does not influence the definition of the N parameter.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’accuratezza diagnostica della tomografia computerizzata multidetettore (TCMD) nella stadiazione preoperatoria del carcinoma del colon-sigma utilizzando due differenti mezzi di contrasto ipodensi endoluminali.Materiali e metodiSettanta pazienti consecutivi con diagnosi endoscopica ed istologica di carcinoma del colon-sigma sono stati sottoposti a TCMD. Trentacinque sono stati valutati mediante colonografia TC con acqua e i restanti trentacinque mediante colonografia TC con aria. I pazienti sono stati assegnati in maniera random ai gruppi di stadiazione con aria o acqua. Le immagini assiali e le ricostruzioni multiplanari (MPR) sono state esaminate in cieco retrospettivamente da due radiologi esperti al fine di determinare i parametri T e N ed i risultati sono stati confrontati con i reperti istologici.RisultatiL’accuratezza diagnostica complessiva della TCMD è risultata del 68,6% per la colonografia con acqua e del 62,8% per quella con aria. Nella valutazione del parametro T, i valori di accuratezza per la colonografia con acqua e aria sono risultati rispettivamente pari a 88,6% e 80%. Nella stadiazione del parametro N, sono stati ottenuti valori di accuratezza del 77,1% e 74,3% rispettivamente per la colonografia con acqua e aria.ConclusioniLa TCMD rappresenta una metodica proponibile per la stadiazione locoregionale del carcinoma del colon-sigma. L’impiego dell’acqua nella valutazione del parametro T risulta più accurata rispetto all’aria. Il tipo di mezzo di contrasto endoluminale non sembra influenzare la definizione del parametro N.

CT-guided needle biopsy performed with modified coaxial technique in the diagnosis of malignant lymphomas

PurposeThe aim of was study was to evaluate the accuracy of computed tomography (CT)-guided core needle biopsy (CNB) performed by modified coaxial technique as an alternative tool to surgical biopsy in patients with suspected malignant lymphoma.Materials and methodsBetween May 2005 and December 2008, 67 CT-guided CNB of deep lesions were performed on 64 patients with suspected malignant lymphoma. In 19 out of 64 patients (29.7%), recurrent lymphoma was suspected. A modified coaxial technique was used in all cases, and multiple samples were obtained for histological and immunohistochemical studies.ResultsA diagnosis of malignant lymphomas with specification of subtype according to the World Health Organization (WHO) classification was established in 41/67 cases. Other malignant neoplasms were found in 13/67, lymphoma without subtype specification was diagnosed in 7/67, whereas no conclusive diagnosis could be established in 6/67 cases. Overall diagnostic accuracy was 80.1%. In patients with a final diagnosis of malignant lymphoma, accuracy was 75.9%. No complications occurred.ConclusionsPercutaneous CT-guided CNB is a safe, effective and reliable tool in the management of lymphomas in patients without superficial lymphadenopathy and can be considered an alternative approach to surgical sampling. The modified coaxial technique represents an effective tool that has a good diagnostic accuracy value with a low complication rate.RiassuntoObiettivoLo scopo del nostro studio è stato verificare l’efficacia della core biopsy (CB) guidata da tomografia computerizzata (TC), eseguita con tecnica coassiale modificata, in pazienti con sospetto linfoma in alternativa alla biopsia chirurgica.Materiali e metodiNel periodo compreso fra maggio 2005 e dicembre 2008 sono state eseguite 67 CB TCguidate, di lesioni non superficiali, in 64 pazienti con sospetto linfoma; 19/64 (29,7%) con sospetto di recidiva di malattia. In tutti i casi è stata utilizzata tecnica coassiale modificata per ottenere multipli prelievi sui quali eseguire esame istologico ed immunoistichimico.RisultatiIn 41/67 casi è stata posta diagnosi di linfoma con sottotipizzazione in accordo con la classificazione World Health Organization (WHO), in 13/67 di altra neoplasia maligna, in 7/67 casi di linfoma senza sottotipo ed in 6/67 il materiale prelevato non ha permesso una diagnosi conclusiva. L’accuratezza diagnostica globale è stata del 80,1%; nei pazienti con diagnosi finale di linfoma è risultata del 75,9%. Non si sono verificate complicanze.ConclusioniLa CB TC-guidata è risultata una tecnica sicura ed utile alternativa alla biopsia chirurgica nell’iter diagnostico dei linfomi nei pazienti senza localizzazioni superficiali di malattia. L’utilizzo della tecnica coassiale modificata è proponibile poiché consente di ottenere una buona accuratezza diagnostica ed una ridotta incidenza di complicanze.

MDCT in the differentiation of adrenal masses: comparison between different scan delays for the evaluation of intralesional washout.

Purpose. To evaluate the accuracy of the washout in the differential diagnosis between adenomas and nonadenomas and to compare the obtained results in delayed CT scans at 5, 10 and 15 minutes. Methods. Fifty patients with adrenal masses were prospectively evaluated. CT scans were performed by using a 320-row MDCT device, before and after injection of contrast material. In 25 cases, delayed scans were performed at 5′ and 10′ (group 1), while in the remaining 25, at 5′ and 15′ (group 2). Absolute and relative wash-out percentage values (APW and RPW) were calculated. Results. Differential diagnosis between adenomas and nonadenomas was obtained in 48/50 (96%) cases, with sensitivity, specificity, and accuracy values of 96%, 95%, and 96%, respectively. In group 1, APW and RPW values were, respectively, 69.8% and 67.2% at 5′ and 75.9% and 73.5% at 10′ for adenomas and 25.1% and 15.8% at 5′ and 33.5% and 20.5% at 10′ for nonadenomas. In group 2, APW and RPW values were 63% and 54.6% at 5′ and 73.8% and 65.5% at 15′ for adenomas and 22% and 12.5% at 5′ and 35.5% and 19.9% at 15′ for nonadenomas. Conclusions. The evaluation of the wash-out values in CT scans performed at 5′, 10′, and 15′ provides comparable diagnostic results. CT scans performed at 5′ are, therefore, to be preferred, since they reduce the examination time and patient discomfort.

Multidetector computed tomography in the study of pancreatic metastases.

PurposeThe aim of this study was to explore the diagnostic performance of multidetector computed tomography (MDCT) in characterising pancreatic metastases.Materials and methodsCT examinations of 17 patients affected by pancreatic metastases were retrospectively reviewed. The primary malignancy was renal cell carcinoma (RCC) in eight cases, uterine leiomyosarcoma in two, lung carcinoma in four and breast carcinoma in three. CT images were assessed for lesion number, size and morphology.ResultsPancreatic lesions were solitary in seven cases and multiple in ten. Lesion size ranged between 8 and 40 mm. Metastases from RCC were hyperattenuating in the arterial phase, metastases from breast cancer and lung cancer were hypoattenuating and metastases from uterine leiomyosarcoma were inhomogeneous. Precise lesion characterisation was obtained by using CT examination in 12 cases. In the remaining five patients, all with solitary metastases from RCC, a precise diagnosis was not possible because the lesions could not be differentiated from a neuroendocrine tumour.ConclusionsMDCT allowed pancreatic metastases characterisation in 70.5% of cases. The lesions were the manifestation of widely disseminated neoplastic disease, with the exception of metastases from RCC, which were exclusively located in the pancreas.RiassuntoObiettivoScopo del nostro lavoro è stato valutare le potenzialità diagnostiche della tomografia computerizzata multidetettore (TCMD) nella caratterizzazione delle metastasi pancreatiche.Materiali e metodiSono stati esaminati retrospettivamente gli esami TC di 17 pazienti, affetti da metastasi pancreatiche, secondarie a carcinoma renale in 8 casi, a leiomiosarcoma uterino in 2 casi, a carcinoma polmonare in 4 casi e a carcinoma mammario in 3 casi. Sono stati considerati: numero, dimensioni, morfologia delle lesioni.RisultatiLe lesioni pancreatiche erano singole in 7 casi e multiple in 10 casi e le loro dimensioni variavano tra 8 e 40 mm. Le metastasi secondarie a carcinoma renale erano iperdense in fase arteriosa, quelle secondarie a carcinoma mammario e polmonare ipodense, quelle da leiomiosarcoma francamente disomogenee. Una precisa caratterizzazione delle lesioni è stata ottenuta con TC in 12 casi. Nei restanti 5 pazienti, tutti affetti da metastasi singole da carcinoma renale, una precisa diagnosi è risultata impossibile, poiché le lesioni non erano differenziabili da un tumore neuroendocrino.ConclusioniLa TCMD ha consentito la caratterizzazione delle metastasi pancreatiche nel 70,5% dei casi. Tali lesioni erano espressione di malattia neoplastica disseminata, con esclusione delle metastasi da carcinoma renale, in cui le localizzazioni pancreatiche erano esclusive.

Prognostic value of loss of wall enhancement for bowel infarction

I have read with interest the article entitled “Prognostic value of multidetector computed tomography in bowel infarction”, by Moschetta et al. [1]. The study stated that loss of bowel wall enhancement was predictive of good outcome in patients with bowel infarction. I believe that a methodological mistake could have led Moschetta and colleagues to wrong conclusions. The authors decided to use the chi-square test for statistical analysis. Nonetheless, the number of patients in the study was small (e.g. two patients had loss of wall enhancement in the deceased group and only one patient in the surviving group). When sample sizes are small the Fisher exact test is preferred because the chi-square test yields poor results, and opposite conclusions can be obtained. A general rule of thumb is to use the Fisher test when either the sample size is less than 30 or the expected number of observations in any cell of a 2×2 contingency table is less than fi ve [2]. I performed the Fisher exact test with the data published in Table 3 and found a signifi cant association with the patient outcome (dead or alive) in three out of ten signs evaluated (wall thickening, intramural pneumatosis and pneumoperitoneum), instead of nine reported by the authors. In the case of loss of wall enhancement the Fisher exact test showed a p-value=0.535. Furthermore, I repeated the chi-square test to evaluate whether an opposite conclusion could be obtained. However, I did not fi nd a signifi cant association either. The chi-square test showed an approximate p-value of 0.3 (p=0.260) rather than a p-value of 0.03, as it is reported in the article. A transcription mistake might have occurred. The statement that absence of wall enhancement is a predictor of good outcome in patients with bowel infarction should be interpreted carefully.

Extralymphatic Disease Is an Independent Prognostic Factor in Hodgkin Lymphoma

&NA; A retrospective study was performed of 341 cases of extralymphatic Hodgkin lymphoma (HL) to identify its characteristics and outcomes. Sites were lung in 29 patients (44%), bone in 22 (33%), and liver in 5 (18%). Extralymphatic HL is a rare occurrence (16%) associated with poor clinical outcome. Purpose: To identify the characteristics and outcomes of patients with extralymphatic Hodgkin lymphoma. Patients and Methods: We performed a retrospective single‐institution study of 341 cases comprising 207 male (61%) and 134 female (39%) subjects with a median follow‐up of 44 months. Results: Fifty‐five patients (16%) had extralymphatic disease. The sites were lung in 29 patients (44%), bone in 22 (33%), liver in 12 (18%), and kidney in 3 (5%). In 46 patients (86%) only one organ was involved, while in 7 patients (13%) extralymphatic disease was present in 2 sites and in 2 patients (3%) in 3 sites. The extralymphatic disease group had a poorer prognosis than the lymphatic disease group. Complete remission rates in the extralymphatic and lymphatic patient subsets were 65% and 82% (P = .043), respectively. Conclusion: Extralymphatic disease in patients with Hodgkin lymphoma is a rare occurrence (16%) associated with poor clinical outcome.

Bone Involvement in Hodgkin's Lymphoma: Clinical Features and Outcome

Hodgkin’s lymphoma (HL) is now a highly curable disease, with an improving 5-year survival rate that has now reached 86%. At the time of presentation, HL is usually almost entirely confined to the lymph nodes. We performed a retrospective single-institution study of 384 cases with a median follow-up of 44 months, with the aim of identifying clinical and radiological characteristics and outcomes of patients with bone HL; 32 patients (8%) had primary bone involvement, always with concurrent nodal disease. These included 22 men (69%) and 10 women (31%) with the median age as 41 years. Advanced stages and nodular sclerosis histology prevailed among the subgroup. Radiographic features of bone HL are not specific but indicate a destructive malignant process with osteosclerosis and/or osteolysis. With current chemotherapeutic regimens, the long-term prognosis of patients with osseous HL appears good. The presence of bone lesions in HL should not be interpreted as implying a worse prognosis than without bone involvement.

Computed tomography-guided needle biopsy performed with modified coaxial technique in patients with suspected lymphoma

Computed tomography-guided needle biopsy performed with modified coaxial technique in patients with suspected lymphoma Francesco Gaudio, Pasquale Pedote, Annunziata Ferrante, Tommasina Perrone, Giuseppe Ingravallo, Amato Antonio Stabile Ianora, Giuseppe Angelelli & Giorgina Specchia a Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari Medical School, Bari, Italy b Section of Radiology, Interdisciplinary Department of Medicine, University of Bari Medical School, Bari, Italy c Department of Pathology, University of Bari Medical School, Bari, Italy Published online: 01 Jun 2015.

Infarto del piccolo intestino da occlusione dell’arteria mesenterica superiore

1. Arteria mesenterica superiore occlusa a livello del III prossimale. 2. Ricostruzioni multiplanari, soprattutto quelle ottenute con programmi MIP. 3. Ansa ileale ipovascolarizzata. 4. Ischemia intestinale da ostruzione arteriosa.