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Featured researches published by Raffaella Lissandrin.


World Journal of Gastroenterology | 2014

Point shear wave elastography method for assessing liver stiffness

Giovanna Ferraioli; Carmine Tinelli; Raffaella Lissandrin; Mabel Zicchetti; Barbara Dal Bello; Gaetano Filice; Carlo Filice

AIM To estimate the validity of the point shear-wave elastography method by evaluating its reproducibility and accuracy for assessing liver stiffness. METHODS This was a single-center, cross-sectional study. Consecutive patients with chronic viral hepatitis scheduled for liver biopsy (LB) (Group 1) and healthy volunteers (Group 2) were studied. In each subject 10 consecutive point shear-wave elastography (PSWE) measurements were performed using the iU22 ultrasound system (Philips Medical Systems, Bothell, WA, United States). Patients in Group 1 underwent PSWE, transient elastography (TE) using FibroScan (Echosens, Paris, France) and ultrasound-assisted LB. For the assessment of PSWE reproducibility two expert raters (rater 1 and rater 2) independently performed the examinations. The performance of PSWE was compared to that of TE using LB as a reference standard. Fibrosis was staged according to the METAVIR scoring system. Receiver operating characteristic curve analyses were performed to calculate the area under the receiver operating characteristic curve (AUC) for F ≥ 2, F ≥ 3 and F = 4. The intraobserver and interobserver reproducibility of PSWE were assessed by calculating Lins concordance correlation coefficient. RESULTS To assess the performance of PSWE, 134 consecutive patients in Group 1 were studied. The median values of PSWE and TE (in kilopascals) were 4.7 (IQR = 3.8-5.4) and 5.5 (IQR = 4.7-6.5), respectively, in patients at the F0-F1 stage and 3.5 (IQR = 3.2-4.0) and 4.4 (IQR = 3.5-4.9), respectively, in the healthy volunteers in Group 2 (P < 10(-5)). In the univariate analysis, the PSWE and TE values showed a high correlation with the fibrosis stage; low correlations with the degree of necroinflammation, aspartate aminotransferase and gamma-glutamyl transferase (GGT); and a moderate negative correlation with the platelet count. A multiple regression analysis confirmed the correlations of both PSWE and TE with fibrosis stage and GGT but not with any other variables. The following AUC values were found: 0.80 (0.71-0.87) for PSWE and 0.82 (0.73-0.89) for TE (P = 0.42); 0.88 (0.80-0.94) for PSWE and 0.95 (0.88-0.98) for TE (P = 0.06); and 0.95 (0.89-0.99) for PSWE and 0.92 (0.85-0.97) for TE (P = 0.30) for F ≥ 2, F ≥ 3 and F = 4, respectively. To assess PSWE reproducibility, 116 subjects were studied, including 47 consecutive patients scheduled for LB (Group 1) and 69 consecutive healthy volunteers (Group 2). The intraobserver agreement ranged from 0.83 (95%CI: 0.79-0.88) to 0.96 (95%CI: 0.95-0.97) for rater 1 and from 0.84 (95%CI: 0.79-0.88) to 0.96 (95%CI: 0.95-0.97) for rater 2. The interobserver agreement yielded values from 0.83 (95%CI: 0.78-0.88) to 0.93 (95%CI: 0.91-0.95). CONCLUSION PSWE is a reproducible method for assessing liver stiffness, and it compares with TE. Compared with patients with nonsignificant fibrosis, healthy volunteers showed significantly lower values.


American Journal of Roentgenology | 2012

Performance of Real-Time Strain Elastography, Transient Elastography, and Aspartate-to-Platelet Ratio Index in the Assessment of Fibrosis in Chronic Hepatitis C

Giovanna Ferraioli; Carmine Tinelli; Antonello Malfitano; Barbara Dal Bello; Gaetano Filice; Carlo Filice; Elisabetta Above; Giorgio Barbarini; Enrico Brunetti; Willy Calderon; Marta Di Gregorio; Raffaella Lissandrin; Serena Ludovisi; Laura Maiocchi; Giuseppe Michelone; Mario U. Mondelli; Savino F A Patruno; Alessandro Perretti; Gianluigi Poma; Paolo Sacchi; Marco Zaramella; Mabel Zicchetti

OBJECTIVE The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard. SUBJECTS AND METHODS Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis. RESULTS One hundred thirty patients (91 men and 39 women) were analyzed. The cutoff values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively. CONCLUSION Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.


European Radiology | 2014

Ultrasound point shear wave elastography assessment of liver and spleen stiffness: effect of training on repeatability of measurements

Giovanna Ferraioli; Carmine Tinelli; Raffaella Lissandrin; Mabel Zicchetti; Stefano Bernuzzi; Laura Salvaneschi; Carlo Filice

AbstractObjectivesTo evaluate reproducibility of measurements of spleen stiffness (SS) and liver stiffness (LS) at several sites by using point shear wave elastography (pSWE) and to investigate any training effect.MethodsHealthy volunteers were consecutively enrolled. Measurements of SS and LS were performed by an expert (observer 1) and a novice (observer 2) at three different sites of liver and spleen. To assess the effect of training the study was conducted in two periods (period 1 and period 2). Concordance correlation coefficient was used to assess intra-observer and inter-observer reproducibility.ResultsA total of 92 subjects (67 men and 25 women) were enrolled in the study. Both intra-observer and inter-observer agreement were higher for the liver than for the spleen. Overall, the highest intra-observer and inter-observer agreement were obtained for the assessment of LS through intercostal space, and for measurements at this site there was a significantly better performance of observer 2 after the training period. For both observers, training improved the repeatability of SS measurements at all sites. A good intra-observer agreement was obtained only for measurements at the spleen lower pole.ConclusionsThe results of this study show that a learning curve in pSWE acquisition should be taken into account both for SS and LS measurements.Key Points• Reproducibility of SS measurements depends on the expertise of the operator. • To achieve good reproducibility between measurements a training period is required. • A learning curve in pSWE acquisition should be taken into account. • SS measurements are less reproducible than LS measurements.


World Journal of Gastroenterology | 2013

Performance of liver stiffness measurements by transient elastography in chronic hepatitis

Giovanna Ferraioli; Carmine Tinelli; Barbara Dal Bello; Mabel Zicchetti; Raffaella Lissandrin; Gaetano Filice; Carlo Filice; Elisabetta Above; Giorgio Barbarini; Enrico Brunetti; Willy Calderon; Marta Di Gregorio; Roberto Gulminetti; Paolo Lanzarini; Serena Ludovisi; Laura Maiocchi; Antonello Malfitano; Giuseppe Michelone; Lorenzo Minoli; Mario U. Mondelli; Stefano Novati; Savino F A Patruno; Alessandro Perretti; Gianluigi Poma; Paolo Sacchi; Domenico Zanaboni; Marco Zaramella

AIM To compare results of liver stiffness measurements by transient elastography (TE) obtained in our patients population with that used in a recently published meta-analysis. METHODS This was a single center cross-sectional study. Consecutive patients with chronic viral hepatitis scheduled for liver biopsy at the outpatient ward of our Infectious Diseases Department were enrolled. TE was carried out by using FibroScan™ (Echosens, Paris, France). Liver biopsy was performed on the same day as TE, as day case procedure. Fibrosis was staged according to the Metavir scoring system. The diagnostic performance of TE was assessed by using receiver operating characteristic (ROC) curves and the area under the ROC curve analysis. RESULTS Two hundred and fifty-two patients met the inclusion criteria. Six (2%) patients were excluded due to unreliable TE measurements. Thus, 246 (171 men and 75 women) patients were analyzed. One hundred and ninety-five (79.3%) patients had chronic hepatitis C, 41 (16.7%) had chronic hepatitis B, and 10 (4.0%) were coinfected with human immunodeficiency virus. ROC curve analysis identified optimal cut-off value of TE as high as 6.9 kPa for F ≥ 2; 7.9 kPa for F ≥ 3; 9.6 kPa for F = 4 in all patients (n = 246), and as high as 6.9 kPa for F ≥ 2; 7.3 kPa for F ≥ 3; 9.3 kPa for F = 4 in patients with hepatitis C (n = 195). Cut-off values of TE obtained by maximizing only the specificity were as high as 6.9 kPa for F ≥ 2; 9.6 kPa for F ≥ 3; 12.2 kPa for F = 4 in all patients (n = 246), and as high as 7.0 kPa for F ≥ 2; 9.3 kPa for F ≥ 3; 12.3 kPa for F = 4 in patients with hepatitis C (n = 195). CONCLUSION The cut-off values of TE obtained in this single center study are comparable to that obtained in a recently published meta-analysis that included up to 40 studies.


World Journal of Gastroenterology | 2014

Controlled attenuation parameter for evaluating liver steatosis in chronic viral hepatitis.

Giovanna Ferraioli; Carmine Tinelli; Raffaella Lissandrin; Mabel Zicchetti; Barbara Dal Bello; Gaetano Filice; Carlo Filice

AIM To assess the performance of controlled attenuation parameter (CAP) in patients with chronic viral hepatitis. METHODS CAP is a new technique that measures the attenuation in the liver of an ultrasound beam, which is directly related to lipid accumulation. Consecutive patients undergoing liver biopsy for chronic viral hepatitis were studied using the M probe of FibroScan device (Echosens, Paris, France). The device estimates liver steatosis in decibel per meter (dB/m). An expert operator performed all measurements. Steatosis was graded according to Kleiners classification. Pearson or Spearman rank coefficient was used to test correlation between two study variables. Linear regression was used for multivariate model to assess the association between CAP and other variables. Receiver operating characteristic curve analysis was performed to calculate area under the curve (AUROC) for S0 vs S1-S3 and S0-S1 vs S2-S3. RESULTS 115 subjects (85 males and 30 females) were prospectively studied. The mean values of CAP were 227.1 ± 43.1 for S0; 254.6 ± 38.9 for S1; 297.8 ± 49.4 dB/m for S2-S3. In univariate analysis CAP showed a significant correlation with age, body mass index (BMI), degree of steatosis, and cholesterol. Multivariate regression analysis confirmed the correlation with the degree of steatosis [coefficient, 1.2 (0.60-1.83); P < 10(-5)] and BMI [coefficient, 4.1 (0.5-7.8); P = 0.03] but not with all other variables. Optimal cutoff values for S ≥ 1 and S ≥ 2 were 219 dB/m [AUROC, 0.76 (0.67-0.84); sensitivity, 91.1% (78.8-97.5); specificity, 51.6% (38.7-64.2); positive predictive value, 56.9% (44.7-68.6); negative predictive value, 89.2% (74.3-97.0); positive likelihood ratio, 1.88 (1.4-2.5); negative likelihood ratio, 0.17 (0.07-0.5)] and 296 dB/m [AUROC, 0.82 (0.74-0.89); sensitivity, 60.0% (32.3-83.7); specificity, 91.5% (83.9-96.3); positive predictive value, 52.9% (27.8-77.0); negative predictive value, 93.5% (86.3-97.6); positive likelihood ratio, 7.05 (3.2-15.4); negative likelihood ratio, 0.44 (0.2-0.8)], respectively. CONCLUSION Controlled attenuation parameter could be a useful tool in the clinical management of patients with chronic viral hepatitis for detecting liver steatosis.


American Journal of Tropical Medicine and Hygiene | 2016

Factors influencing the serological response in hepatic echinococcus granulosus infection

Raffaella Lissandrin; Francesca Tamarozzi; Luca Piccoli; Carmine Tinelli; Annalisa De Silvestri; Mara Mariconti; Valeria Meroni; Francesca Genco; Enrico Brunetti

Knowledge of variables influencing serology is crucial to evaluate serology results for the diagnosis and clinical management of cystic echinococcosis (CE). We analyzed retrospectively a cohort of patients with hepatic CE followed in our clinic in 2000-2012 to evaluate the influence of several variables on the results of commercial enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) tests. Sera from 171 patients with ≥ 1 hepatic CE cyst, and 90 patients with nonparasitic cysts were analyzed. CE cysts were staged according to the WHO-IWGE classification and grouped by activity. A significant difference in ELISA optical density (OD) values and percentage of positivity was found among CE activity groups and with controls (P < 0.001). The serological response was also influenced by age (P < 0.001) and cyst number (P = 0.003). OD values and cyst size were positively correlated in active cysts (P = 0.001). IHA test showed comparable results. When we analyzed the results of 151 patients followed over time, we found that serology results were significantly influenced by cyst activity, size, number, and treatment ≤ 12 months before serum collection. In conclusion, serological responses as assessed by commercial tests depend on CE cyst activity, size and number, and time from treatment. Clinical studies and clinicians in their practice should take this into account.


American Journal of Tropical Medicine and Hygiene | 2015

Patterns of hepatosplenic brucella abscesses on cross-sectional imaging: A review of clinical and imaging features

Tom Heller; Sabine Bélard; Claudia Wallrauch; Edoardo Carretto; Raffaella Lissandrin; Carlo Filice; Enrico Brunetti

While diffuse involvement of liver and spleen is frequently seen in brucellosis, suppurative abscesses caused by Brucella are less common but well described. With the increased availability of cross-sectional imaging techniques, reports have become more frequent. Four patients with hepatosplenic abscesses caused by Brucella spp. are described and included in a review of 115 previously published cases. Clinical characteristics and patterns on ultrasound (US) and computed tomography imaging were analyzed. Furthermore, the proportion of patients with brucellosis affected by suppurative hepatosplenic lesions was estimated. Hepatosplenic abscesses were seen in 1.2% of patients with brucellosis and were mostly caused by Brucella melitensis. Imaging analysis revealed two main distinct patterns. Solitary abscesses involving liver more frequently than spleen, and showing characteristic central calcifications, characterize the first pattern. Multiple smaller abscesses, frequent spleen involvement, and absence of calcifications characterize the second pattern. Blood and aspirate cultures were frequently negative, however, the positivity rate increased over the past years. Indirect Coombs test was positive in 96%. Half of the patients were cured by antibiotic treatment; case fatality in this series was 1.9%. Hepatosplenic abscesses due to Brucella infections have characteristic imaging findings. Clinicians should be aware of these and the proactive use of cross-sectional imaging, particularly US, should be encouraged in endemic regions.


European Journal of Pediatrics | 2012

Assessment of liver stiffness with transient elastography by using S and M probes in healthy children

Giovanna Ferraioli; Raffaella Lissandrin; Mabel Zicchetti; Carlo Filice

We read with great interest the article by Engelmann etal. [2] in the February 2012 issue of EJP and wouldlike to raise an important issue in relation to their work.In their study, the authors investigated the feasibility oftransient elastography (TE) in healthy children to definenormal values of liver stiffness. Examinations were per-formed by using two types of probes (S or M) depend-ing on thorax circumference and according to themanufacturer recommendations. By using the appropri-ate probe, normal liver stiffness values were 4.40, 4.73,and 5.1 kPa, respectively, in three age groups—namely0–5, 6–11, and 12–18 years. Eighty percent of measure-ments were performed with the S probe and 20 % withthe M probe.Unfortunately, the utilization of different probes (S orM) introduces a severe bias that limits the results of thestudy. Indeed, the values obtained with different probesare not comparable due to technical aspects, such asfocal length, vibration amplitude, and depth of measure-ment [5]. In adults, it has been demonstrated that TEresults obtained by using M and XL probes are system-atically different because of the different region of inter-est [1, 3, 5]. Myers et al. [5] have found that, in patientswho were studied with both probes, the values obtainedwith XL probe were 1–2 kPa lower than that obtainedwith the M probe. It can be inferred that similar differ-ences could also be expected between the S and Mprobes, and this aspect should be taken into accountand thoroughly investigated. On the other hand, in arecent study, in which the results of TE measurementsobtained with an XL probe were compared to that ofliver biopsy, it was found that there was an overestima-tion of liver fibrosis with the XL probe [4].References


Liver International | 2016

The clinical value of controlled attenuation parameter for the noninvasive assessment of liver steatosis.

Giovanna Ferraioli; Carmine Tinelli; Annalisa De Silvestri; Raffaella Lissandrin; Elisabetta Above; Carolina Dellafiore; Gianluigi Poma; Marta Di Gregorio; Laura Maiocchi; Renato Maserati; Carlo Filice

Ultrasound is the imaging modality most widely utilized in the general population for diagnostic purposes. Controlled attenuation parameter is a novel noninvasive method for assessing steatosis. Our aim was to investigate whether the clinical value of controlled attenuation parameter in patients referred for abdominal ultrasound examinations is affected by liver fibrosis.


European Journal of Gastroenterology & Hepatology | 2015

Correlation of the controlled attenuation parameter with indices of liver steatosis in overweight or obese individuals: A pilot study

Giovanna Ferraioli; Carmine Tinelli; Raffaella Lissandrin; Mabel Zicchetti; Milena Anna Faliva; Simone Perna; Guido Perani; Francesco Alessandrino; Fabrizio Calliada; Mariangela Rondanelli; Carlo Filice

Objective The aim of this study was to assess the clinical relevance of the controlled attenuation parameter (CAP) by analyzing the correlations between CAP and indirect indices of liver steatosis in obese or overweight individuals. Methods Consecutive participants were prospectively enrolled. BMI, waist circumference, hepatic steatosis index, fatty liver index, percent fat mass and regional fat masses as assessed by dual-energy X-ray absorptiometry (DXA), fat signal fraction as assessed by MRI, and CAP were obtained. Pearson’s r coefficient was used to test the correlation between two study variables. Results A total of 88 individuals were studied. They included 31 men [age, 50.4 years (12.9 years); BMI, 30.7 kg/m2 (4.8 kg/m2)] and 57 women [age, 49.0 years (12.6 years); BMI, 31.4 kg/m2 (5.6 kg/m2)]. DXA, anthropometric parameters, and fatty liver index were moderately correlated with CAP in men. In women, there was a moderate correlation of CAP with the hepatic steatosis index and anthropometric parameters and only a slight or fair correlation of CAP with DXA parameters. CAP and fat signal fraction showed a good correlation (r=0.65 in men, P=0.002; r=0.68 in women, P=0.0009). Conclusion Measurement of CAP is a reliable method for noninvasive assessment of liver steatosis, showing a correlation with other indirect markers of central obesity and a good correlation with MRI results.

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Andrea M. Isidori

Sapienza University of Rome

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Carlo Catalano

Sapienza University of Rome

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