Silvia Ravelli

Apparent Diffusion Coefficient Value and Ratio as Noninvasive Potential Biomarkers to Predict Prostate Cancer Grading: Comparison With Prostate Biopsy and Radical Prostatectomy Specimen

OBJECTIVE. The purpose of this study is to test the association between diffusion-weighted MRI and prostate cancer Gleason score at both biopsy and final pathologic analysis after radical prostatectomy. SUBJECTS AND METHODS. Patients with prostate cancer (n = 72) underwent diffusion-weighted MRI (b values, 0, 800, and 1600 s/mm(2)) with an endorectal coil. Apparent diffusion coefficient (ADC) and ADC ratio were obtained in normal and pathologic tissue and were correlated with transrectal ultrasound-guided biopsy (n = 72) and histopathologic (n = 39) Gleason scores using the ANOVA test. ADC accuracy was estimated using ROC curves. RESULTS. Lesions suspicious for prostate cancer were detected in 65 patients. The mean ADC was 1.47 and 0.87 × 10(-3) mm(2)/s for normal and pathologic tissue, respectively (p < 0.001). When we divided the population into four groups (normal tissue and biopsy Gleason scores of 6, 7, and 8-10), then the mean ADC value was 1.47, 0.96, 0.80, and 0.78 × 10(-3) mm(2)/s, respectively (p < 0.001). The ADC ratio decreased along with an increase in biopsy Gleason score (66.9%, 56.7%, and 51.5% for Gleason scores of 6, 7 and 8-10, respectively) (ANOVA, p = 0.003) and pathologic Gleason score (ANOVA, p < 0.001). ROC curves had an AUC of 0.94 and 0.86 for ADC and ADC ratio, respectively (p = 0.012 and 0.042, respectively). CONCLUSION. Decreasing ADC values may represent a strong risk factor of harboring a poorly differentiated prostate cancer, independently of biopsy characteristics.

Tailored Breast Cancer Screening Program with Microdose Mammography, US, and MR Imaging: Short-term Results of a Pilot Study in 40–49-Year-Old Women

PURPOSEnTo evaluate the feasibility, performance, and cost of a breast cancer screening program aimed at 40-49-year-old women and tailored to their risk profile with supplemental ultrasonography (US) and magnetic resonance (MR) imaging.nnnMATERIALS AND METHODSnThe institutional review board approved this study, and informed written consent was obtained. A total of 3017 40-49-year-old women were invited to participate. The screening program was tailored to lifetime risk (Gail test) and mammographic density (according to Breast Imaging Reporting and Data Systems [BI-RADS] criteria) with supplemental US or MR imaging and bilateral two-view microdose mammography. The indicators suggested by European guidelines, US incremental cancer detection rate (CDR), and estimated costs were evaluated.nnnRESULTSnA total of 1666 women (67.5% participation rate) were recruited. The average lifetime risk of breast cancer was 11.6%, and nine women had a high risk of breast cancer; 917 women (55.0%) had a high density score (BI-RADS density category 3 or 4). The average glandular dose for screening examinations was 1.49 mGy. Screening US was performed in 835 study participants (50.1%), mostly due to high breast density (800 of 1666 women [48.0%]). Screening MR imaging was performed in nine women (0.5%) at high risk for breast cancer. Breast cancer was diagnosed in 14 women (8.4 cases per 1000 women). Twelve diagnoses were made with microdose mammography, and two were made with supplemental US in dense breasts (2.4 cases per 1000 women). All patients were submitted for surgery, and 10 underwent breast-conserving surgery. The sentinel lymph node was evaluated in 11 patients, resulting in negative findings in six. Pathologic analysis resulted in the diagnosis of four ductal carcinomas in situ and 10 invasive carcinomas (five at stage I).nnnCONCLUSIONnA tailored breast cancer screening program in 40-49-year-old women yielded a greater-than-expected number of cancers, most of which were low-stage disease.

Intraindividual comparison of gadobutrol and gadopentetate dimeglumine for detection of myocardial late enhancement in cardiac MRI.

OBJECTIVEnGadobutrol is an extracellular macrocyclic gadolinium chelate recently introduced in MRI, and it has already been used for cardiac late enhancement imaging; however, until now it has never been compared with gadopentetate dimeglumine. The purpose of our study was to compare 0.1 mmol/kg gadobutrol to 0.2 mmol/kg gadopentetate dimeglumine for the detection of myocardial late enhancement in the same group of patients.nnnSUBJECTS AND METHODSnThis was an exploratory single-blind parallel group study comparing gadobutrol (0.1 mmol/kg) to gadopentetate dimeglumine (0.2 mmol/kg) in 20 adult patients scheduled for cardiac late enhancement MRI with gadopentetate dimeglumine and whose MR images showed late enhancement. MR images were acquired at 10, 15, and 20 minutes after peripheral injection of gadobutrol by using a 3D turbo field echo inversion recovery T1-weighted sequence. Volume and percentage of late enhancement, number of involved segments, late enhancement localization and pattern, and late enhancement signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between contrast agents.nnnRESULTSnLate enhancement was not significantly different with gadobutrol and gadopentetate dimeglumine both in terms of total volume of myocardium (mean ± SD, 37.8 ± 56.1 and 35.1 ± 46.7 cm(3), respectively; p = 0.33) and percentage of myocardial wall involvement (22.5% ± 19.1% and 22.0% ± 17.2%, respectively; p = 0.67). The number of segments involved was not different (138 with gadobutrol vs 134 with gadopentetate dimeglumine). Furthermore, SNR and CNR were not different (gadopentetate dimeglumine, 123.8 ± 82.9 and gadobutrol, 117.2 ± 88.6, p = 0.58 and gadopentetate dimeglumine, 96.2 ± 68.9 and gadobutrol, 88.4 ± 72.9, p = 0.53, respectively).nnnCONCLUSIONnA single dose of gadobutrol seems to be as effective as a double dose of gadopentetate dimeglumine for the detection of late enhancement.

Apparent diffusion coefficient in the evaluation of side-specific extracapsular extension in prostate cancer: Development and external validation of a nomogram of clinical use

OBJECTIVESnThe aim of this study is to develop a nomogram of clinical utility based on apparent diffusion coefficient (ADC) from diffusion-weighted imaging to predict extracapsular extension (ECE), and to validate externally its clinical utility.nnnMATERIALS AND METHODSnA total of 101 men (70 for the creation and 31 for external validation of the nomogram) underwent 1.5T multiparametric magnetic resonance imaging followed by radical prostatectomy at 2 different institutions. ADC values were assessed for normal and pathological tissue. Clinical and pathological variables were investigated by univariate and multivariate logistic regression analyses on 70 patients and logistic regression coefficients were used to develop our nomogram. Receiver operating characteristic curve analysis was performed to determine the optimal ADC cut off for ECE. The nomogram was then externally validated on 31 patients at another institution.nnnRESULTSnAt univariate analysis, the following variables were associated with ECE: pathological ADC and Gleason at biopsy (P<0.001) along with tumor volume and ECE at imaging (P = 0.003). At multivariate analysis, pathological ADC (P = 0.027), tumor volume (P = 0.011), and biopsy Gleason (P = 0.040) maintained their independent predictor status and were included in our nomogram together with normal ADC and ECE at imaging. Our nomogram showed a significant higher sensitivity (88%) than T2-weighted imaging (54%; P = 0.010). External validation resulted in an overall accuracy of 81%.nnnCONCLUSIONSnADC represents a potential imaging biomarker to predict side-specific ECE in patients with prostate cancer. Our nomogram could improve the current diagnostic pathway and possibly the therapeutic approach for this disease.

Magnetic resonance imaging of a hypereosinophilic endocarditis with apical thrombotic obliteration in Churg–Strauss syndrome complicated with acute abdominal aortic embolic occlusion

Churg-Strauss syndrome can be associated with Loeffler-like eosinophilic endocarditis. We report a case of a young woman in which the diagnosis of Churg-Strauss syndrome was made subsequently to the magnetic resonance demonstration of eosinophilic endocarditis associated to left ventricle apical thrombosis. In our report, this rare condition evolved in an unusual complication: the embolic migration of the left ventricle apical thrombus in the abdominal aorta as showed by multi-detector-computed-tomography angiography.

MR-guided stereotactic breast biopsy using a mixed ferromagnetic-nonmagnetic coaxial system with 12- to 18-gauge needles: clinical experience and long-term outcome

PurposeThis study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle.Materials and methodsMRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle.ResultsOf the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26±19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant.ConclusionsMRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’applicazione clinica di un sistema di biopsia mammaria guidata da risonanza magnetica (MRBB) composto da ago coassiale amagnetico e ago ferromagnetico per core biopsy.Materiali e metodiLa MRBB è stata eseguita su 70 lesioni mammarie. Il materiale per le biopsie consisteva in un ago amagnetico coassiale da 14–16 Gauge e un ago ferromagnetico da biopsia da 16–18 Gauge.Risultati. Delle 70 lesioni, 29 sono risultate maligne e 41 non maligne. Tutte le 29 lesioni maligne sono andate incontro a intervento chirurgico e sono state confermate come maligne all’istologia definitiva. Delle 41 lesioni non maligne, 35 sono state sottoposte a MRI mammaria di follow-up (media 26±19 mesi), che non ha dimostrato modificazioni delle lesioni stesse; 6 lesioni sono andate incontro a intervento chirurgico a causa della insufficiente correlazione radiologica-patologica e sono risultate essere non maligne in 3 casi, bordeline in 1 caso (carcinoma lobulare in situ) e maligne in 2 casi (carcinoma tubulare ben differenziato e carcinoma duttale infiltrante). Sensibilità, specificità, valori predittivi positive e negativo, accuratezza diagnostica sono risultati essere, rispettivamente, 93,5%, 100%, 100%, 95,1% e 97,1% considerando il carcinoma lobulare in situ un risultato istologico non maligno; 90,6%, 100%, 100%, 92,7% e 95,7% considerandolo benignoConclusioniLa MRBB con un sistema coassiale ferromagnetico-amagnetico ha rappresentato un modo semplice per eseguire una procedura bioptica ed è stata facilmente applicabile nella routine clinica.

Biopsia mammaria stereotassica RM-guidata mediante sistema coassiale misto ferromagnetico-amagnetico con aghi da 12-18 Gauge: esperienza clinica e risultati a lungo termine

PurposeThis study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle.Materials and methodsMRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle.ResultsOf the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26±19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant.ConclusionsMRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’applicazione clinica di un sistema di biopsia mammaria guidata da risonanza magnetica (MRBB) composto da ago coassiale amagnetico e ago ferromagnetico per core biopsy.Materiali e metodiLa MRBB è stata eseguita su 70 lesioni mammarie. Il materiale per le biopsie consisteva in un ago amagnetico coassiale da 14–16 Gauge e un ago ferromagnetico da biopsia da 16–18 Gauge.Risultati. Delle 70 lesioni, 29 sono risultate maligne e 41 non maligne. Tutte le 29 lesioni maligne sono andate incontro a intervento chirurgico e sono state confermate come maligne all’istologia definitiva. Delle 41 lesioni non maligne, 35 sono state sottoposte a MRI mammaria di follow-up (media 26±19 mesi), che non ha dimostrato modificazioni delle lesioni stesse; 6 lesioni sono andate incontro a intervento chirurgico a causa della insufficiente correlazione radiologica-patologica e sono risultate essere non maligne in 3 casi, bordeline in 1 caso (carcinoma lobulare in situ) e maligne in 2 casi (carcinoma tubulare ben differenziato e carcinoma duttale infiltrante). Sensibilità, specificità, valori predittivi positive e negativo, accuratezza diagnostica sono risultati essere, rispettivamente, 93,5%, 100%, 100%, 95,1% e 97,1% considerando il carcinoma lobulare in situ un risultato istologico non maligno; 90,6%, 100%, 100%, 92,7% e 95,7% considerandolo benignoConclusioniLa MRBB con un sistema coassiale ferromagnetico-amagnetico ha rappresentato un modo semplice per eseguire una procedura bioptica ed è stata facilmente applicabile nella routine clinica.

MR-guided stereotactic breast biopsy using a mixed ferromagnetic-nonmagnetic coaxial system with 12- to 18-gauge needles: clinical experience and long-term outcome@@@Biopsia mammaria stereotassica RM-guidata mediante sistema coassiale misto ferromagnetico-amagnetico con aghi da 12–18 Gauge: esperienza clinica e risultati a lungo termine

PurposeThis study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle.Materials and methodsMRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle.ResultsOf the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26±19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant.ConclusionsMRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’applicazione clinica di un sistema di biopsia mammaria guidata da risonanza magnetica (MRBB) composto da ago coassiale amagnetico e ago ferromagnetico per core biopsy.Materiali e metodiLa MRBB è stata eseguita su 70 lesioni mammarie. Il materiale per le biopsie consisteva in un ago amagnetico coassiale da 14–16 Gauge e un ago ferromagnetico da biopsia da 16–18 Gauge.Risultati. Delle 70 lesioni, 29 sono risultate maligne e 41 non maligne. Tutte le 29 lesioni maligne sono andate incontro a intervento chirurgico e sono state confermate come maligne all’istologia definitiva. Delle 41 lesioni non maligne, 35 sono state sottoposte a MRI mammaria di follow-up (media 26±19 mesi), che non ha dimostrato modificazioni delle lesioni stesse; 6 lesioni sono andate incontro a intervento chirurgico a causa della insufficiente correlazione radiologica-patologica e sono risultate essere non maligne in 3 casi, bordeline in 1 caso (carcinoma lobulare in situ) e maligne in 2 casi (carcinoma tubulare ben differenziato e carcinoma duttale infiltrante). Sensibilità, specificità, valori predittivi positive e negativo, accuratezza diagnostica sono risultati essere, rispettivamente, 93,5%, 100%, 100%, 95,1% e 97,1% considerando il carcinoma lobulare in situ un risultato istologico non maligno; 90,6%, 100%, 100%, 92,7% e 95,7% considerandolo benignoConclusioniLa MRBB con un sistema coassiale ferromagnetico-amagnetico ha rappresentato un modo semplice per eseguire una procedura bioptica ed è stata facilmente applicabile nella routine clinica.

Magnetic Resonance Imaging of the Aorta

Non-invasive imaging techniques have now completely replaced invasive angiography in the diagnosis of aortic disease. Among the non-invasive cardiovascular diagnostic methods, magnetic resonance imaging (MRI) holds a central role, beside ultrasonography and computed tomography. The main strengths of MRI in the setting of aortic disease lie in the large spectrum of techniques available, which give the possibility of studying any single aspect of the patient’s aortic disease, ranging from characterization of an aortic wall thickening, to precise measurements of the vessel diameter, as well as functional and quantitative evaluation of the vessel flow. Moreover, the recent technological advances have improved magnetic resonance performance and have further expanded the techniques available, making MRI more suitable also for application in the emergency setting.

Studio funzionale: sequenze cine e velocity-encoded

Il cuore e una pompa muscolare che crea un flusso pulsato unidirezionale grazie alla sequenza ritmica di rilasciamento (riempimento) e contrazione (svuotamento), governata dall’eccitazione elettrica che si propaga lungo il sistema di conduzione. Da un punto di vista fisiologico, il ciclo cardiaco puo essere schematicamente suddiviso in diverse fasi: una fase di contrazione isovolumetrica (la pressione all’interno dei ventricoli aumenta rapidamente, il volume rimane costante, entrambe le valvole sono chiuse), la fase di eiezione (la valvola aortica si apre, il volume ventricolare si riduce prima rapidamente poi lentamente; la pressione ventricolare aumenta lentamente per poi ridursi), una seconda fase isovolumetrica (chiusura della valvola aortica, il miocardio ventricolare si rilassa comportando una rapida riduzione della pressione a volume costante) ed infine una fase di riempimento con progressivo aumento volumetrico a pressione costante (la valvola atrioventricolare si apre, il volume aumenta prima in modo rapido e poi piu lentamente e, infine, si ha un ultimo piccolo contributo al riempimento ventricolare, dato dalla contrazione atriale).