Showing papers by "Andrea Laghi published in 2007"

Cost-effectiveness of colorectal cancer screening with computed tomography colonography: the impact of not reporting diminutive lesions.

Abstract: BACKGROUND. Prior cost-effectiveness models analyzing computed tomography colonography (CTC) screening have assumed that patients with diminutive lesions (� 5 mm) will be referred to optical colonoscopy (OC) for polypectomy. However, consensus guidelines for CTC recommend reporting only polyps measuring � 6 mm. The purpose of the current study was to assess the potential harms, benefits, and cost-effectiveness of CTC screening without the reporting of diminutive lesions compared with other screening strategies. METHODS. The cost-effectiveness of screening with CTC (with and without a 6-mm reporting threshold), OC, and flexible sigmoidoscopy (FS) were evaluated using a Markov model applied to a hypothetical cohort of 100,000 persons age 50 years. RESULTS. The model predicted an overall cost per life-year gained relative to no screening of $4361, $7138, $7407, and $9180, respectively, for CTC with a 6-mm reporting threshold, CTC with no threshold, FS, and OC. The incremental costs associated with reporting diminutive lesions at the time of CTC amounted to $118,440 per additional life-year gained, whereas the incidence of colorectal cancer was reduced by only 1.3% (from 36.5% to 37.8%). Compared with primary OC screening, CTC with a 6-mm threshold resulted in a 77.6% reduction in invasive endoscopic procedures (39,374 compared with 175,911) and 1112 fewer reported OC-related complications from perforation or bleeding.

European society of gastrointestinal and abdominal radiology (ESGAR): Consensus statement on CT colonography

Abstract: Rapid clinical dissemination of CT colonography (CTC) is occurring in parallel with continued research into technique optimisation and diagnostic performance. A need exists therefore for current guidance as to basic prerequisites for effective clinical implementation. A questionnaire detailing CTC technique, analysis, training and clinical implementation was developed by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) CTC committee and circulated to all faculty members of previous ESGAR “hands-on” CTC training courses. Responses were collated and a consensus statement produced. Of 27 invited to participate, 24 responded. Reasonable consensus was reached on bowel preparation, colonic distension, patient positioning, use of IV contrast and optimal scan parameters. Both primary 2D and primary 3D analysis were advocated equally, with some evidence that more experienced readers prefer primary 2D. Training was universally recommended, although there was no consensus regarding minimum requirements. CTC was thought superior to barium enema, although recommended for screening only in the presence of validated local experience. There was consensus that polyps 4 mm or less could be ignored assuming agreement from local gastroenterological colleagues. There is increasing consensus amongst European experts as to the current best practice in CTC.

MRI and ultrasound for hepatic fat quantification:relationships to clinical and metabolic characteristics of pediatric nonalcoholic fatty liver disease.

Abstract: Objective: The aims of this study were to evaluate hepatic steatosis severity in a series of obese children through both magnetic resonance imaging (MRI) and ultrasound, and to correlate imaging findings to clinical and metabolic characteristics of the study population. Methods: Fifty obese children presenting hepatomegaly and/or elevated aminotransferases were candidates for assessment of hepatic fat fraction (HFF) by MRI. All subjects underwent dual energy X-ray absorptiometry scan measurement, and liver ultrasound scanning. Fasting blood samples were taken for the estimation of serum concentrations of glucose, insulin, leptin, aminotransferases and serum lipid profile. Results: A diagnosis of fatty liver was established by MRI in 20 (40%) children; of these, 12 had HFF of 9‐18%, while the remaining ones had HFF of 19% or higher. HFF was not correlated to age, SDS-BMI, pubertal status and fat mass. HFF was positively associated with serum concentrations of alanine aminotransferase (ALT; r = 0.62; p < 0.0001) and AST (r = 0.39; p = 0.006), as well as with insulin (r = 0.44; p = 0.001) and insulin resistance (r = 0.49; p < 0.0001). Overall, ultrasound correlated well with MRI (p < 0.0001). However, HFF ranged greatly in subjects with moderate (2‐37%) as well as with severe (11‐25%) degree of ultrasound hepatic steatosis. In fact, the mean hepatic fat fraction in children with severe steatosis was not statistically different from that found in patients with moderate steatosis (p = 0.98). In multiple regression analysis, the most powerful predictors of elevated ALT, after correction for age, gender, BMI and pubertal status, were insulin resistance (p < 0.01) and MRI HFF (p < 0.0001). Conclusions: Unlike sonography, an operator-dependent procedure, MRI is not subject to interpretation or inter-observer variation, and may be more useful than ultrasound for the monitoring of young patients with hepatic steatosis.

Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography.

Abstract: Purpose This study was undertaken to evaluate the accuracy of 64-row computed tomography angiography (CTA) in the study of vascular anatomy by assessing the incidence of anatomical variations of the origin of the coeliac trunk, mesenteric arteries and collateral branches.

Adult celiac disease: MRI findings.

Abstract: The purpose of our report is to describe a spectrum of findings of celiac disease at MR enterography MR enterography is a non-invasive, feasible, and reproducible imaging technique for the evaluation of small bowel Findings on MR enterography, similar to those of conventional barium studies, may suggest a diagnosis of celiac disease

Multidetector CT (64 Slices) of the liver: examination techniques.

Abstract: Sixty-four-row MDCT, although developed primarily for cardiac imaging, has the potential to have a great impact on liver imaging as well. Liver-imaging protocols with sub-millimeter collimation improve longitudinal spatial resolution, making the acquired dataset a real isotropic volume perfectly designed for optimal three-dimensional rendering and accurate organ and lesion volumetry. The 64-row detector array offers a wide volumetric coverage (up to 40 mm), suitable not only for shortening scanning time and improving spatial resolution, but also for including a large volume per single rotation, particularly useful for accurate CT perfusion studies. In order to take full benefit from the enormous performance offered by new 64-row MDCT scanners, imaging protocols need to be redesigned. Due to the extremely short scanning window, contrast agent injection should be performed at high flow rate and followed by saline bolus chaser; the use of highly concentrated contrast media might be useful. Timing should be accurately calculated either by a test bolus or, better, by using an automatic bolus-detection technique. Radiation exposure is kept under control, using automatic device-modulating dose delivery according to the patient’s anatomy. Finally, the evaluation of acquired volumetric datasets needs the extensive use of a dedicated workstation, with software with sophisticated rendering capabilities.

Spectrum of Normal Findings, Anatomic Variants and Pathology of Ileocecal Valve: CT Colonography Appearances and Endoscopic Correlation

Abstract: Knowledge of the potential variants of ileocecal valve, the most frequent pathologic conditions as well as some pitfalls encountered during the analysis of CT Colonography images are thus indispensable for radiologists who perform and interpret such examinations and for general practitioners who are approaching this technique. Awareness of these different diagnostic possibilities is mandatory for radiologists evaluating CT Colonography datasets. Combined analysis of 2D axial and reformatted slices and 3D endouminal views provides the highest level of diagnostic accuracy. We present the multidetector CT Colonography findings with endoscopic correlation and discuss the possible pathologies and the practical implications

Focal nodular hyperplasia: intraindividual comparison of dynamic gadobenate dimeglumine- and ferucarbotran-enhanced magnetic resonance imaging

Abstract: Purpose To intraindividually compare the enhancement pattern of focal nodular hyperplasia (FNH) after dynamic administration of two bolus-injectable liver-specific MR contrast agents, ferucarbotran and gadobenate dimeglumine. Materials and Methods A total of 19 patients with 24 FNHs underwent gadobenate dimeglumine- and ferucarbotran-enhanced MRI during the hepatic arterial-dominant phase (HAP; 25 seconds), the portal-venous phase (PVP; 60 seconds), and the equilibrium phase (EP; 180 seconds). Hepatospecific phases were acquired on T1-weighted images 120 minutes after gadobenate dimeglumine administration, and on T2-weighted images 10 minutes after ferucarbotran administration. Lesion enhancement was independently analyzed by two observers. The kappa statistic was determined to evaluate the agreement between the enhancement patterns of the lesions. Results On gadobenate dimeglumine–enhanced MR images during HAP, PVP, and EP, FNHs were: hyperintense (24/20/13); isointense (0/4/11); and hypointense (0/0/0). On ferucarbotran-enhanced MR images during HAP, PVP, and EP, FNHs were: hyperintense (2/0/0); isointense (16/9/14); and hypointense (6/15/10). Overall, poor agreement between both contrast agents was observed. During the hepatospecific phases, most (20/24; 83%) FNHs showed a typical enhancement pattern during the delayed hepatospecific phase. Conclusion The dynamic enhancement pattern of FNHs is significantly different between gadobenate dimeglumine– and ferucarbotran-enhanced MRI. With respect to hepatospecific phase, the majority of FNHs showed a typical behavior on both contrast agents. J. Magn. Reson. Imaging 2007. © 2007 Wiley-Liss, Inc.

Projected impact of colorectal cancer screening with computerized tomographic colonography on current radiological capacity in Europe.

Abstract: Summary Background The impact of a primary colorectal cancer screening with computerized tomographic colonography on current radiological capacity is unknown. The multispecialty needs for computerized tomographic examinations raise some doubts on the feasibility of a mass colorectal cancer screening with computerized tomographic colonography. Aim To assess whether the number of available computerized tomographic units in Europe is adequate to cover population screening with computerized tomographic colonography. Methods A mathematical and a Markov model were, respectively, used to assess the number of computerized tomographic colonography procedures needed to be performed each day in the start-up and in the steady-state phases of a colorectal cancer screening programme in Europe. Such outcome was divided for the total number of computerized tomographic machines aged <10 years estimated to be present in the European hospitals. Results At a simulated 30% compliance, 28 760 130 European people would need to be screened by the 3482 available computerized tomographic units in a 5-year start-up period, corresponding to 6.6 CTC/CT unit/day. Assuming a 10-year repetition of computerized tomographic colonography between 50 and 80 years, the number of computerized tomographic colonography needed to be performed in the steady-state period appeared to be 4.3/CT unit/day. Conclusions The current radiological capacity may cover the need for a primary colorectal cancer screening with computerized tomographic colonography in a steady state. On the other hand, a substantial implementation of the current computerized tomographic capacity or a synergistic approach with other techniques seems to be necessary for the start-up period.

A piece of chainlink fence in the heart.

Abstract: A 63-year-old man was mowing the grass along a chainlink fence when he felt a brief stab of intense pain in the middle of his chest. Hours later, precordial pain suddenly arose. On his arrival at our emergency department, a small, bleeding lesion was evident near the right edge of the sternum (Fig. 1). Fig. 1 Six-month follow-up photograph shows the chest entry point (3rd intercostal space), which is apparently inconsistent with the final position of the penetrating fragment. It is possible that the fragment entered the pericardium, migrated, and penetrated ... Electrocardiographic (ECG) results were normal, as were cardiac enzyme levels. Chest radiographs revealed a metallic foreign body over the cardiac silhouette (Fig. 2). Transthoracic echocardiography (TTE) showed a hyperechoic fixed mass (1.5 cm) between the interventricular septum and the posterior–inferior left ventricular wall (Fig. 3). Mild pericardial effusion was present. Although very near the mass, the mitral valve apparatus appeared neither damaged nor functionally altered, and no segmental wall-motion abnormalities were seen. On contrast-enhanced computed tomography (CT), the fragment seen was near the apex (Fig. 4A); on volume-rendered 3-dimensional reconstruction, it appeared to be almost completely embedded within the left ventricular wall (Fig. 4B). Fig. 2 Anteroposterior (A) and lateral (B) chest radiographs show a metallic fragment (arrows) over the cardiac silhouette. Fig. 3 Transthoracic echocardiography in the apical long-axis view confirms the presence of the foreign body (arrow) in the left ventricle. Real-time motion images are available at texasheart.org/journal Fig. 4 A) 64-Slice contrast-enhanced computed tomographic scan shows the foreign body near the apex of the heart. B) Volume-rendered 3-dimensional computed tomographic reconstruction reveals the fragment (arrow) in the left ventricle. Ao = aorta; LV = ... Because the patient was clinically and hemodynamically stable, he did not undergo urgent surgery; he was admitted for follow-up. Blood cultures were obtained, and therapy with broad-spectrum antibiotics was started. At the 6-month follow-up examination, the patient was asymptomatic. The Holter ECG was unremarkable, without any arrhythmic event during the 24-hour recording. The TTE and CT scans were substantially unchanged; the foreign body lay in the same position.

Anatomical variations of the coeliac trunk and the mesenteric arteries evaluated with 64-row CT angiography Studio sulla variabilità anatomica del tripode celiaco e delle arterie mesenteriche mediante angiografia con TC spirale multistrato a 64 strati

Abstract: Purpose. This study was undertaken to evaluate the accuracy of 64-row computed tomography angiography (CTA) in the study of vascular anatomy by assessing the incidence of anatomical variations of the origin of the coeliac trunk, mesenteric arteries and collateral branches. Mterials and methods. Sixty patients were evaluated with 64row CTA (VCT, General Electric Healthcare, Milwaukee, WI, USA) with a collimation of 0.625 mm after the injection of iodinated nonionic contrast material (4 ml/s). Exclusion criteria were the presence of any pathological condition likely to affect normal vascular anatomy. Rults. The coeliac trunk had a normal trifurcation in 56.7% of cases. The common hepatic artery was normal in 60% of patients. The inferior pancreaticoduodenal arteries were either absent or not assessable in 8.3% of cases and there was a double trunk in 5%, a common trunk in 83.3% and a single vessel in 3.3%. The number of jejunal and ileal arteries ranged from a minimum of six to a maximum of 13 (mean value 8.7 ± 1.34). The Riolan arcade was assessable in 31.7% and developed in 68.4% of these. Conclusions. The 64-row CTA enables visualisation of small vessels and accessory arteries that are difficult to identify with other techniques. The technique’s high sensitivity allowed us to observe that the prevalence of vascular abnormalities is higher than that reported in the literature.