Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 42
Filter
1.
Radiol Med ; 114(3): 496-508, 2009 Apr.
Article in English, Italian | MEDLINE | ID: mdl-19322634

ABSTRACT

PURPOSE: The aim of this paper is to report on the implementation of new guidelines on the use of injectable iodinated contrast media (ICM) at our workplace and specific protocols for the preparation of patients at risk. MATERIALS AND METHODS: Operators received training with continuing medical education (CME) credits. The new documentation (patient history/screening form and informed consent form) is available on the hospital Web site and requests serum creatinine determination with estimation of glomerular filtration rate (GFR) for every patient. Additional tests are required for high-risk patients only. RESULTS: Attendance rates were 57.2% among referring physicians and 74.5% among Radiology Department personnel. The Cockcroft-Gault formula was used to estimate GFR in adults. The main problem encountered in the implementation process was that referring physicians failed to evaluate the GFR in 80% of patients, with low GFR being discovered in the Radiology Department on the day of examination in 20% of patients, resulting in a need to reschedule the examination. CONCLUSIONS: Although not an easy task, implementation of the new guidelines for ICM use is both feasible and necessary. An additional refresher training course for personnel and GFR evaluation of the patient on referral are indispensable to ensure proper preparation of patients at increased risk of adverse reactions to ICM.


Subject(s)
Contrast Media/standards , Iodine , Contrast Media/administration & dosage , Contrast Media/adverse effects , Creatinine/blood , Education, Medical, Continuing , Glomerular Filtration Rate , Guidelines as Topic , Humans , Injections , Iodine/adverse effects , Radiology/education , Referral and Consultation
2.
Allergy ; 52(33 Suppl): 28-31, 1997.
Article in English | MEDLINE | ID: mdl-9188945

ABSTRACT

Rhinitis is defined as nasal congestion, sneezing, itching and rhinorrhoea, recently classified as allergic, infective, structural or "other". The increasing employment of flexible rhynolaringoscopy may represent one of the most useful diagnostic tools in the complex differential diagnosis between allergic and nonallergic rhinitis. Furthermore, chronic allergic rhinitis, with secondary impairment of mucociliary clearance and the plethora of frequent anatomical variations, especially in the ostiomeatal complex, appear to predispose the patient to recurrent rhinosinusitis. In the last two decades, a better understanding of mucociliary clearance of nasal cavity and paranasal sinuses has shifted the attention from the maxillary sinuses to the area of the antherior ethmoid sinuses. Plain film radiographic examination, the historical standard, due to its inability to individualize ethmoid and sphenoid disease, is being rapidly supplanted by computed tomography and magnetic resonance imaging in the diagnosis of rhinosinusitis. In allergic and non-allergic rhinitis the diagnostic role of magnetic resonance imaging and computed tomography is still under debate. Computed tomography and magnetic resonance imaging are more efficient in demonstrating the bone wall, mucosal layer and sinus content than classical and computerized radiology; they have a higher diagnostic performance index in spite of a higher cost and, for computed tomography, a higher radiation dose.


Subject(s)
Fiber Optic Technology/methods , Magnetic Resonance Imaging/methods , Rhinitis/diagnosis , Tomography, X-Ray Computed/methods , Diagnosis, Differential , Humans , Sinusitis/complications , Sinusitis/physiopathology
3.
Pediatr Radiol ; 26(9): 650-6, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8781105

ABSTRACT

BACKGROUND: A simple, accurate, reproducible and noninvasive method of body iron overload assessment would be of great clinical use. Objective. The purpose of the study was the implementation of a 0. 5-T MRI method for liver iron overload measurement. MATERIALS AND METHODS: Thirty patients with thalassemia major took part in the study. Liver and paraspinal muscle signal intensity (SI) measurements were performed on T1-weighted images and normalized on a standard phantom, and a subjective hemochromatosis grading scale was made on both T1- and T2-weighted images. Serum ferritin levels and tissue iron from liver biopsy specimens were determined for comparison. RESULTS: A close correlation was found between bioptic liver iron and both the liver-to-phantom SI ratio (r = -0.88) and the subjective grading scale (rho = 0.89). Serum ferritin correlated poorly with liver iron deposition, whether assessed by biopsy (r = 0. 62) or MRI (r = -0.69). CONCLUSIONS: Both the subjective and the quantitative MRI methods proposed here are clinically valuable, with the former being adequate for a gross, the latter for an accurate estimation of tissue iron overload.


Subject(s)
Hemochromatosis/diagnosis , Iron/metabolism , Liver/metabolism , Magnetic Resonance Imaging/methods , beta-Thalassemia/diagnosis , Adolescent , Adult , Biopsy , Child , Female , Ferritins/blood , Hemochromatosis/etiology , Hemochromatosis/metabolism , Humans , Liver/pathology , Male , Regression Analysis , Reproducibility of Results , beta-Thalassemia/blood , beta-Thalassemia/complications
4.
Skeletal Radiol ; 25(6): 545-9, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8865488

ABSTRACT

OBJECTIVE: To establish the precision of sonographic measurement of the thickness of the articular cartilage of the hip and knee in children. DESIGN: The precision was assessed by evaluating the intra- and interobserver variations in sonographic measurements. PATIENTS: A total of 65 healthy children were in the study. The articular cartilage of the right hip and knee of 40 subjects (mean age 10.3 years, range 4-16.9 years) was evaluated in masked fashion by two observers to assess the interobserver variability. The articular cartilage of the right hip and knee of 25 children (mean age 10.4 years, range 6.2-15.5 years) was examined twice by the same observer to assess the intraobserver variability. RESULTS AND CONCLUSIONS: Discrepancies between repeated measurements were expressed as data differences. The "limits of agreement" of data differences, i.e. the mean +2 SD and the mean -2 SD, ranged from -0.26 to +0.22 mm and from -0.56 to +0.48 mm for the interobserver analysis of the femoral head cartilage (FHC) and femoral condylar cartilage (FCC), respectively. The "limits of agreement" for the intraobserver analysis ranged from -0.16 to +0.15 mm and from -0.51 to +0.41 mm for the FHC and the FCC, respectively. The overall precision of the sonographic measurements was satisfactory. When used for determination of skeletal age, sonographic assessment of FHC thickness resulted in under/overestimation of skeletal age by about 7.5 months. In conclusion, sonographic measurement of articular cartilage is precise enough to be used in clinical practice.


Subject(s)
Cartilage, Articular/diagnostic imaging , Hip Joint/diagnostic imaging , Knee Joint/diagnostic imaging , Age Determination by Skeleton/methods , Child , Female , Femur/diagnostic imaging , Femur Head/diagnostic imaging , Humans , Male , Observer Variation , Reproducibility of Results , Ultrasonography
6.
Skeletal Radiol ; 25(3): 247-9, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8741060

ABSTRACT

The objective of this study was the validation of a CT multiprojection scout view method for the evaluation of cervical spine integrity in severely head-injured patients. Following brain CT, 130 consecutive patients underwent anteroposterior, laterolateral, and 45 degrees right and left oblique scout views of the cervical spine. The method allowed direct and prompt detection of traumatic lesions of the cervical spine in ten cases without moving the patients from the scanner table.


Subject(s)
Cervical Vertebrae/diagnostic imaging , Craniocerebral Trauma/diagnostic imaging , Tomography, X-Ray Computed , Adult , Brain/diagnostic imaging , Cervical Vertebrae/injuries , Humans , Joint Dislocations/diagnostic imaging , Male , Reproducibility of Results , Spinal Fractures/diagnostic imaging , Tomography, X-Ray Computed/methods
7.
Haematologica ; 80(5): 398-404, 1995.
Article in English | MEDLINE | ID: mdl-8566878

ABSTRACT

BACKGROUND: Iron overload in patients with thalassemia is a common feature which requires continuous chelation therapy and monitoring. Serum ferritin determination is widely accepted as a simple method for following iron load in patients with primary hemochromatosis; however, several reports on thalassemic patients emphasize that ferritinemia is not accurate and that other methods such as direct measurement of iron in the liver (HIC) and magnetic resonance imaging (MRI) are more precise. MATERIALS AND METHODS: In order to contribute to the general understanding of iron load in thalassemia we used liver MRI to study 33 thalassemic patients, most of whom were also evaluated for iron content by liver biopsy. The data were then compared with serum ferritin levels. RESULTS: Ferritin levels ranged between 276 and 8031 ng/mL, and liver iron content ranged from 1.6 to 31.0 mg/g dry weight; grade III or IV liver siderosis was recorded in 23/33 patients, just as 23/33 patients were found to have severe or very severe siderosis at MRI. Significant correlations with ferritin levels were recorded between grade IV and grades III, II and I (p < 0.01, p = 0.02, and p = 0.03, respectively). Ferritinemia also showed significant linearity with liver iron content (r = 0.603, p = 0.001). No significant differences of levels were recorded, however, between patients found to have severe and those with mild iron load at MRI (p = 0.073). CONCLUSIONS: Our study shows that serum ferritin levels exhibit a tendency to be significantly correlated with the true status of hemochromatosis in thalassemic patients; however, the discrepancies recorded in several patients and the scarce or total lack of correlation with MRI suggest exploring other approaches to this problem in order to make proper decisions about therapy.


Subject(s)
Ferritins/blood , Hemosiderosis/metabolism , Iron/metabolism , Liver/metabolism , Magnetic Resonance Imaging , Thalassemia/metabolism , Adolescent , Adult , Biopsy , Child , Child, Preschool , Combined Modality Therapy , Female , Hemosiderosis/etiology , Hemosiderosis/pathology , Hepatitis, Viral, Human/complications , Hepatitis, Viral, Human/metabolism , Hepatitis, Viral, Human/pathology , Humans , Iron/analysis , Liver/pathology , Liver Cirrhosis/etiology , Liver Cirrhosis/metabolism , Liver Cirrhosis/pathology , Male , Splenectomy , Thalassemia/complications , Thalassemia/pathology , Thalassemia/therapy , Transfusion Reaction
8.
Neuroradiology ; 37(5): 365-9, 1995 Jul.
Article in English | MEDLINE | ID: mdl-7477835

ABSTRACT

Diagnosis of brain death must be certain to allow discontinuation of artificial ventilation and organ transplantation. Brain death is present when all functions of the brain stem have irreversibly ceased. Clinical and electrophysiological criteria may be misinterpreted due to drug intoxication, hypothermia or technical artefacts. Thus, if clinical assessment is suboptimal, reliable early confirmatory tests may be required for demonstrating absence of intracranial blood flow. We have easily carried out and interpreted 99mTc HM-PAO SPECT in a consecutive series of 40 comatose patients with brain damage, without discontinuing therapy. Brain death was diagnosed in 7 patients, by recognising absence of brain perfusion, as shown by no intracranial radionuclide uptake. In patients in whom perfusion was seen on brain scans, HM-PAO SPECT improved assessment of the extent of injury, which in general was larger than suggested by CT.


Subject(s)
Brain Death/diagnostic imaging , Brain/blood supply , Organotechnetium Compounds , Oximes , Tomography, Emission-Computed, Single-Photon , Adolescent , Adult , Aged , Aged, 80 and over , Brain Damage, Chronic/diagnostic imaging , Child , Coma/diagnostic imaging , Female , Humans , Life Support Care , Male , Middle Aged , Prognosis , Regional Blood Flow/physiology , Technetium Tc 99m Exametazime
9.
Radiol Med ; 89(1-2): 112-6, 1995.
Article in Italian | MEDLINE | ID: mdl-7716289

ABSTRACT

The preoperative radiologic study of female stress urinary incontinence is still incomplete and often not well tolerated. MRI is becoming a major diagnostic tool for pelvis assessment also thanks to its allowing dynamic studies. Therefore, MRI was used for the static and dynamic assessment of the pelvic floor, which is compromised in stress incontinence, in a series of 21 patients. Dynamic studies were reliable in all but two cases. Our MRI technique demonstrated anatomical and functional stress urinary incontinence alterations, such as the increased distance between urethra and pubic symphysis (16 patients), vaginal changes (7 patients), levator ani muscle changes (9 patients) and urethropelvic ligaments changes (9 patients). The functional changes caused by pelvic floor collapse were observed in all the patients with reliable dynamic studies, i.e., the posterior urethrovesical angle was increased and the pelvic floor excessively lowered during pelvic strain. Our preliminary results suggest that MRI can play a major role in the preoperative assessment of stress urinary incontinence, notwithstanding the fact that the exam is performed with the patient supine and therefore with no gravity.


Subject(s)
Magnetic Resonance Imaging , Urinary Incontinence, Stress/diagnosis , Aged , Evaluation Studies as Topic , Female , Humans , Middle Aged , Preoperative Care , Urinary Incontinence, Stress/surgery
10.
Pediatr Radiol ; 25(7): 544-8, 1995.
Article in English | MEDLINE | ID: mdl-8545187

ABSTRACT

Exostoses are a common skeletal disorder. Despite their incidence, little is yet known about their origin and biological behaviour. In particular, spontaneous regression of exostoses--an extremely rare event--is still a subject for debate. In this study, we describe two additional cases of spontaneous regression of exostosis; one was a solitary lesion while the other occurred in a patient with multiple heritable exostoses. Radiographic findings are presented along with some of the theories which aim at explaining this phenomenon.


Subject(s)
Bone Neoplasms/diagnostic imaging , Exostoses, Multiple Hereditary/diagnostic imaging , Osteochondroma/diagnostic imaging , Child , Child, Preschool , Female , Humans , Male , Neoplasm Regression, Spontaneous , Radiography , Radius/diagnostic imaging
11.
Clin Nucl Med ; 19(8): 699-702, 1994 Aug.
Article in English | MEDLINE | ID: mdl-7955750

ABSTRACT

The authors examined regional cerebral blood flow by using Tc-99m HMPAO SPECT studies in a patient who received a gunshot wound to the brain. Although the presence of the retained bullet's fragments adversely affected the quality of CT images and contraindicated MRI studies, the SPECT examination did not have the same constraints and allowed both therapy assessment and prognostic evaluation. The repair of the cortical defect could also be assessed.


Subject(s)
Brain Injuries/diagnostic imaging , Cerebrovascular Circulation/physiology , Organotechnetium Compounds , Oximes , Tomography, Emission-Computed, Single-Photon , Wounds, Gunshot/diagnostic imaging , Adult , Brain Injuries/physiopathology , Brain Injuries/therapy , Humans , Male , Technetium Tc 99m Exametazime , Wounds, Gunshot/physiopathology , Wounds, Gunshot/therapy
12.
Clin Nucl Med ; 18(11): 953-4, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8269675

ABSTRACT

Brain death imaging is often a diagnostic challenge. Cerebral angioscintigraphy is extensively used for this analysis, but this test does not allow the perfusion evaluation of the posterior fossa. The authors report a case in which a SPECT study showed persistence of blood flow in infratentorial structures with total absence of cerebral (supratentorial) perfusion. This finding excluded the diagnosis of brain death.


Subject(s)
Brain Death/diagnostic imaging , Brain/diagnostic imaging , Cerebrovascular Circulation/physiology , Tomography, Emission-Computed, Single-Photon , Adult , Female , Humans , Organotechnetium Compounds , Oximes , Technetium Tc 99m Exametazime
14.
Nucl Med Commun ; 13(11): 824-31, 1992 Nov.
Article in English | MEDLINE | ID: mdl-1470425

ABSTRACT

A scintigraphic single photon emission computed tomographic (SPECT) evaluation of frontal perfusion alteration was performed in five patients with known cerebellar lesions but with normal supratentorial computed tomographic (CT) or magnetic resonance (MR) scans. A clearly evident asymmetry was found in prefrontal areas in the four subjects with acquired cerebellar damage. The fifth subject, who had congenital left cerebellar hypoplasia, did not show any frontal flow asymmetry. The data support the growing clinical evidence that the cerebellum contributes to the cognitive processes of the frontal lobes and suggest a possible role for SPECT examination in the assessment of functional cognitive impairment in patients with acquired cerebellar lesions.


Subject(s)
Cerebellar Diseases/physiopathology , Cerebral Cortex/physiopathology , Tomography, Emission-Computed, Single-Photon , Adolescent , Adult , Cerebellar Diseases/diagnostic imaging , Child , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Organotechnetium Compounds , Oximes , Technetium Tc 99m Exametazime , Tomography, X-Ray Computed
18.
Radiol Med ; 82(3): 260-4, 1991 Sep.
Article in Italian | MEDLINE | ID: mdl-1947259

ABSTRACT

In everyday practice, the radiologist is concerned with the diagnosis of inflammatory conditions of the nose and paranasal sinuses. This paper was aimed at evaluating and comparing the diagnostic efficacy of the main diagnostic imaging procedures currently available. Fifty-six patients were studied: 25 with computed radiography (CR) and CT, 21 with CR and MRI (0.22 T resistive magnet), and 10 with CR, CT, and MRI. From the diagnostic point of view, the conventional-like CR image was assumed as analog to the conventional radiographic (RX) one on the basis of previous personal experience. The following elements were separately considered for RX, CR, CT, and MRI: anatomical structure identificability, spatial resolution, dosimetry, time consumption, diagnostic results, and economics. A global performance index was calculated (RX less than 1; CR = 1; MRI ranging 1.2-2.2; CT = 7.3). CR was superior to RX, from both a diagnostic and a dosimetric point of view, but buying the equipment is nowadays expensive. CT and MRI were superior to both RX and CR in the diagnosis of inflammatory conditions of the nose and paranasal sinuses. When an inflammatory condition is unquestionable, MRI is more accurate than CT, but the latter (thanks to its optimal documentation of both bony walls and soft tissues) is superior to MRI in the differential diagnosis of a generic disease of the nose and paranasal sinuses--that is, when the inflammatory nature is questionable. MRI limitations were poor visualization of bone walls, high cost, and poor access. Thus, CT emerged as the technique of choice, thanks to its diagnostic results, easy access and low cost, with a negligible radiation dose to patients.


Subject(s)
Magnetic Resonance Imaging , Rhinitis/diagnosis , Sinusitis/diagnosis , Tomography, X-Ray Computed , Adult , Aged , Humans , Middle Aged
19.
Radiol Med ; 81(3): 197-212, 1991 Mar.
Article in Italian | MEDLINE | ID: mdl-2014321

ABSTRACT

Ninety-eight consecutive patients with 344 collapsed vertebrae underwent conventional and/or digital radiography and MRI. Vertebral collapse was due to osteopenia (16 cases), trauma (17 cases), and vertebral osteonecrosis (3 cases). Other causes were: spondylodiscitis (9 patients), primary neoplasm (4 patients), metastases (37 patients), and hemomyelopathies (7 patients); 5 patients bore vertebral angiomas. Sixty-three patients also underwent CT and 25 bone scintigraphy. As far as collapsed vertebral endplates are concerned, according to a previous classification, outcomes were divided into 4 groups. Type 1 (focal concave collapse) was observed in 10% of benign lesions and in 1% of malignant ones; type 2 (diffuse concave collapse) in 24% of benign and in 16% of malignant lesions; type 3 (focal collapse with an acute angle) in 11% of benign and malignant lesions, and type 4 (diffuse collapse with an acute angle) in 11% of benign and in 26% of malignant lesions. Neural arch involvement was observed in 3% of benign lesions and in 16% of malignant ones; paravertebral soft-tissue involvement in 6% of benign and in 29% of malignant lesions; vertebral canal involvement in 11% of benign lesions and in 20% of malignant ones. The intervertebral disk proximal to vertebral collapse was more involved in benign lesions (24%) than in malignant ones (8%). MR signal followed 4 main patterns: low signal on T1-weighted images and high signal on proton-density and T2-weighted images (2% of benign lesions, 49% of malignant ones), low signal on all sequences (7% of benign lesions and 25% of malignant ones), isointense signal on all sequences (50% of benign and 21% of malignant lesions), and high signal on all sequences (41% of benign lesions and 0% of malignant ones).


Subject(s)
Spinal Diseases/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Spinal Diseases/etiology , Tomography, X-Ray Computed
20.
Cardiology ; 79(2): 120-6, 1991.
Article in English | MEDLINE | ID: mdl-1933963

ABSTRACT

The prognostic implication of a right ventricular aneurysm after a first acute myocardial infarction (AMI) was assessed on a series of 137 AMI patients 12 of whom had a right ventricular aneurysm detected at radionuclide angiocardiography. The follow-up lasted 36 months. Mortality was 50 and 18.4% in patients with and without right ventricular aneurysm, respectively (p less than 0.02). Groups did not differ in age, male-to-female ratio, AMI site, left ventricular ejection fraction (LVEF), peak filling rate (PFR), left ventricular size. A multivariate logistic analysis showed that only three out of ten clinical and functional variables qualified to be independent predictors of death: right ventricular aneurysm (odd ratio = 2.48, confidence limits = 1.21-4.98), LVEF less than 52% (odd ratio = 1.91, confidence limits = 1.03-3.48), abnormal terminal P wave forces (odd ratio = 1.72, confidence limits = 1.07-2.75). The analysis of single case histories did not provide a clue to clarify the reasons accounting for the negative prognostic implication of a right ventricular aneurysm. In conclusion, a significant positive relationship between right ventricular aneurysm and mortality after AMI has been demonstrated; further study is needed to clarify the relevant mechanisms.


Subject(s)
Heart Aneurysm/complications , Myocardial Infarction/mortality , Aged , Electrocardiography , Female , Heart Aneurysm/diagnostic imaging , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Odds Ratio , Prognosis , Radionuclide Angiography , Regression Analysis , Stroke Volume
SELECTION OF CITATIONS
SEARCH DETAIL
...