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Takx R.A.P.,Medical University of South Carolina | Takx R.A.P.,Maastricht University | Schoepf U.J.,Medical University of South Carolina | Moscariello A.,Medical University of South Carolina | And 7 more authors.
European Journal of Radiology | Year: 2013

Objective: To prospectively compare subjective and objective image quality in 20% tube current coronary CT angiography (cCTA) datasets between an iterative reconstruction algorithm (SAFIRE) and traditional filtered back projection (FBP). Materials and methods: Twenty patients underwent a prospectively ECG-triggered dual-step cCTA protocol using 2nd generation dual-source CT (DSCT). CT raw data was reconstructed using standard FBP at full-dose (Group-1a) and 80% tube current reduced low-dose (Group-1b). The low-dose raw data was additionally reconstructed using iterative raw data reconstruction (Group-2). Attenuation and image noise were measured in three regions of interest and signal-to-noise-ratio (SNR) as well as contrast-to-noise-ratio (CNR) was calculated. Subjective diagnostic image quality was evaluated using a 4-point Likert scale. Results: Mean image noise of group-2 was lowered by 22% on average when compared to group-1b (p < 0.0001-0.0033), while there were no significant differences in mean attenuation within the same anatomical regions. The lower image noise resulted in significantly higher SNR and CNR ratios in group-2 compared to group-1b (p < 0.0001-0.0232). Subjective image quality of group-2 (1.88 ± 0.63) was also rated significantly higher when compared to group-1b (1.58 ± 0.63, p = 0.004). Conclusions: Image quality of 80% tube current reduced iteratively reconstructed cCTA raw data is significantly improved when compared to standard FBP and consequently may improve the diagnostic accuracy of cCTA. © 2012 Elsevier Ireland Ltd.

Marinozzi F.,University of Rome La Sapienza | Bini F.,University of Rome La Sapienza | Marinozzi A.,Policlinico Universitario Campus Bio Medico | Zuppante F.,University of Rome La Sapienza | Paolis A.D.,University of Rome La Sapienza
Annali dell'Istituto Superiore di Sanita | Year: 2013

Introduction. Micro-CT analysis is a powerful technique for a non-invasive evaluation of the morphometric parameters of trabecular bone samples. This elaboration requires a previous binarization of the images. A problem which arises from the binarization process is the partial volume artifact. Voxels at the external surface of the sample can contain both bone and air so thresholding operates an incorrect estimation of volume occupied by the two materials. Aim. The aim of this study is the extraction of bone volumetric information directly from the image histograms, by fitting them with a suitable set of functions. Methods. Nineteen trabecular bone samples were extracted from femoral heads of eight patients subject to a hip arthroplasty surgery. Trabecular bone samples were acquired using micro-CT Scanner. Hystograms of the acquired images were computed and fitted by Gaussian-like functions accounting for: a) gray levels produced by the bone x-ray absorption, b) the portions of the image occupied by air and c) voxels that contain a mixture of bone and air. This latter contribution can be considered such as an estimation of the partial volume effect. Results. The comparison of the proposed technique to the bone volumes measured by a reference instrument such as by a helium pycnometer show the method as a good way for an accurate bone volume calculation of trabecular bone samples.

Cellini F.,Policlinico Universitario Campus Bio Medico | Valentini V.,University Cattolica ore
Current Medicinal Chemistry | Year: 2014

Oesophageal cancer is the sixth cause of cancer-related death worldwide. Nowadays radiochemotherapy (RTCT) plays a central role in the treatment settings of such disease. Evaluation of molecular targeted therapies is an attractive opportunity for the management of oesophageal, GEJ and gastric cancers to improve outcomes as for other primary tumours. Clinical trials focused on the potential of many molecular targeted agents included in CT schedules, and also on the possibility, efficacy and tolerance of their use combined with RT. This review will focus on the over 15 more promising agents studied in combination with RT for esophagogastric tumour, describing the mechanism and target of action, evidences and potential future role on over 50 trials evaluated. Mechanisms of action, studies and evidences about Human Epidermal Growth Factor type 2 Targeting Agents (one of the more promising), Epidermal Growth Factor's Receptor Inhibitors (nowadays showing a lower potential than expected), Vascular Endothelial Growth Factor Inhibitors, Mesenchymal Epithelial Transition Factor, Hepatocyte Growth Factor and other targeting agents are reviewed. © 2014 Bentham Science Publishers.

Hu M.I.,University of Houston | Glezerman I.G.,Sloan Kettering Cancer Center | Leboulleux S.,Institute Gustave Roussy | Insogna K.,Yale University | And 11 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Hypercalcemia of malignancy (HCM) in patients with advanced cancer is often caused by excessive osteoclast-mediated bone resorption. Patients may not respond to or may relapse after iv bisphosphonate therapy. CopyrightObjective: We investigated whether denosumab, a potent inhibitor of osteoclast-mediated bone resorption, reduces serum calcium in patients with bisphosphonate-refractory HCM. Design, Setting, and Participants: In this single-arm international study, participants had serum calcium levels corrected for albumin (CSC) >12.5 mg/dL (3.1 mmol/L) despite bisphosphonates given >7 and ≤30 days before screening.Intervention: Patients received 120 mg sc denosumab on days 1, 8, 15, and 29 and then every 4 weeks.Main Outcome Measures: The primary endpoint was the proportion of patients with CSC ≤11.5 mg/dL (2.9 mmol/L) (response) by day 10. Secondary endpoints included response by visit, duration of response, and the proportion of patients with a complete response (CSC ≤10.8 mg/dL [2.7 mmol/L]) by day 10 and during the study.Results: Patients (N = 33) had solid tumors or hematologic malignancies. By day 10, 21 patients (64%) reachedCSC≤11.5 mg/dL,and12 patients (33%) reachedCSC≤10.8 mg/dL. During the study, 23 patients (70%) reached CSC ≤11.5 mg/dL, and 21 patients (64%) reached CSC ≤10.8 mg/dL. Estimated median response duration was 104 days. The most common serious adverse events were hypercalcemia worsening (5 patients, 15%) and dyspnea (3 patients, 9%).Conclusions: In patients with HCM despite recent iv bisphosphonate treatment, denosumab lowered serum calcium in64%of patients within 10 days, inducing durable responses.Denosumabmay offer a new treatment option for HCM. © 2014 by the Endocrine Society.

Faldini C.,University of Bologna | Di Martino A.,Policlinico Universitario Campus Bio Medico | Borghi R.,University of Bologna | Perna F.,University of Bologna | And 2 more authors.
European Spine Journal | Year: 2015

Purpose: Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle measurements, but recently it has been demonstrated that sagittal spinopelvic alignment plays a critical role in determining the final outcome. The aim of this paper is to compare the clinical and radiological results of 81 patients affected by adult scoliosis, treated with short or long fusions, and followed for 2–5 year follow-up. Materials and methods: 81 patients affected by degenerative lumbar scoliosis managed by posterior-only surgery were retrospectively evaluated. Fifty-seven patients underwent to a short fusion procedure, while 24 had a long fusion. Clinical and radiographic coronal and sagittal spinopelvic parameters were compared between the two groups. Results: Coronal Cobb angle was 24° preoperatively and passed to 12° in the short fusion group, while changed from 45° to 10° in the long fusion group. Lumbar lordosis was 45° preoperatively and 60° at final follow-up in the short fusion group passed from 24° to 55° in the long fusion group. Sacral slope passed from 25° to 45° in the short fusion group, while from 10° to 40° in the long fusion group. Pelvic tilt passed from 24° to 13° in the short fusion group, and from 28° to 23° in the long fusion group. Conclusion: Surgical treatment of degenerative lumbar scoliosis improved balance and alignment of the spine, and also the coronal plane in terms of Cobb angle. These results were associated to a consistent clinical improvement and an acceptable rate of complications. © 2015, Springer-Verlag Berlin Heidelberg.

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