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Maruzzelli L.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Parr A.J.,University of Pittsburgh | Miraglia R.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Tuzzolino F.,Specialized Tech | Luca A.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT
Academic Radiology | Year: 2014

Rationale and Objectives: To evaluate, in a group of candidates for liver donation, the role of unenhanced computed tomography (CT) and magnetic resonance (MR) as noninvasive means to measure hepatic steatosis (HS). Materials and Methods: Sixty-one consecutive candidates underwent CT and MR evaluation for liver donation within 3weeks of liver biopsy. On CT, three methods of HS quantification were evaluated: the measurement of hepatic attenuation (CT L), the ratio of hepatic attenuation to splenic attenuation (CT L/S), and the difference between the hepatic and splenic attenuation (CT L-S). On MR, HS was reported in terms of fat signal fraction (FSF) using in-phase/opposed-phase and fat/non-fat- saturated images, with and without normalization with the spleen (T1W IP/OP FSF, T1W IP/OP FSF spleen and T2W±FS FSF, TW2±FS FSF spleen). The accuracy of each imaging index in the diagnosis of HS, according to various thresholds, was assessed using receiver operating characteristic analysis. Results: On biopsy, 35 donors showed no significant HS (<5%); the remaining 26 showed HS ranging from 5% to 40%. With all CT and MR indices, there was a trend toward increasing diagnostic accuracy as the threshold levels of HS increased. When comparing all the indices, TW2±FS FSF(spl) showed higher accuracy at threshold levels of 5% and 10% of steatosis but without reaching statistical significance. Conclusions: In candidates for living donation, MR and CT indices are similar in estimating liver-fat content; however, MR with T2W±FS FSF(spl) sequences shows higher accuracy when low threshold levels of steatosis (≤5% and ≤10% HS) are selected. © 2014 AUR. Source


Luca A.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Caruso S.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Milazzo M.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Marrone G.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | And 6 more authors.
Radiology | Year: 2012

Purpose: To define the natural course of extrahepatic nonmalignant partial portal vein thrombosis (PVT), including the progression from partial to complete PVT, in patients with cirrhosis who had undergone multidetector computed tomography (CT). Materials and Methods: This study was institutional review board and ethics committee approved. Written informed consent was obtained for each procedure. Forty-two consecutive patients with cirrhosis and untreated extrahepatic, nonmalignant partial PVT were followed up until the final clinical evaluation, liver transplantation, or death. Multidetector CT was used to evaluate the thrombus lumen occlusion, patent lumen area, thrombus area, total lumen area, and diameter of main portal vein, superior mesenteric vein, and splenic vein. Statistical analysis was performed with the Wilcoxon Mann-Whitney U test, χ2 test, Wilcoxon matched-pairs signed-rank test, life-table analysis, Kaplan-Meier method, and log-rank test, as appropriate. Results: After a mean follow-up period of 27 months, partial PVT worsened in 20 (48%) patients, improved in 19 (45%), and was stable in three (7%). The Kaplan-Meier probability of episodes of hepatic decompensation at 1 and 2 years was 41% and 57%; probability of hospital admission for hepatic decompensation, 37% and 54%; and survival rates, 77% and 57%, respectively. There was no clear association between progression or regression of partial PVT and clinical outcome. Multivariate analysis showed that the Child-Pugh score at diagnosis was the only independent predictor of survival (hazard ratio, 1.97; 95% confidence interval: 1.19, 3.23; P = .007) and hepatic decompensation (hazard ratio, 1.51; 95% confidence interval: 1.18, 1.19; P = .001). Conclusion: Extrahepatic nonmalignant partial PVT improved spontaneously in 45% of patients with cirrhosis, and the progression of partial PVT was not associated with clinical outcome, which appeared to be dependent on the severity of cirrhosis. © RSNA, 2012. Source


Curcio G.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Traina M.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Mocciaro F.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Liotta R.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | And 7 more authors.
Gastrointestinal Endoscopy | Year: 2012

Background: Brushing is the most commonly used technique for biliary sampling at ERCP, despite its limited sensitivity. Objective: To evaluate intraductal aspiration (IDA) as a new combined endoscopic technique for cytodiagnosis, its cellular adequacy, diagnostic accuracy for cancer detection, feasibility, and safety. Design: Prospective, observational study. Setting: Single tertiary referral center. Main Outcome Measurements: IDA cellular adequacy, diagnostic accuracy for cancer detection, feasibility, and safety. Patients and Methods: From April 2009 to September 2010, 42 consecutive patients with suspected malignant biliary stricture underwent ERCP, with tissue sampling obtained with IDA. IDA included performance of standard brushing in all patients. After standard brushing, to perform IDA, we removed the brush from its catheter and used the tip of the catheter as a scraping device. The tip was scraped back and forth across the stricture at least 10 times. The catheter and a suction line were connected to a specimen trap to obtain intraductal aspiration of fluids and samplings. Results: Our cytopathologists found adequate cellular yield in 39 of the 42 IDA samples (92.8%) versus 15 of the 42 brushing samples (35.7%) (P <.001). IDA showed a significantly higher sensitivity than brushing (89% vs 78% for adequate samples and 89% vs 37% for all samples) and provided significantly superior cellular adequacy (92.8% vs 35.7%). Limitations: Observational study, small number of patients. Conclusions: IDA significantly improves brushing cellular adequacy and has high sensitivity for cancer detection. It was also safe, simple, rapid, and applicable during routine diagnostic ERCP, with no additional costs. © 2012 American Society for Gastrointestinal Endoscopy. Source


Miraglia R.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Maruzzelli L.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT | Tuzzolino F.,Specialized Tech | Indovina P.L.,Medical Physic ISMETT Consultant | Luca A.,Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT
CardioVascular and Interventional Radiology | Year: 2013

Purpose: The aim of this study was to estimate radiation exposure in pediatric liver transplants recipients who underwent biliary interventional procedures and to compare radiation exposure levels between biliary interventional procedures performed using an image intensifier-based angiographic system (IIDS) and a flat panel detector-based interventional system (FPDS). Materials and Methods: We enrolled 34 consecutive pediatric liver transplant recipients with biliary strictures between January 2008 and March 2013 with a total of 170 image-guided procedures. The dose-area product (DAP) and fluoroscopy time was recorded for each procedure. The mean age was 61 months (range 4-192), and mean weight was 17 kg (range 4-41). The procedures were classified into three categories: percutaneous transhepatic cholangiography and biliary catheter placement (n = 40); cholangiography and balloon dilatation (n = 55); and cholangiography and biliary catheter change or removal (n = 75). Ninety-two procedures were performed using an IIDS. Seventy-eight procedures performed after July 2010 were performed using an FPDS. The difference in DAP between the two angiographic systems was compared using Wilcoxon rank-sum test and a multiple linear regression model. Results: Mean DAP in the three categories was significantly greater in the group of procedures performed using the IIDS compared with those performed using the FPDS. Statistical analysis showed a p value = 0.001 for the PTBD group, p = 0.0002 for the cholangiogram and balloon dilatation group, and p = 0.00001 for the group with cholangiogram and biliary catheter change or removal. Conclusion: In our selected cohort of patients, the use of an FPDS decreases radiation exposure. © 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Source


This paper discusses a method developed for the construction of logical structures and its mathematical description with use of objective functions (quality functions). The mentioned method can be applied to describe radwaste repositories, radwaste itself, and any processes in the field of radwaste management. The paper also discusses the extension of the list of quality indices groups in the objective function construction. Source

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