Unita Operativa di Radiologia

Santa Maria Nuova, Italy

Unita Operativa di Radiologia

Santa Maria Nuova, Italy
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Gobbi P.G.,University of Pavia | Bergonzi M.,University of Pavia | Bassi E.,Radiologia | Merli F.,Unita Operativa di Ematologia | And 2 more authors.
Hematological Oncology | Year: 2013

We verified whether early resistance to treatment can be predicted in a subset of patients with very favourable, early stage Hodgkin lymphoma, treated with VBM (vinblastine, bleomycin and methotrexate) chemotherapy and involved-field radiotherapy, an effective combination with very low early and late toxicity. The relative tumour burden (rTB) was volumetrically measured from the staging computed tomography and analysed together with the parameters of pre-therapy evaluation in 61 patients enrolled into the protocol MH-1b of the Gruppo Italiano Studio Linfomi between 1996 and 2003. Early failure, codified by either less than complete remission (i.e. partial/null response or progression) or early relapse (within 12months from the end of therapy), was considered as clinical expression of resistance to treatment. Logistic regression and failure-free survival were the statistical tools for the analysis. The rTB demonstrated to be the best predictor of early failure, outperforming every other pre-treatment parameter, International Prognostic Score included. With a mean rTB value of 44.964±34.788cm3/m2 in the 53 patients successfully treated and of 130.185±63.993cm3/m2 in the eight with early treatment failure, the risk of resistance showed fivefold and 10-fold increases at rTB of 52.002 and 74.497cm3/m2, respectively. Only two patients relapsed more than 12months after the end of therapy; both had a high initial rTB. The rTB is the best predictor of resistance also in the subset of patients with very favourable, early stage disease. Safe rTB limits are proposed for successful administration of VBM chemotherapy plus involved-field radiotherapy. © 2012 John Wiley & Sons, Ltd.

Piciucchi S.,IRST Instituto Romagnolo Studio e Cura dei Tumori | Romagnoli M.,Unita Operativa di Pneumologia Interventistica | Chilosi M.,University of Verona | Bigliazzi C.,Unita Operativa di Pneumologia Interventistica | And 5 more authors.
Radiologia Medica | Year: 2011

Purpose. This study compared the results of high-resolution computed tomography (HRCT) and cytohistology after transbronchial biopsy in the evaluation of drug-related interstitial lung disease (DR-ILD). Materials and methods. Patients with a clinical and imaging diagnosis of DR-ILD were prospectively included in a study protocol lasting 5 years. All patients were evaluated by bronchoscopy with transbronchial biopsy or bronchoalveolar lavage (BAL) following an HRCT examination that raised a suspicion of DR-ILD. Two radiologists (one senior and one junior), unaware of the diagnosis, reported the single HRCT findings, their distribution and predominant pattern. In the event of disagreement, the diagnosis was subsequently reached by consensus. Cytohistological examination was considered the gold standard in the diagnosis of DR-ILD. Patients who were unable to undergo the endoscopic procedure were excluded from the study. Results. The study included 42 patients (25 men, 17 women; age range 20-84 years). Transbronchial biopsy was performed in all but four patients (one case of alveolar haemorrhage and three cases of lipoid pneumonia) in whom the diagnosis was established with BAL. Assessment of the HRCT images revealed the following patterns: noncardiogenic pulmonary oedema (n=13); organising pneumonia (OP) (n=9); hypersensitivity pneumonitis (HP) (n=2); alveolar haemorrhage (AH) (n=2); nonspecific interstitial pneumonia (NSIP) (n=5); lipoid pneumonia (LP) (n=1); sarcoid-like pattern (n=1). Cytohistological diagnosis revealed diffuse alveolar damage (DAD) in 11 patients, OP in seven, HP in three, AH in three, chronic interstitial pneumonia (CIP) in eight, LP in three and pseudosarcoidosis in one. Subdivision of the drugs into antineoplastic and nonantineoplastic agents showed that the most common patterns were CIP (n=6), DAD (n=2) and OP (n=2) in the antineoplastic group and DAD (n=9) and OP (n=5) in the nonantineoplastic group. Sensitivity and specificity of the radiological analysis was excellent, especially for patterns such as OP and DAD (sensitivity 0.86 and specificity 0.88 for OP; sensitivity 1 and specificity 0.93 for DAD). Conclusions. HRCT demonstrated excellent sensitivity and specificity. In cases in which its specificity was low, HRCT was nonetheless useful for biopsy planning and clinical-radiological monitoring after discontinuation of the drug treatment. © 2010 Springer-Verlag.

Rebonato A.,University of Perugia | Vannini E.,University of Perugia | Giganti M.,University of Ferrara | Volterrani L.,University of Siena | And 3 more authors.
Recenti Progressi in Medicina | Year: 2012

In 18 patients with 19 RO, 9 hypervascularity and hypovascularity was identified in 9 and 10 RO, respectively, in the cortico-medullary phase (CMP). Hypervascular RO showed increased density in the CMP (151.4±38.5 HU) and a gradual wash-out in the nephrographic phase (133.8±34.6 HU) and excretory phase (79±23 HU). Hypovascular RO showed increased density in the CMP (87.8±20.1 UH) and a gradual wash-out in the nephrographic phase (100.3±33 UH) and excretory phase (20.9±86.9 UH). © Il Pensiero Scientifico Editore.

Ravaglia C.,U.O. Pneumologia | Gurioli C.,U.O. Pneumologia | Asioli S.,Servizio di Anatomia Patologica | Dubini A.,Servizio di Anatomia Patologica | And 2 more authors.
Rassegna di Patologia dell'Apparato Respiratorio | Year: 2015

This article describes the case of a 58 years old male with abrupt onset of dyspnoea, fever, bilateral pulmonary consolidations and acute respiratory failure. Clinical reasoning and laboratory findings (pancytopenia, increased values of ferritin, transaminases and LDH), together with the presence of splenomegaly, led to the hypothesis of hemophagocytic syndrome. This rare and serious disease can be primitive or, more frequently, secondary, in particular to infections, inflammatory diseases or malignancy, mostly lymphoma. Cytologic analysis of BAL (broncho-alveolar lavage) showed atypical pneumocytes (diffuse alveolar damage), alveolar hemosiderin-laden macrophages and blast lymphoid cells, thus confirming the suspicion of hemophagocytic syndrome secondary to a neoplastic disease. The bone marrow biopsy led to the definitive diagnosis of extranodal peripheral T-cell lymphoma, with a cytotoxic phenotype. The hemophagocytic syndrome is characterized by non-malignant proliferation of histiocytes and uncontrolled hemophagocytosis in bone marrow, spleen and lymph nodes; when associated with lymphoma, it has acute and explosive onset, often masking the underlying lymphoproliferative disease. In this particular case report, the respiratory manifestation was due to the presence in the lung of both the lymphoproliferative process itself and the secondary hemophagocytic syndrome; this combination of elements was found to be quite clear on BAL cytology. In conclusion, pulmonologists are not usually directly involved in the diagnosis and management of these diseases, however, the assessment of respiratory problems can not be confined to the lung.

Gardelli G.,Unita Operativa di Radiologia | Feletti F.,Presidio | Nanni A.,Unita Operativa di Anestesia Rianimazione | Mughetti M.,Unita Operativa di Radiologia | And 2 more authors.
Respiratory Care | Year: 2012

Chest diagnostic imaging is essential when dealing with a critically ill patient. At present, direct visualization of the lung parenchyma is performed with a chest x-ray and computed tomography with the patient in the supine position. The relative ease of bedside ultrasound examination and the availability of user-friendly, inexpensive, portable equipment have made chest ultrasonography an interesting and alternative method in various situations, because it offers accurate information that is of therapeutic and diagnostic relevance. We describe equipment and examination technique, normal findings, and chest ultrasonography signs detected in some pathological situations, such as pneumothorax, consolidations, pleural effusions, ARDS, and pulmonary edema. © 2012 Daedalus Enterprises.

Rebonato A.,University of Perugia | Pierotti L.,Unita Operativa di Radiologia | Barberini F.,University of Perugia | Rosi G.,University of Perugia | And 2 more authors.
Recenti Progressi in Medicina | Year: 2012

The aim of this study was to define enhancement patterns of small renal cell carcinoma (RCC) (≤4 cm) by triphasic spiral CT. In 24 patients with RCC, hypervascularity and hypovascularity were identified in 12 and 12 RO, respectively, in the cortico-medullary phase (CMP). Hypervascular RCC showed increased density in the CMP (170,7±46,3 UH) and a gradual wash-out in the nephrographic phase (NP) (152,5±41 UH) and pielographic phase (PF) (99,2±38 UH). Hypovascular RCC showed increased density in the CMP (52,9±24,7 UH) and a gradual wash-out in NP (64,5±16,9 UH) and PP phases (55,0±17,3 UH). © Il Pensiero Scientifico Editore.

Ferraro S.,Laboratorio Analisi Chimico Cliniche | Ferraro S.,University of Milan | Mozzi R.,Laboratorio Analisi Chimico Cliniche | Mozzi R.,University of Milan | And 4 more authors.
Biochimica Clinica | Year: 2013

Markedly increased CA 125 and CA 19.9 concentrations in serum are considered specific enough to reliably identify malignant cancers (ovarian and gastrointestinal tumours, respectively), although a consistent body of literature has reported marker elevations in several benign conditions. Here we report the case of a woman in post-menopausal status, with a previous history of hysterectomy, presenting with a 12-cm pelvic mass at sonography and serum CA 125 and CA 19.9 concentrations >400 kU/L. One month after initial presentation, she underwent surgical evaluation for laparoscopy, repeating marker determinations. Concentrations of CA 125 and CA 19.9 were still elevated, but decreased if compared with the previous data (-200 kU/L). Magnetic resonance imaging characterized a multicystic mass in the mesentery, allowing to hypothesize a benign multicystic mesothelioma of the peritoneum (BMMP). The laparoscopy revealed multiple cysts, some of them resulting in colliquation, associated to ascites. Histological examination of biopsy specimens confirmed BMMP as composed of multiple, thin-walled, irregularly spaced cysts lined by flattened and cuboidal mesothelial cells. The cystic colliquation was though as the main cause for decrease in marker concentrations. To our knowledge, this is the first case of BMMP associated with significantly increased concentrations of CA 125 and CA 19.9 and their decrease before any surgical treatment.

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