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Guido LIGABUE

Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2023 - Abdominal Fat Characteristics and Mortality in Rectal Cancer: A Retrospective Study [Articolo su rivista]
Pellegrini, Massimo; Besutti, Giulia; Ottone, Marta; Canovi, Simone; Bonelli, Efrem; Venturelli, Francesco; Farì, Roberto; Damato, Angela; Bonelli, Candida; Pinto, Carmine; Ligabue, Guido; Pattacini, Pierpaolo; Giorgi Rossi, Paolo; El Ghoch, Marwan
abstract

: The aim of this study was to evaluate the association of adipose tissue characteristics with survival in rectal cancer patients. All consecutive patients, diagnosed with stage II-IV rectal cancer between 2010-2016 using baseline unenhanced Computed Tomography (CT), were included. Baseline total, subcutaneous and visceral adipose tissue areas (TAT, SAT, VAT) and densities (TATd, SATd, VATd) at third lumbar vertebra (L3) were retrospectively measured. The association of these tissues with cancer-specific and progression-free survival (CCS, PFS) was assessed by using competitive risk models adjusted by age, sex and stage. Among the 274 included patients (median age 70 years, 41.2% females), the protective effect of increasing adipose tissue area on survival could be due to random fluctuations (e.g., sub-distribution hazard ratio-SHR for one cm2 increase in SAT = 0.997; 95%confidence interval-CI = 0.994-1.000; p = 0.057, for CSS), while increasing density was associated with poorer survival (e.g., SHR for one Hounsfield Unit-HU increase in SATd = 1.03, 95% CI = 1.01-1.05, p = 0.002, for CSS). In models considering each adipose tissue area and respective density, the association with CSS tended to disappear for areas, while it did not change for TATd and SATd. No association was found with PFS. In conclusion, adipose tissue density influenced survival in rectal cancer patients, raising awareness on a routinely measurable variable that requires more research efforts.

2023 - Author Correction: Consensus Statement on the definition and classification of metabolic hyperferritinaemia (Nature Reviews Endocrinology, (2023), 19, 5, (299-310), 10.1038/s41574-023-00807-6) [Articolo su rivista]
Valenti, L.; Corradini, E.; Adams, L. A.; Aigner, E.; Alqahtani, S.; Arrese, M.; Bardou-Jacquet, E.; Bugianesi, E.; Fernandez-Real, J. M.; Girelli, D.; Hagström, H.; Henninger, B.; Kowdley, K.; Ligabue, G.; Mcclain, D.; Lainé, F.; Miyanishi, K.; Muckenthaler, M. U.; Pagani, A.; Pedrotti, P.; Pietrangelo, A.; Prati, D.; Ryan, J. D.; Silvestri, L.; Spearman, C. W.; Stål, P.; Tsochatzis, E. A.; Vinchi, F.; Zheng, M. H.; Zoller, H.
abstract

2023 - Consensus Statement on the definition and classification of metabolic hyperferritinaemia [Articolo su rivista]
Valenti, Luca; Corradini, Elena; Adams, Leon A.; Aigner, Elmar; Alqahtani, Saleh; Arrese, Marco; Bardou-Jacquet, Edouard; Bugianesi, Elisabetta; Fernandez-Real, Jose-Manuel; Girelli, Domenico; Hagström, Hannes; Henninger, Benjamin; Kowdley, Kris; Ligabue, Guido; Mcclain, Donald; Lainé, Fabrice; Miyanishi, Koji; Muckenthaler, Martina U.; Pagani, Alessia; Pedrotti, Patrizia; Pietrangelo, Antonello; Prati, Daniele; Ryan, John D.; Silvestri, Laura; Spearman, C. Wendy; Stål, Per; Tsochatzis, Emmanuel A.; Vinchi, Francesca; Zheng, Ming-Hua; Zoller, Heinz
abstract

Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunction and fatty liver. Metabolic hyperferritinaemia reflects alterations in iron metabolism that facilitate iron accumulation in the body and is associated with an increased risk of cardiometabolic and liver diseases. Genetic variants that modulate iron homeostasis and tissue levels of iron are the main determinants of serum levels of ferritin in individuals with metabolic dysfunction, raising the hypothesis that iron accumulation might be implicated in the pathogenesis of insulin resistance and the related organ damage. However, validated criteria for the non-invasive diagnosis of metabolic hyperferritinaemia and the staging of iron overload are still lacking, and there is no clear evidence of a benefit for iron depletion therapy. Here, we provide an overview of the literature on the relationship between hyperferritinaemia and iron accumulation in individuals with metabolic dysfunction, and on the associated clinical outcomes. We propose an updated definition and a provisional staging system for metabolic hyperferritinaemia, which has been agreed on by a multidisciplinary global panel of expert researchers. The goal is to foster studies into the epidemiology, genetics, pathophysiology, clinical relevance and treatment of metabolic hyperferritinaemia, for which we provide suggestions on the main unmet needs, optimal design and clinically relevant outcomes.

2023 - Multi-center validation of an artificial intelligence system for detection of COVID-19 on chest radiographs in symptomatic patients [Articolo su rivista]
Kuo, Michael D; Chiu, Keith W H; Wang, David S; Larici, Anna Rita; Poplavskiy, Dmytro; Valentini, Adele; Napoli, Alessandro; Borghesi, Andrea; Ligabue, Guido; Fang, Xin Hao B; Wong, Hing Ki C; Zhang, Sailong; Hunter, John R; Mousa, Abeer; Infante, Amato; Elia, Lorenzo; Golemi, Salvatore; Yu, Leung Ho P; Hui, Christopher K M; Erickson, Bradley J
abstract

Objectives While chest radiograph (CXR) is the first-line imaging investigation in patients with respiratory symptoms, differentiating COVID-19 from other respiratory infections on CXR remains challenging. We developed and validated an AI system for COVID-19 detection on presenting CXR. Methods A deep learning model (RadGenX), trained on 168,850 CXRs, was validated on a large international test set of presenting CXRs of symptomatic patients from 9 study sites (US, Italy, and Hong Kong SAR) and 2 public datasets from the US and Europe. Performance was measured by area under the receiver operator characteristic curve (AUC). Bootstrapped simulations were performed to assess performance across a range of potential COVID-19 disease prevalence values (3.33 to 33.3%). Comparison against international radiologists was performed on an independent test set of 852 cases. Results RadGenX achieved an AUC of 0.89 on 4-fold cross-validation and an AUC of 0.79 (95%CI 0.78-0.80) on an independent test cohort of 5,894 patients. Delong's test showed statistical differences in model performance across patients from different regions (p < 0.01), disease severity (p < 0.001), gender (p < 0.001), and age (p = 0.03). Prevalence simulations showed the negative predictive value increases from 86.1% at 33.3% prevalence, to greater than 98.5% at any prevalence below 4.5%. Compared with radiologists, McNemar's test showed the model has higher sensitivity (p < 0.001) but lower specificity (p < 0.001). Conclusion An AI model that predicts COVID-19 infection on CXR in symptomatic patients was validated on a large international cohort providing valuable context on testing and performance expectations for AI systems that perform COVID-19 prediction on CXR.

2022 - Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: Acute chest pain evaluation; Stent and coronary artery bypass graft patency evaluation; Planning of coronary revascularization and transcatheter valve procedures; Cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation [Articolo su rivista]
Carrabba, N.; Pontone, G.; Andreini, D.; Buffa, V.; Cademartiri, F.; Carbone, I.; Clemente, A.; Guaricci, A. I.; Guglielmo, M.; Indolfi, C.; La Grutta, L.; Ligabue, G.; Liguori, C.; Mercuro, G.; Mushtaq, S.; Neglia, D.; Palmisano, A.; Sciagra, R.; Seitun, S.; Vignale, D.; Francone, M.; Esposito, A.
abstract

In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.

2022 - Imaging-based indices combining disease severity and time from disease onset to predict COVID-19 mortality: A cohort study [Articolo su rivista]
Besutti, Giulia; Djuric, Olivera; Ottone, Marta; Monelli, Filippo; Lazzari, Patrizia; Ascari, Francesco; Ligabue, Guido; Guaraldi, Giovanni; Pezzuto, Giuseppe; Bechtold, Petra; Massari, Marco; Lattuada, Ivana; Luppi, Francesco; Galli, Maria Giulia; Pattacini, Pierpaolo; Giorgi Rossi, Paolo
abstract

Background: COVID-19 prognostic factors include age, sex, comorbidities, laboratory and imaging findings, and time from symptom onset to seeking care. Purpose: The study aim was to evaluate indices combining disease severity measures and time from disease onset to predict mortality of COVID-19 patients admitted to the emergency department (ED). Materials and methods: All consecutive COVID-19 patients who underwent both computed tomography (CT) and chest X-ray (CXR) at ED presentation between 27/02/2020 and 13/03/2020 were included. CT visual score of disease extension and CXR Radiographic Assessment of Lung Edema (RALE) score were collected. The CT- and CXR-based scores, C-reactive protein (CRP), and oxygen saturation levels (sO2) were separately combined with time from symptom onset to ED presentation to obtain severity/time indices. Multivariable regression age- and sex-adjusted models without and with severity/time indices were compared. For CXR-RALE, the models were tested in a validation cohort. Results: Of the 308 included patients, 55 (17.9%) died. In multivariable logistic age- and sex-adjusted models for death at 30 days, severity/time indices showed good discrimination ability, higher for imaging than for laboratory measures (AUCCT = 0.92, AUCCXR = 0.90, AUCCRP = 0.88, AUCsO2 = 0.88). AUCCXR was lower in the validation cohort (0.79). The models including severity/time indices performed slightly better than models including measures of disease severity not combined with time and those including the Charlson Comorbidity Index, except for CRP-based models. Conclusion: Time from symptom onset to ED admission is a strong prognostic factor and provides added value to the interpretation of imaging and laboratory findings at ED presentation.

2022 - Modifications of Chest CT Body Composition Parameters at Three and Six Months after Severe COVID-19 Pneumonia: A Retrospective Cohort Study [Articolo su rivista]
Besutti, Giulia; Pellegrini, Massimo; Ottone, Marta; Bonelli, Efrem; Monelli, Filippo; Farì, Roberto; Milic, Jovana; Dolci, Giovanni; Fasano, Tommaso; Canovi, Simone; Costi, Stefania; Fugazzaro, Stefania; Massari, Marco; Ligabue, Guido; Croci, Stefania; Salvarani, Carlo; Pattacini, Pierpaolo; Guaraldi, Giovanni; Giorgi Rossi, Paolo
abstract

We aimed to describe body composition changes up to 6-7 months after severe COVID-19 and to evaluate their association with COVID-19 inflammatory burden, described by the integral of the C-reactive protein (CRP) curve. The pectoral muscle area (PMA) and density (PMD), liver-to-spleen (L/S) ratio, and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, and IMAT) were measured at baseline (T0), 2-3 months (T1), and 6-7 months (T2) follow-up CT scans of severe COVID-19 pneumonia survivors. Among the 208 included patients (mean age 65.6 ± 11 years, 31.3% females), decreases in PMA [mean (95%CI) -1.11 (-1.72; -0.51) cm2] and in body fat areas were observed [-3.13 (-10.79; +4.52) cm2 for TAT], larger from T0 to T1 than from T1 to T2. PMD increased only from T1 to T2 [+3.07 (+2.08; +4.06) HU]. Mean decreases were more evident for VAT [-3.55 (-4.94; -2.17) cm2] and steatosis [L/S ratio increase +0.17 (+0.13; +0.20)] than for TAT. In multivariable models adjusted by age, sex, and baseline TAT, increasing the CRP interval was associated with greater PMA reductions, smaller PMD increases, and greater VAT and steatosis decreases, but it was not associated with TAT decreases. In conclusion, muscle loss and fat loss (more apparent in visceral compartments) continue until 6-7 months after COVID-19. The inflammatory burden is associated with skeletal muscle loss and visceral/liver fat loss.

2022 - Preclinical Validation of a Semi-Autonomous Robot for Transperineal Prostate Biopsy [Articolo su rivista]
Maris, B.; Fiazza, M. -C.; De Piccoli, M.; Tenga, C.; Palladino, L.; Puliatti, S.; Iseppi, A.; Ferrari, R.; Piro, A.; Bonetti, L. R.; Ligabue, G.; Tafuri, A.; Micali, S.; Fiorini, P.
abstract

Prostate biopsy is a manual procedure carried out mostly under ultrasound (US) guidance to confirm the presence of cancer. The standard biopsy is random and includes at least 12 insertions; targeted biopsy makes use of dedicated hardware and software, but is still performed manually. We present here the pre-clinical validation of PROST, a robot primarily designed to automate targeted transperineal biopsy. The overall validation of the system was performed on cadavers, while some features, such as image segmentation, were tested on human tissue. PROST is designed to minimize human error by introducing some autonomy in the execution of key steps of the procedure, i.e., target selection, image fusion and needle positioning. The protocol was approved by the ethics committee; 10 cadavers were included in the study. We envision that PROST has the potential to increase the detection of clinically significant prostate cancer, to simplify the procedure, to reduce human errors and to shorten training time. The use of a robot for the biopsy of the prostate will create the possibility to include also a treatment, such as focal ablation, to be delivered through the same system.

2022 - Vessel inflammation and morphological changes in patients with large vessel vasculitis: A retrospective study [Articolo su rivista]
Besutti, G.; Muratore, F.; Mancuso, P.; Ferrari, M.; Galli, E.; Spaggiari, L.; Monelli, F.; Casali, M.; Versari, A.; Boiardi, L.; Marvisi, C.; Ligabue, G.; Pattacini, P.; Giorgi Rossi, P.; Salvarani, C.
abstract

Objective The aim was to identify any association between imaging signs of vessel wall inflammation (positron emission tomography-CT (PET-CT) score and CT/MR wall thickening) and synchronous and subsequent vascular damage (stenoses/dilations) in patients with large vessel vasculitis (LVV). Methods Consecutive patients with LVV referred to a tertiary centre in 2007-2020 with baseline PET-CT and morphological imaging (CT/MR angiography) performed within 3 months were included. All available PET-CT and CT/MR scans were reviewed to assess PET-CT uptake (4-point semi-quantitative score), wall thickening, stenoses and dilations for 15 vascular segments. The associations of baseline PET score and CT/MR wall thickening with synchronous and incident stenoses/dilations at CT/MR performed 6-30 months from baseline were evaluated in per-segment and per-patient analyses. Respective areas under the receiver operating characteristic curve (AUC) were calculated. Results We included 100 patients with LVV (median age: 48 years, 22% males). Baseline PET score and wall thickening were strongly associated (Cuzick non-parametric test for trend across order groups (NPtrend) <0.001). The association with synchronous stenoses/dilations was weak for PET score (NPtrend=0.01) and strong for wall thickening (p<0.001). In per-patient analyses, sensitivity/specificity for ≥1 synchronous stenoses/dilations were 44%/67% for PET score ≥2 and 66.7%/60.5% for wall thickening. Subsequent CTs/MRs were available in 28 patients, with seven incident stenoses/dilations. Baseline PET score was strongly associated with incident stenoses/dilations (p=0.001), while baseline wall thickening was not (p=0.708), with AUCs for incident stenoses/dilations of 0.80 for PET score and 0.52 for wall thickening. Conclusion PET score and wall thickening are strongly associated, but only baseline PET score is a good predictor of incident vessel wall damage in LVV.

2021 - Baseline liver steatosis has no impact on liver metastases and overall survival in rectal cancer patients [Articolo su rivista]
Besutti, G.; Damato, A.; Venturelli, F.; Bonelli, C.; Vicentini, M.; Monelli, F.; Mancuso, P.; Ligabue, G.; Pattacini, P.; Pinto, C.; Giorgi Rossi, P.
abstract

Background: The liver is one of the most frequent sites of metastases in rectal cancer. This study aimed to evaluate how the development of synchronous or metachronous liver metastasis and overall survival are impacted by baseline liver steatosis and chemotherapy-induced liver damage in rectal cancer patients. Methods: Patients diagnosed with stage II to IV rectal cancer between 2010 and 2016 in our province with suitable baseline CT scan were included. Data on cancer diagnosis, staging, therapy, outcomes and liver function were collected. CT scans were retrospectively reviewed to assess baseline steatosis (liver density < 48 HU and/or liver-to-spleen ratio < 1.1). Among patients without baseline steatosis and treated with neoadjuvant chemotherapy, chemotherapy-induced liver damage was defined as steatosis appearance, ≥ 10% liver volume increase, or significant increase in liver function tests. Results: We included 283 stage II to IV rectal cancer patients with suitable CT scan (41% females; mean age 68 ± 14 years). Steatosis was present at baseline in 90 (31.8%) patients, synchronous liver metastasis in 42 (15%) patients and metachronous liver metastasis in 26 (11%); 152 (54%) deaths were registered. The prevalence of synchronous liver metastasis was higher in patients with steatosis (19% vs 13%), while the incidence of metachronous liver metastasis was similar. After correcting for age, sex, stage, and year of diagnosis, steatosis was not associated with metachronous liver metastasis nor with overall survival. In a small analysis of 63 patients without baseline steatosis and treated with neoadjuvant chemotherapy, chemotherapy-induced liver damage was associated with higher incidence of metachronous liver metastasis and worse survival, results which need to be confirmed by larger studies. Conclusions: Our data suggest that rectal cancer patients with steatosis had a similar occurrence of metastases during follow-up, even if the burden of liver metastases at diagnosis was slightly higher, compatible with chance.

2021 - Changes in central adipose tissue after switching to integrase inhibitors [Articolo su rivista]
Debroy, Paula; Feng, Han; Miao, Hongyu; Milic, Jovana; Ligabue, Guido; Draisci, Stefano; Besutti, Giulia; Carli, Federica; Menozzi, Marianna; Mussini, Cristina; Guaraldi, Giovanni; Lake, Jordan E
abstract

Background: Treatment with integrase strand transfer inhibitors (INSTIs) has been associated with excess weight gain, however the long-term effect of INSTI-based regimens on adipose tissue (AT) compartments remains unknown. Objectives: To evaluate the effect of switching to an INSTI on visceral (VAT) and subcutaneous (SAT) AT in virologically-suppressed adults with HIV. Methods: We performed a retrospective observational cohort study of ART experienced adults referred to the metabolic Clinic of the University of Modena and Reggio Emilia who had ≥2 assessments of body composition by abdominal computed tomography. An interrupted time series model with mixed-effect model incorporated was used to calculate VAT and SAT change rate, adjusting for smoking status, use of alcohol, and physical activity. Results: A total of 698 patients were included: 156 who switched to an INSTI-based regimen and 542 who did not. After switch to INSTI, mean SAT area increased approximately 3-fold (before 0.27 vs after 0.73 cm2/month; p = 0.011), and VAT area 7-fold (0.18 vs 1.30 cm2/month; p < 0.001). Conclusions: Among PLWH on ART, both SAT and VAT gain accelerated after switching to an INSTI-based regimen. The associations between INSTIs and central adiposity require further investigation.

2021 - Feasibility and efficiency of European guidelines for NAFLD assessment in patients with type 2 diabetes: A prospective study [Articolo su rivista]
Besutti, G.; Bonilauri, L.; Manicardi, E.; Venturelli, F.; Bonelli, E.; Monelli, F.; Manicardi, V.; Valenti, L.; Ligabue, G.; Schianchi, S.; Massari, M.; Riva, N.; Froio, E.; Tagliavini, E.; Pattacini, P.; Giorgi Rossi, P.
abstract

Aim: We aimed to evaluate the feasibility and efficiency of a guidelines-compliant NAFLD assessment algorithm in patients with newly diagnosed type 2 diabetes (T2D). Methods: Consecutive patients aged < 75 newly diagnosed with T2D without coexisting liver disease or excessive alcohol consumption were enrolled. Patients were stratified based on liver enzymes, fatty liver index, ultrasound, fibrosis scores and liver stiffness measurement. Referral rates and positive predictive values (PPVs) for histological non-alcoholic steatohepatitis (NASH) and significant fibrosis were evaluated. Results: Of the 171 enrolled patients (age 59 ± 10.2 years, 42.1% females), 115 (67.3%) were referred to a hepatologist due to abnormal liver enzymes (n = 60) or steatosis plus indeterminate (n = 37) or high NAFLD fibrosis score (n = 18). Liver biopsy was proposed to 30 patients (17.5%), but only 14 accepted, resulting in 12 NASH, one with significant fibrosis. The PPV of hepatological referral was 12/76 (15.8%) for NASH and 1/76 (1.3%) for NASH with significant fibrosis. The PPV of liver biopsy referral was 12/14 (85.7%) for NASH and 1/14 (7.1%) for NASH with significant fibrosis. Conclusions: By applying a guidelines-compliant algorithm, many patients with T2D were referred for hepatological assessment and liver biopsy. Further studies are necessary to refine non-invasive algorithms.

2021 - Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients [Articolo su rivista]
Besutti, G.; Massaro, F.; Bonelli, E.; Braglia, L.; Casali, M.; Versari, A.; Ligabue, G.; Pattacini, P.; Cavuto, S.; Merlo, D. F.; Luminari, S.; Merli, F.; Vaccaro, S.; Pellegrini, M.
abstract

Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17–18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26–4.65; p = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10–11.40; p = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03–1.7; p = 0.03, and HR = 1.30; CI = 1.04–1.64; p = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.

2021 - SIRM–SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis [Articolo su rivista]
Esposito, A.; Francone, M.; Andreini, D.; Buffa, V.; Cademartiri, F.; Carbone, I.; Clemente, A.; Guaricci, A. I.; Guglielmo, M.; Indolfi, C.; La Grutta, L.; Ligabue, G.; Liguori, C.; Mercuro, G.; Mushtaq, S.; Neglia, D.; Palmisano, A.; Sciagra, R.; Seitun, S.; Vignale, D.; Pontone, G.; Carrabba, N.
abstract

In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric “one-stop-shop” approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.

2021 - Subjective Symptoms in Magnetic Resonance Imaging Personnel: A Multi-Center Study in Italy [Articolo su rivista]
Bravo, Giulia; Modenese, Alberto; Arcangeli, Giulio; Bertoldi, Chiara; Camisa, Vincenzo; Corona, Gianluca; Giglioli, Senio; Ligabue, Guido; Moccaldi, Roberto; Mucci, Nicola; Muscatello, Martina; Venturelli, Irene; Vimercati, Luigi; Zaffina, Salvatore; Zanotti, Giulio; Gobba, Fabriziomaria
abstract

2021 - Systematic review of existing guidelines for NAFLD assessment [Articolo su rivista]
Monelli, F.; Venturelli, F.; Bonilauri, L.; Manicardi, E.; Manicardi, V.; Rossi, P. G.; Massari, M.; Ligabue, G.; Riva, N.; Schianchi, S.; Bonelli, E.; Pattacini, P.; Bassi, M. C.; Besutti, G.
abstract

Aim: In this systematic review, guidelines on non-alcoholic fatty liver disease (NAFLD) were evaluated, aiming at a guideline synthesis focusing on diagnosis and staging. Methods: A systematic literature search was conducted on any relevant database or institutional website to find guidelines on NAFLD assessment intended for clinical use on humans, in English, published from January 2010 to August 2020. Included guidelines were appraised using the AGREE II Instrument; those with higher scores and intended for use in adult patients were included in a comparative analysis. Results: Fourteen guidelines were included in the systematic review, eight of which reached an AGREE II score sufficiently high to be recommended for clinical use, of which one developed for pediatric patients only. British and North American guidelines received the highest scores. Most guidelines recommend a screening or case-finding approach in patients with metabolic risk factors who are at increased risk of steatohepatitis or fibrosis. Ultrasound is mostly recommended to confirm steatosis, while the presence of metabolic syndrome, liver function tests, fibrosis scores, and elastographic techniques may help in selecting high-risk patients to be referred to the hepatologist, who may consider liver biopsy, although referral criteria for liver biopsy are not clearly defined. Most guidelines identify the development of noninvasive tests to replace liver biopsy as a research priority. Conclusion: Several high-quality guidelines exist for NAFLD assessment, with no complete agreement on whether to screen high-risk patients and on the tests and biomarkers suggested to stratify patients and select those to be referred to liver biopsy.

2021 - The effect of diffuse liver diseases on the occurrence of liver metastases in cancer patients: A systematic review and meta-analysis [Articolo su rivista]
Monelli, F.; Besutti, G.; Djuric, O.; Bonvicini, L.; Fari, R.; Bonfatti, S.; Ligabue, G.; Bassi, M. C.; Damato, A.; Bonelli, C.; Pinto, C.; Pattacini, P.; Rossi, P. G.
abstract

This systematic review with meta-analysis aimed to assess the effect of diffuse liver diseases (DLD) on the risk of synchronous (S-) or metachronous (M-) liver metastases (LMs) in patients with solid neoplasms. Relevant databases were searched for systematic reviews and cross-sectional or cohort studies published since 1990 comparing the risk of LMs in patients with and without DLD (steatosis, viral hepatitis, cirrhosis, fibrosis) in non-liver solid cancer patients. Outcomes were prevalence of S-LMs, cumulative risk of M-LMs and LM-free survival. Risk of bias (ROB) was assessed using the Newcastle-Ottawa Scale. We report the pooled relative risks (RR) for S-LMs and hazard ratios (HR) for M-LMs. Subgroup analyses included DLD, primary site and continent. Nineteen studies were included (n = 37,591 patients), the majority on colorectal cancer. ROB appraisal results were mixed. Patients with DLD had a lower risk of S-LMs (RR 0.50, 95% CI 0.34–0.76), with a higher effect for cirrhosis and a slightly higher risk of M-LMs (HR 1.11 95% CI, 1.03–1.19), despite a lower risk of M-LMs in patients with vs without viral hepatitis (HR 0.57, 95% CI 0.40–0.82). There may have been a publication bias in favor of studies reporting a lower risk for patients with DLD. DLD are protective against S-LMs and slightly protective against M-LMs for viral hepatitis only.

2021 - The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients [Articolo su rivista]
Besutti, Giulia; Pellegrini, Massimo; Ottone, Marta; Cantini, Michele; Milic, Jovana; Bonelli, Efrem; Dolci, Giovanni; Cassone, Giulia; Ligabue, Guido; Spaggiari, Lucia; Pattacini, Pierpaolo; Fasano, Tommaso; Canovi, Simone; Massari, Marco; Salvarani, Carlo; Guaraldi, Giovanni; Rossi, Paolo Giorgi; Canovi, Simoneg; Massari, Marcoh; Salvarani, Carloi; Guaraldi, Giovannif; Rossi, Paolo Giorgie; Grilli, Roberto; Marino, Massimiliano; Formoso, Giulio; Formisano, Debora; Bedeschi, Emanuela; Perilli, Cinzia; la Rosa, Elisabetta; Bisaccia, Eufemia; Venturi, Ivano; Vicentini, Massimo; Campari, Cinzia; Gioia, Francesco; Broccoli, Serena; Iotti, Valentina; Mancuso, Pamela; Nitrosi, Andrea; Foracchia, Marco; Colla, Rossana; Zerbini, Alessandro; Ferrari, Anna Maria; Pinotti, Mirco; Facciolongo, Nicola; Lattuada, Ivana; Trabucco, Laura; de Pietri, Stefano; Danelli, Giorgio Francesco; Albertazzi, Laura; Bellesia, Enrica; Corradini, Mattia; Mag-Nani, Elena; Pilia, Annalisa; Polese, Alessandra; Incerti, Silvia Storchi; Zaldini, Piera; Bonanno, Orsola; Revelli, Matteo; Pinto, Carmine; Venturelli, Francesco; Teopompi, Elisabetta; Gallina, Annalisa; Bertellini, Annalisa; Costi, Stefania; Fugazzaro, Stefania
abstract

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.

2020 - 18Fluoride-based molecular imaging of coronary atherosclerosis in HIV infected patients [Articolo su rivista]
Guaraldi, G.; Milic, J.; Prandini, N.; Ligabue, G.; Esposito, F.; Ciusa, G.; Malagoli, A.; Scaglioni, R.; Besutti, G.; Beghetto, B.; Nardini, G.; Roncaglia, E.; Mussini, C.; Raggi, P.
abstract

Background and aims: Molecular imaging with 18Fluorodeoxyglucose (FDG) and 18F-sodium-fluoride (NaF) captures arterial inflammation and micro-calcification and can reveal potentially unstable atherosclerotic plaques. Methods: We performed FDG and NaF PET/CT imaging in two clinically similar cohorts of patients living with HIV (PLWH) with no symptomatic cardiovascular disease. The prevalence and intensity of coronary artery uptake of each tracer, measured as target-to-background ratio (TBR), were assessed in patients at low and high cardiovascular risk. Results: Ninety-three PLWH were submitted to PET/CT imaging with FDG (N = 43) and NaF (N = 50); 42% were at low and 58% at high cardiovascular risk. The intensity of uptake and multivessel coronary artery uptake were significantly higher with NaF than FDG both in low and high-risk patients. When each 18F-tracer was tested in low and high-risk patients, an equal proportion of subjects showed no vessel, single and multivessel NaF uptake; the same was true for no and single vessel uptake of FDG (no multivessel FDG uptake was noted). Waist circumference, CRP, D-dimer, HIV duration and treatment with nucleoside reverse transcriptase inhibitors were associated with high NaF uptake in univariable analyses; D-dimer remained significant in multivariable analyses (OR = 1.05; p=0.02). There were no significant associations with FDG uptake. Conclusions: The prevalence of coronary artery uptake was higher with NaF compared to FDG both in high and low risk patients, hence microcalcification imaging may be a more sensitive tool to detect coronary atherosclerosis than inflammation imaging. However, the uptake of each 18Fluoride tracer was similar between low and high-risk subjects, and this underscores the discordance between clinical and imaging based risk assessment. Future investigation should address the prognostic significance of NaF coronary artery uptake.

2020 - Abdominal Visceral Infarction in 3 Patients with COVID-19 [Articolo su rivista]
Besutti, G.; Bonacini, R.; Iotti, V.; Marini, G.; Riva, N.; Dolci, G.; Maiorana, M.; Spaggiari, L.; Monelli, F.; Ligabue, G.; Guaraldi, G.; Rossi, P. G.; Pattacini, P.; Massari, M.
abstract

A high incidence of thrombotic events has been reported in patients with coronavirus disease (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We report 3 clinical cases of patients in Italy with COVID-19 who developed abdominal viscera infarction, demonstrated by computed tomography.

2020 - Acute myocarditis as the main clinical manifestation of SARS-CoV 2 infection: A case report [Articolo su rivista]
Cuomo, G.; Menozzi, M.; Carli, F.; Digaetano, M.; Raimondi, A.; Reggianini, L.; Ligabue, G.; Guaraldi, G.; Mussini, C.
abstract

We describe a case of acute myocarditis which was reported as the main COVID-19 clinical manifestation, with a favorable outcome. In addition to symptoms, laboratory tests (BNP and troponin), echocardiogram and cardiac MRI contributed to diagnosis. Regardless heart biopsy was not obtained, it is likely an immunological pathogenesis of this condition which pave the way to further therapeutic implications, since there are currently no standardized treatments.

2020 - COVID-19-associated vasculitis and thrombotic complications: from pathological findings to multidisciplinary discussion [Articolo su rivista]
Vacchi, Caterina; Meschiari, Marianna; Milic, Jovana; Marietta, Marco; Tonelli, Roberto; Alfano, Gaetano; Volpi, Sara; Faltoni, Matteo; Franceschi, Giacomo; Ciusa, Giacomo; Bacca, Erica; Tutone, Marco; Raimondi, Alessandro; Menozzi, Marianna; Franceschini, Erica; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Di Gaetano, Margherita; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Cossarizza, Andrea; Castaniere, Ivana; Ligabue, Guido; De Ruvo, Nicola; Manco, Gianrocco; Rolando, Giovanni; Gelmini, Roberta; Maiorana, Antonino; Girardis, Massimo; Mascia, Maria Teresa; Mussini, Cristina; Salvarani, Carlo; Guaraldi, Giovanni
abstract

Neutrophilic arterial vasculitis in COVID-19 represents a novel finding and could be responsible for thrombotic complications.

2020 - Cardiac MRI: technical basis [Articolo su rivista]
Russo, V.; Lovato, L.; Ligabue, G.
abstract

Cardiac magnetic resonance (CMR) imaging is an effective method for noninvasively imaging the heart which in the last two decades impressively enhanced spatial and temporal resolution and imaging speed, broadening its spectrum of applications in cardiovascular disease. CMR imaging techniques are designed to noninvasively assess cardiovascular morphology, ventricular function, myocardial perfusion, tissue characterization, flow quantification and coronary artery disease. These intrinsic features yield CMR suitable for diagnosis, follow-up and longitudinal monitoring after treatment of cardiovascular diseases. The aim of this paper is to review the technical basis of CMR, from cardiac imaging planes to cardiac imaging sequences.

2020 - Cardiac Magnetic Resonance Characterization of Myocarditis-Like Acute Cardiac Syndrome in COVID-19 [Articolo su rivista]
Esposito, A.; Palmisano, A.; Natale, L.; Ligabue, G.; Peretto, G.; Lovato, L.; Vignale, D.; Fiocchi, F.; Marano, R.; Russo, V.
abstract

2020 - Effects of atazanavir, darunavir, and raltegravir on fat and muscle among persons living with HIV [Articolo su rivista]
Adrian, S.; Miao, H.; Feng, H.; Scherzinger, A.; Nardini, G.; Beghetto, B.; Roncaglia, E.; Ligabue, G.; Milic, J.; Guaraldi, G.; Lake, J. E.; Erlandson, K. M.
abstract

Background: Antiretroviral therapy (ART) is associated with gain in quantity of fat and muscle, but the impact on quality is less understood. The objective of this study was to compare fat and muscle density among people with HIV (PWH) on stable raltegravir (RAL), atazanavir with ritonavir (ATV/r), or darunavir with ritonavir (DRV/r), and explore implications on muscle function. Methods: Participants from the Modena HIV Metabolic Clinic taking RAL, ATV/r, or DRV/r with at least 1 computed tomography (CT) scan were included. CT scans were reanalyzed for area and density of truncal fat and musculature. Multivariate models explored the effect of ART on fat and muscle density. Results: One hundred six participants were receiving ATV/r, 48 DRV/r, and 141 RAL. In multivariate models (reference ATV/r), only DRV/r was associated with greater subcutaneous (SAT) and visceral adipose tissue (VAT) area, lower lateralis muscle density (more fat), and greater lateralis intermuscular fat area. Compared to ATV/r, RAL was independently associated with less psoas intermuscular fat area. Among all, greater paraspinal muscle density correlated with better physical function. No associations between ART group and physical function were seen among men; DRV/r was associated with stronger grip strength among women. Conclusion: DRV/r was associated with greater fat area and lower density of both fat and muscle, and RAL with less intermuscular psoas fat. Higher density psoas and paraspinal musculature were associated with better physical function, suggesting potential clinical relevance of these findings.

2020 - Testicular pain as an unusual presentation of COVID-19: a brief review of SARS-CoV-2 and the testis [Articolo su rivista]
La Marca, Antonio; Busani, Stefano; Donno, Valeria; Guaraldi, Giovanni; Ligabue, Guido; Girardis, Massimo
abstract

Can the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus induce testis damage and dysfunction?

2019 - Accuracy of imaging methods for steatohepatitis diagnosis in non-alcoholic fatty liver disease patients: A systematic review [Articolo su rivista]
Besutti, Giulia; Valenti, Luca; Ligabue, Guido; Bassi, Maria Chiara; Pattacini, Pierpaolo; Guaraldi, Giovanni; Giorgi Rossi, Paolo
abstract

Non-invasive tests to diagnose non-alcoholic steatohepatitis (NASH) are urgently needed. This systematic review aims to evaluate imaging accuracy in diagnosing NASH among non-alcoholic fatty liver disease (NAFLD) patients, using liver biopsy as reference.

2019 - External validation of a novel side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer: preliminary outcomes on a series diagnosed with multiparametric magnetic resonance imaging-targeted plus systematic saturation biopsy [Articolo su rivista]
Sighinolfi, Maria Chiara; Sandri, Marco; Torricelli, Pietro; Ligabue, Guido; Fiocchi, Federica; Scialpi, Michele; Eissa, Ahmed; Reggiani Bonetti, Luca; Puliatti, Stefano; Bianchi, Giampaolo; Rocco, Bernardo
abstract

no abstract

2019 - Molecular Imaging of Vascular Calcification with 18 F-Sodium-Fluoride in Patients Infected with Human Immunodeficiency Virus [Articolo su rivista]
Raggi, Paolo; Prandini, Napoleone; Ligabue, Guido; Braglia, Giovanni; Esposito, Francesco; Milic, Jovana; Malagoli, Andrea; Scaglioni, Riccardo; Besutti, Giulia; Beghetto, Barbara; Nardini, Giulia; Roncaglia, Enrica; Mussini, Cristina; Guaraldi, Giovanni
abstract

18F-Sodium Fluoride (NaF) accumulates in areas of active hydroxyapatite deposition and potentially unstable atherosclerotic plaques. We assessed the presence of atherosclerotic plaques in 50 adult patients with HIV (HIV+) who had undergone two cardiac computed tomography scans to measure coronary artery calcium (CAC) progression. CAC and its progression are predictive of an unfavorable prognosis. Tracer uptake was quantified in six arterial territories: aortic arch, innominate carotid artery, right and left internal carotid arteries, left coronary (anterior descending and circumflex) and right coronary artery. Thirty-one patients showed CAC progression and 19 did not. At least one territory with high NaF uptake was observed in 150 (50%) of 300 arterial territories. High NaF uptake was detected more often in non-calcified than calcified areas (68% vs. 32%), and in patients without than in those with prior CAC progression (68% vs. 32%). There was no correlation between clinical and demographic variables and NaF uptake. In clinically stable HIV+ patients, half of the arterial territories showed a high NaF uptake, often in the absence of macroscopic calcification. NaF uptake at one time point did not correlate with prior progression of CAC. Prospective studies will demonstrate the prognostic significance of high NaF uptake in HIV+ patients.

2019 - STUDIO SUGLI EFFETTI SENSORIALI SOGGETTIVI IN OPERATORI DI RISONANZA MAGNETICA [Abstract in Rivista]
Bertoldi, C.; Muscatello, M.; Venturelli, I.; Modenese, A.; Bravo, G.; Arcangeli, G.; Camisa, V.; Corona, G.; Giglioli, S.; Ligabue, G.; Moccaldi, R.; Mucci, N.; Vimercati, L.; Zaffina, S.; Zanotti, G.; Gobba, F.
abstract

2019 - Significant chronic airway abnormalities in never-smoking HIV-infected patients [Articolo su rivista]
Besutti, G.; Santoro, A.; Scaglioni, R.; Neri, S.; Zona, S.; Malagoli, A.; Orlando, G.; Beghe, B.; Ligabue, G.; Torricelli, P.; Manfredini, M.; Pellacani, G.; Fabbri, L. M.; Guaraldi, G.
abstract

Objectives The aim of the study was to describe chronic lung disease in HIV-infected never-smokers by looking at clinical, structural and functional abnormalities. Methods This comparative cross-sectional study included 159 HIV-infected never-smoking patients [mean (+/- standard deviation) age 54.6 +/- 9.1 years; 13.2% female; 98.1% with undetectable viral load] and 75 nonmatched never-smoking controls [mean (+/- standard deviation) age 52.6 +/- 6.9 years; 46.7% female]. We examined calcium scoring computer tomography (CT) scans or chest CT scans, all with a lung-dedicated algorithm reconstruction, to assess emphysema and airway disease (respiratory bronchiolitis and/or bronchial wall thickening), tested pulmonary function using spirometry, lung volumes and the diffusion lung capacity of carbon monoxide (DLCO), and assessed respiratory symptoms using the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT). Results Twenty-five (17.2%) of the HIV-infected patients versus two (2.7%) of the controls had a CAT score > 10. Only 5% of the HIV-infected patients showed FEV1% < 80%, and 25% had DLCO CT scans, they had increased prevalences, compared with the controls, of airway disease (37% versus 7.9%, respectively) and emphysema (18% versus 4%, respectively), with more severe and more frequent centrilobular disease. After correction for age, sex and clinical factors, HIV infection was significantly associated with CAT > 10 [odds ratio (OR) 7.7], emphysema (OR 4), airway disease (OR 4.5) and DLCO < 75% of predicted (OR 4). Conclusions Although comparisons were limited by the different enrolment methods used for HIV-infected patients and controls, the results suggest that never-smoking HIV-infected patients may present with chronic lung damage characterized by CT evidence of airway disease. A minority of them showed respiratory symptoms, without significant functional abnormalities.

2019 - Thymus Imaging Detection and Size Is Inversely Associated With Metabolic Syndrome and Frailty in People With HIV [Articolo su rivista]
Guaraldi, Giovanni; Franconi, Iacopo; Milic, Jovana; Besutti, Giulia; Pintassilgo, Ines; Scaglioni, Riccardo; Ligabue, Guido; Riva, Nicoletta; Raimondi, Alessandro; Menozzi, Marianna; Carli, Federica; Zona, Stefano; Santoro, Antonella; Malagoli, Andrea; Borghi, Vanni; Torricelli, Pietro; Cossarizza, Andrea; Mussini, Cristina
abstract

People with HIV (PWH) may experience accentuating aging in relation to immuno-activation. Little is known regarding thymus (THY) involution in this process. We sought to investigate the relationship between THY imaging detection/size and clinically relevant aging outcomes such as metabolic syndrome (MetS), multimorbidity (MM), and frailty in PWH.

2018 - 1650a Subjective symptoms in magnetic resonance imaging operators: preliminary results of an italian study [Abstract in Rivista]
Zanotti, G; Modenese, A; Bravo, G; Arcangeli, G; Camisa, V; Corona, G; Giglioli, S; Ligabue, G; Moccaldi, R; Mucci, N; Vimercati, L; Zaffina, S; Gobba, F
abstract

2018 - Fluid - Structure interaction of blood flow in human aorta under dynamic conditions: A numerical approach [Relazione in Atti di Convegno]
Martelli, Francesca; Milani, Massimo; Montorsi, Luca; Ligabue, Guido; Torricelli, Pietro
abstract

The paper proposes a numerical approach for the analysis of the blood flow in human aorta under real operating conditions. An ad-hoc procedure is developed for importing the aorta geometry from magnetic resonance imaging in order to have a patient based analysis. The aortic flow is simulated accounting for the dynamic behavior of the flow resulting from the heart pulse and for the non-Newtonian properties of blood. Fluid - structure analysis is carried out to address the mutual influence of the flow transient nature and the aorta walls' deformation on the pressure flow field and tissue's stresses. Finite element method approach is used for the structural analysis of the aorta walls which are assumed as a linear elastic isotropic material; nevertheless, different regions are introduced to account for the Young modulus variation from the ascending aorta to the common iliac arteries. Mesh morphing techniques are adopted to simulate the wall deformation and a two equation turbulence model is adopted to include the turbulence effects. The proposed numerical approach is validated against the measurements carried out on magnetic resonance imaging scanner and a good agreement is found in terms of aorta wall maximum and minimum deformation during the cardiac cycle. Therefore, the fluid-structure analysis can provide an important tool to extend the insight of the aortic system from magnetic resonance imaging techniques and improve the understanding of arteriosclerosis and the related phenomena as well as their dependence on flow structure and tissue stresses.

2017 - Os acromiale: frequency and a review of 726 shoulder MRI [Articolo su rivista]
Rovesta, Claudio; Marongiu, M. C; Corradini, Alessandro; Torricelli, Pietro; Ligabue, Guido
abstract

Os acromiale consist in a lack of fusion between the different ossification spots of the acromial side of scapula from the age of 23-25 years. A relation between os acromiale and some shoulder pathology like impingement syndrome, cuff tear and subacromial bursitis has been described. The etiology is not already known. The aim of this study was to evaluate the frequency of os acromiale in our population, the link between os acromiale and sex, side and shoulder pathology. 1042 shoulder MRI were evaluated to find out os acromiale and the linked cuff pathology. In our population, the frequency of os acromiale was 3.44% without differences between sexes, with prevalence on the right shoulder. No differences in cuff and bursa pathology were present between affected and unaffected subjects. Os acromiale is an anomaly still underdiagnosed. It is important to be recognized because it allows to make an accurate pre-surgical plan. To make a correct diagnosis, axial MRI cut or TC is necessary.

2016 - Cardiac-CT and Cardiac-MR examinations cost analysis, based on data of four Italian Centers [Articolo su rivista]
Centonze, Maurizio; Lorenzin, Giuseppe; Francesconi, Andrea; Cademartiri, Filippo; Casagranda, Giulia; Fusaro, Michele; Ligabue, Guido; Zanetti, Giovanna; Spanti, Demetrio; De Cobelli, Francesco
abstract

Purpose: To establish the appropriate number of Cardiac-CT and Cardio-MR examinations, to determine an economically justified and sustainable investment in these two technologies, for an exclusive cardiologic use. Materials and methods: From July 2013 to July 2014, through a survey in four different Italian Departments of Radiology, data on the costs of Cardiac-CT and Cardiac-MR examinations were collected. For the evaluation of the costs of examinations, it was used an analytical accounting system, considering only the direct costs (consumables, health personnel work time, equipment amortization/maintenance) and other costs (utilities, services, etc.). Indirect costs (general costs) were not assessed. It was made a simulation, assuming an exclusive use of the CT and MR equipments for Cardiac-CT and Cardiac-MR examinations, calculating the annual number necessary to arrive at the Break Even Point (BEP: the point at which cost or expenses and revenue are equal). Results: On the basis of the CT costs, in order to reach the BEP, performing only Cardiac-CT examinations, an average of 2641–2752 examinations/year is needed. The annual time commitment of the Medical Professional to ensure the number of examinations to reach the BEP is 2625–2750 h/year, equivalent to two Medical Doctors in a Cardiology Department. The recent Cardiac-CT Italian Registry, in the period January–June 2011, reports a number of examinations of 3455 patients in 47 different Centers, distributed throughout the whole national territory. With regard to MR, in order to reach the BEP, performing only Cardiac-MR examinations, an average of 2435–3123 examinations/year is needed. The annual time commitment of the Medical Professional to ensure the number of examinations to reach the BEP is 2437–3125 h/year, equivalent to two Medical Doctors in a Cardiology Department. The recent Cardiac-MR Italian Registry reports a number of examinations of 3776 patients in 40 Centers, distributed throughout the whole national territory. Conclusion: This research has shown that, only on the basis of costs, currently in Italy is anti-economic an exclusive use of CT or MR equipment for cardiac exams, unless it’s not decided, regardless of the recent guidelines and clinical indications, to submit all patients with cardiac diseases (diseases of the coronary arteries and cardiomyopathies) to Cardiac-CT and Cardiac-MR examinations. This might likely to increase both the inappropriate examinations and either health spending and in the case of CT with important repercussions, in terms of radio-exposure, subject to forensic procedures.

2016 - Emphysema distribution and diffusion capacity predict emphysema progression in human immunodeficiency virus infection [Articolo su rivista]
Leung, Janice M.; Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Scaglioni, Riccardo; Dai, Darlene; Hague, Cameron; Leipsic, Jonathon; Sin, Don D.; Man, S. F. Paul; Guaraldi, Giovanni
abstract

Background Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. Methods 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ô2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. Results 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41-0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93-48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Conclusion Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression.

2016 - Independent association of subclinical coronary artery disease and emphysema in HIV-infected patients [Articolo su rivista]
Besutti, Giulia; Raggi, P.; Zona, Stefano; Scaglioni, Riccardo; Santoro, Antonella; Orlando, Gabriella; Ligabue, Guido; Leipsic, J.; Sin, D. D.; Man, S. F. P.; Guaraldi, Giovanni
abstract

Chronic obstructive pulmonary disease (COPD) and coronary artery disease are inflammatory states with a significant clinical impact. The relationship between them has not been investigated in patients with HIV infection. We assessed the presence of subclinical emphysema and coronary artery disease using chest computed tomography (CT) imaging in a cohort of HIV-infected patients receiving antiretroviral therapy.

2016 - Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis [Articolo su rivista]
Esposito, Antonio; Francone, Marco; Faletti, Riccardo; Centonze, Maurizio; Cademartiri, Filippo; Carbone, Iacopo; De Rosa, Roberto; Di Cesare, Ernesto; La Grutta, Ludovico; Ligabue, Guido; Lovato, Luigi; Maffei, Erica; Marano, Riccardo; Midiri, Massimo; Pontone, Gianluca; Natale, Luigi; De Cobelli, Francesco
abstract

Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. Main messages: • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.

2016 - Sintomi soggettivi negli operatori di risonanza magnetica ed in un gruppo di controllo: studio su alcuni fattori correlate. [Abstract in Atti di Convegno]
Zanotti, G; Ligabue, G; Corona, G; Venturelli, L; Longhi, F; Ruggieri, F; Tomasini, E.; Gobba, F.
abstract

Sintomi soggettivi negli operatori di risonanza magnetica ed in un gruppo di controllo: studio su alcuni fattori correlate.

2016 - Subjective symptoms in Magnetic Resonance Imaging operators: prevalence, short-term evolution and possible related factors [Articolo su rivista]
Zanotti, Giulio; Ligabue, Guido; Korpinen, Leena; Gobba, Fabriziomaria
abstract

The number of Magnetic Resonance Imaging (MRI) operators is rapidly increasing. In these workers, a high prevalence of certain subjective symptoms has been described but until now scant research is available on this topic.

2015 - Epicardial adipose tissue and coronary artery calcium predict incident myocardial infarction and death in HIV-infected patients [Articolo su rivista]
Raggi, Paolo; Zona, Stefano; Scaglioni, Riccardo; Stentarelli, Chiara; Ligabue, Guido; Besutti, Giulia; Menozzi, Marianna; Santoro, Antonella; Malagoli, Andrea; Bellasi, Antonio; Guaraldi, Giovanni
abstract

Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown.

2015 - HIV patients exhibit similar rates of emphysema progression observed in older HIV-uninfected patients with higher cumulative smoke exposure. [Abstract in Rivista]
Leung, J; Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Dai, D; Mayo, J; Lam, S; Sin, D; Man, S; Guaraldi, Giovanni
abstract

HIV patients face the burden of chronic obstructive pulmonary disease (COPD). How quickly COPD phenotypes such as emphysema progress, what risk factors are associated with COPD progression in an HIV-infected population, and whether this risk of progression is in excess compared to HIV-uninfected patients are unknown.

2015 - HIV patients exhibit similar rates of emphysema progression observed in older HIV-uninfected patients with higher cumulative smoke exposure. [Abstract in Rivista]
Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Guaraldi, Giovanni
abstract

HIV patients face the burden of chronic obstructive pulmonary disease (COPD). How quickly COPD phenotypes such as emphysema progress, what risk factors are associated with COPD progression in an HIV-infected population, and whether this risk of progression is in excess compared to HIV-uninfected patients are unknown.

2015 - Italian registry of cardiac computed tomography [Articolo su rivista]
Cademartiri, Filippo; Di Cesare, Ernesto; Francone, Marco; Ballerini, Giovanni; Ligabue, Guido; Maffei, Erica; Romagnoli, Andrea; Argiolas, Giovanni Maria; Russo, Vincenzo; Buffa, Vitaliano; Marano, Riccardo; Guzzetta, Maria; Belgrano, Manuel; Carbone, Iacopo; Macarini, Luca; Borghi, Claudia; Di Renzi, Paolo; Barile, Vicenzo; Patriarca, Lucia; Donato, Rocco; Zerboni, Filippo; Tresoldi, Silvia; Tessa, Carlo; Rengo, Marco; Manglaviti, Giuseppina; Danti, Massimiliano; Crusco, Federico; Carotti, Lucia; Zobel, Bruno Beomonte; Bernardini, Antonio; Scardapane, Arnaldo; Banderali, Simone; Acquafresca, Manlio; Carusi, Luca Maria; Negro, Umberto; Priotto, Roberto; De Cobelli, Francesco; Quarenghi, Matteo; Paganoni, Silvia; Secchi, Francesco; Sforza, Nicola; Lumia, Domenico; De Rosa, Roberto; Bissoli, Ernesto; Olivotti, Luca; Barbiero, Giulio; Centonze, Maurizio; Leurini, Rodolfo; Malagò, Roberto; Pinto, Dario
abstract

Purpose Cardiac CT (CCT) is an imaging modality that is becoming a standard in clinical cardiology. We evaluated indications, safety, and impact on patient management of routine CCT in a multicenter national registry. Materials and methods During a period of 6 months, 47 centers in Italy enrolled 3,455 patients. Results CCT was performed mainly with 64-slice CT scanners (73.02%). Contrast agents were administrated in 3,185 patients (92.5%). Mean DLP changes with type of scanner and was lower in >64 row detector scanner. The most frequent indication for CCT was suspected CAD (44.8%), followed by calcium scoring (9.6%), post-angioplasty/stenting (8.3%), post-CABGs (7.5%), study of cardiac anatomy (4.22%) and assessment in patients with known CAD (4.1%) and acute chest pain (1.99%). Most of the CCTs were performed in outpatient settings (2,549; 74%) and a minority in inpatient settings (719, 20.8%). Adverse clinical events (mild–moderate) occurred in 26 examinations (0.75%). None of them was severe. In 45.3% of the cases CCT findings impacted patient management. Conclusion CCT is performed with different workloads in participating centers. It is a safe procedure and its results have a strong impact on patient management.

2015 - Lung and Heart Diseases Are Better Predicted by Pack-Years than by Smoking Status or Duration of Smoking Cessation in HIV Patients [Articolo su rivista]
Guaraldi, Giovanni; Raggi, Paolo; Gomes, André; Zona, Stefano; Marchi, Enrico; Santoro, Antonella; Besutti, Giulia; Scaglioni, Riccardo; Ligabue, Guido; Leipsic, Jonathon; Man, Paul; Sin, Don
abstract

BACKGROUND: The objective of this study was to assess the relationship of pack-years smoking and time since smoking cessation with risk of lung and heart disease. METHODS: We investigated the history of lung and heart disease in 903 HIV-infected patients who had undergone thoracic computed tomography (CT) imaging stratified by smoking history. Multimorbidity lung and heart disease (MLHD) was defined as the presence of ≥ 2 clinical or subclinical lung abnormalities and at least one heart abnormality. RESULTS: Among 903 patients, 23.7% had never smoked, 28.7% were former smokers and 47.6% were current smokers. Spirometry indicated chronic obstructive pulmonary disease in 11.4% of patients and MLHD was present in 53.6%. Age, male sex, greater pack-years smoking history and smoking cessation less than 5 years earlier vs. more than 10 years earlier (OR 2.59, 95% CI 1.27-5.29, p = 0.009) were independently associated with CT detected subclinical lung and heart disease. Pack-years smoking history was more strongly associated with MLHD than smoking status (p<0.001). CONCLUSIONS: MLHD is common even among HIV-infected patients who never smoked and pack- years smoking history is a stronger predictor than current smoking status of MLHD. A detailed pack-years smoking history should be routinely obtained and smoking cessation strategies implemented

2015 - Prevalence of subjective symptoms in a group of physicians recently involved in Magnetic Resonance Imaging (MRI) procedures. [Abstract in Atti di Convegno]
Zanotti, G; Modenese, A; Corona, G; Ligabue, G; Gobba, F.
abstract

Prevalence of subjective symptoms in a group of physicians recently involved in Magnetic Resonance Imaging (MRI) procedures.

2015 - Prevalenza di sintomi soggettivi negli operatori di risonanza magnetica ed in un gruppo di controllo. [Abstract in Atti di Convegno]
Zanotti, G; Ligabue, G; Gobba, F.
abstract

Prevalenza di sintomi soggettivi negli operatori di risonanza magnetica ed in un gruppo di controllo.

2015 - Subjective symptoms and their evolution in a small group of magnetic resonance imaging (MRI) operators recently engaged [Articolo su rivista]
Zanotti, Giulio; Ligabue, Guido; Gobba, Fabriziomaria
abstract

Using a specific questionnaire, we examined subjective symptoms in a group of 17 physicians (9 males and 8 females, mean age 32.9 ± 3.71), attending a Postgraduate Medical School in Radiology and engaged in MRI for less than 1 year. Sixteen subjects (94%) reported the presence of at least one of the investigated symptoms during the period of MRI activity. The main symptoms were: unusual drowsiness/tiredness (88%), concentration problems (82%), headaches (76%), sleep disorders (47%), nausea (47%), illusion of movement (47%) and dizziness/vertigo (35%); the former two were subjectively related to MRI by the majority of the operators. These symptoms appeared (or worsened) in more than 15 min and, in the vast majority disappeared 30 min, or more, after the end of exposure. In 13 subjects (81%), the symptom (or some symptoms) appeared at least weekly. In this small group of health care workers recently exposed to MRI, the prevalence of subjective symptoms was higher than reported in other similar studies but, notably, the majority of subjects (77%) reported a regression within 4-8 weeks, suggesting some form of adaptation.

2015 - Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging [Articolo su rivista]
Fiocchi, Federica; Petrella, Elisabetta; Nocetti, Luca; Currà, Serena; Ligabue, Guido; Costi, Tiziana; Torricelli, Pietro; Facchinetti, Fabio
abstract

This study aimed to evaluate 3-T magnetic resonance imaging in the analysis of caesarean scars in women with prior caesarean section (pCS) and investigate the potential added value of diffusion tensor imaging (3T-MR-DTI) with fibre tracking reconstruction, compared with transvaginal ultrasound (TVUS). Thirty women who had previously undergone elective CS in a singleton pregnancy at term were examined (19 women with one pCS formed group 1 and 11 women with two pCS formed group 2). Patients underwent TVUS and 3T-MR-DTI within 2 days. Twelve women with prior vaginal delivery served as controls and underwent only 3T-MR. Uterine fibre architecture was depicted by MR-DTI with 3D tractography reconstruction providing quali-quantitative analysis of fibre, described as the reduction of number of longitudinal fibres that run through the uterine scar. Six subjects were excluded. According to 3T-MR morphology, scars were described as linear (n = 12) and retracting (n = 12); disagreement with TVUS was 54 %. The thickness of myometrium at the scar level was found to be significantly greater with 3T-MR compared to TVUS in linear scars (p = 0.01). No difference was found among retracting scars. In controls, according to 3T-MR-DTI, longitudinal myometrial fibres running in the anterior wall were similar to those in the posterior wall at same level -2 %; -27 % + 22 %). In groups 1 and 2 there was significant reduction in anterior fibres compared to posterior ones (-53 %; -77 % - 34 %; p = 0.0001). Among retracting scars, fibre reduction was significantly higher compared to linear scars, p &lt; 0.016. The added value of 3T-MR with DTI lies in the prompt evaluation of muscle fibre remaining at scar level.

2014 - Acute obstructive jaundice: a possible clinical manifestation of IPMT. Case report and review of the literature [Articolo su rivista]
Gargaglia, Eleonora; Iotti, Valentina; Ligabue, Guido; Gelmini, Roberta
abstract

I NTRODUCTION : Pancreatic masses causing acute obstructive jaundice still pose diagnostic difficulties and their character- ization can often be complex as there is significant overlap in their imaging features. C ASE R EPORT : We describe a case of Intraductal Papillary Mucinous Tumor (IPMT) presenting with acute obstructive jaundice in a patient with history of recurrent mild pancreatitis. Clinical evaluation, abdominal ultrasonography (US) and CT-scan posed suspicion of adenocarcinoma with cystic degeneration of the pancreatic head or mucinous cystadeno- carcinoma; magnetic resonance (MR) with magnetic resonance cholangiopancreatography (MRCP) demonstrated the com- munication of the mass with the main pancreatic duct, posing differential diagnosis between main-duct-IPMT and muci- nous cystadenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated the presence of a mucus- secreting lesion inside duodenum and duodenal biopsies showed no evidence of neoplastic cells. R ESULTS : The patient underwent spleen preserving total pancreatectomy that led to histological diagnosis of intraduc- tal papillary mucinous with carcinoma in situ. D ISCUSSION : The international guidelines for management of IPMT, reported in 2006 and revised in 2012, estab- lish that the resectability and the absence of an invasive carcinoma are the most important prognostic factors in IPMT. Therefore an early diagnosis and a radical resection are crucial to improve the patient survival and reduce the recur- rence rate. C ONCLUSION : When an IPMT is suspected, the imaging modalities are essential to pose the diagnosis, maximise the chance to select the right surgical candidate and to perform the best treatment for each patient.

2014 - Burden of subclinical heart and lung disease detected on thoracic CT scans of HIV patients on HAART [Abstract in Rivista]
Zona, Stefano; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Mussini, Cristina; Raggi, Paolo; Leipsic, Jonathon; Sin, Don D; Guaraldi, Giovanni
abstract

The aim was to determine the prevalence of lung and heart abnormalities on thoracic CT scans in HIV-infected patients who were treated with antiretroviral therapy (ART).

2014 - Evoluzione della sintomatologia soggettiva in un gruppo di operatori sanitari recentemente assunti in Risonanza Magnetica per Immagini (RMI) [Abstract in Rivista]
Zanotti, Giulio; Ligabue, Guido; Gobba, Fabriziomaria
abstract

Abbiamo valutato la sintomatologia soggettiva in un gruppo di operatori addetti alla RMI da meno di un anno. Una proporzione molto alta (94%) ha riferito almeno uno dei sintomi indagati e quelli più frequenti erano: astenia, cefalea e difficoltà di concentrazione. Il 76,5% di questi ha però riferito una regressione della sintomatologia dopo circa 1-2 mesi. Questi risultati suggeriscono un possibile adattamento nel breve termine.

2014 - Response to letter regarding article, good prognosis for pericarditis with and without myocardial involvement: Results from a multicenter, prospective cohort study [Articolo su rivista]
Imazio, Massimo; Brucato, Antonio; Barbieri, Andrea; Ferroni, Francesca; Maestroni, Silvia; Ligabue, Guido; Chinaglia, Alessandra; Cumetti, Davide; DELLA CASA, Giovanni; Bonomi, Federica; Mantovani, Francesca; Di Corato, Paola; Lugli, Roberta; Faletti, Riccardo; Leuzzi, Stefano; Bonamini, Rodolfo; Modena, Maria Grazia; Belli, Riccardo
abstract

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2014 - The Burden of Image Based Emphysema and Bronchiolitis in HIV-Infected Individuals on Antiretroviral Therapy [Articolo su rivista]
Guaraldi, Giovanni; Besutti, Giulia; Scaglioni, Riccardo; Santoro, Antonella; Zona, Stefano; Ligabue, Guido; Marchioni, Alessandro; Orlando, Gabriella; Carli, Federica; Beghe', Bianca; Fabbri, Leonardo; J., Leipsic; D., Don Sin; S. F. P., Man
abstract

Abstract Background: With the widespread use of anti-retroviral therapy (ART), individuals infected with human immune deficiency virus (HIV) are increasingly experiencing morbidity and mortality from respiratory disorders. However, the prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown. Methods: Thoracic computed tomography (CT) scans were performed in 1,446 patients infected with HIV who were on ART and who attended a tertiary care metabolic clinic (average age 48 years and 29% females). Detailed history and physical examination including anthropometric measurements were performed. Complete pulmonary function tests were performed in a subset of these patients (n = 364). No subjects were acutely ill with a respiratory condition at the time of CT scanning. Findings: Nearly 50% of the subjects had CT evidence for emphysema, bronchiolitis or both with 13% (n = 195) showing bronchiolitis, 19% (n = 274) showing emphysema and 16% (n = 238) revealing both. These phenotypes were synergistically associated with reduced regular physical activity (p for interaction ,.0001). The most significant risk factors for both phenotypes were cigarette smoking, intravenous drug use and peripheral leucocytosis. Together, the area-under-the curve statistics was 0.713 (p = 0.0037) for discriminating those with and without these phenotypes. There were no significant changes in lung volumes or flow rates related to these phenotypes, though the carbon monoxide diffusion capacity was reduced for the emphysema phenotype. Interpretation: Emphysema and bronchiolitis are extremely common in HIV-infected patients who are treated with ART and can be identified by use of thoracic CT scanning.

2013 - Associatioin of epicardial adipose tissue with incident coronary heart disease and death in HIV infected patients. [Abstract in Rivista]
Guaraldi, Giovanni; Scaglioni, Riccardo; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Besutti, Giulia; Menozzi, Marianna; Santoro, Antonella; Beghetto, Barbara; Mussini, Cristina; P., Raggi
abstract

Epicardial adipose tissue has been reported to be highly inflamed and to be associated with incident coronary artery disease and all cause mortality in the general population. Its association with adverse events in HIV is unknown.

2013 - Association between left ventricular non-compaction and patent ductus arteriosus. Multimodal diagnostic approach [Articolo su rivista]
Ratti, C.; Grassi, L.; Casa, G. D.; Ligabue, G.; Veronesi, B.; Bompani, B.
abstract

2013 - Emphysema is an independent predictor of coronary artery calcium score in a large cohort of HIV infected patients [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Besutti, Giulia; Scaglioni, Riccardo; Santoro, Antonella; Zona, Stefano; Ligabue, Guido; Orlando, Gabriella; Carli, Federica; Mussini, Cristina; J. Leipsic D. D., Sin; S. F. P., Man
abstract

The objective of this study was to evaluate the association between emphysema and CAC in a large cohort of HIV infected patients undergoing ART

2013 - Emphysema is an independent predictor of coronary artery calcium score in a large cohort of HIV-infected patients. [Abstract in Rivista]
Guaraldi, Giovanni; Besutti, Giulia; Scaglioni, Riccardo; Santoro, Antonella; Zona, Stefano; Ligabue, Guido; Mussini, Cristina; Orlando, Gabriella; Carli, Federica; J., Lipsic; D. D., Sin; S. F. P., Man
abstract

The complex relationship between chronic obstructive pulmonary disease and cardiovascular disease has not been investigated in patients chronically infected with HIV. The objective of this study was to evaluate the association between emphysema and coronary artery calcium score as surrogate for coronary artery diasease in a large cohort of HIV-infected patients on antiretroviral treatment.

2013 - Good prognosis for pericarditis with and without myocardial involvement: Results from a multicenter, prospective cohort study [Articolo su rivista]
Massimo, Imazio; Antonio, Brucato; Andrea, Barbieri; Francesca, Ferroni; Silvia, Maestroni; Ligabue, Guido; Alessandra, Chinaglia; Federica, Bonomi; Mantovani, Francesca; Paola, Di Corato; Lugli, Roberta; Riccardo, Faletti; Stefano, Leuzzi; Rodolfo, Bonamini; Modena, Maria Grazia; Riccardo, Belli
abstract

Background—The natural history of myopericarditis/perimyocarditis is poorly known and recently published data have presented contrasting data on their outcomes. The aim of the present article is to assess their prognosis in a multicenter, prospective cohort study. Methods and Results—A total of 486 patients (median age 39 years, range 18-83, 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis) (85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of 2 of 4 clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atipycal ECG changes for pericarditis, arrhythmias, cardiac troponin elevation and/or new or worsening ventricular dysfunction on echocardiography, and confirmed by cardiac magnetic resonance. After a median follow-up of 36 months normalization of LV function was achieved in &gt;90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, as well as evolution to heart failure or symptomatic LV dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up and were more frequently recorded in patients with acute pericarditis (32%) than myopericarditis (11%) or perimyocarditis (12%; p&lt;0.001). Troponin elevation was not associated with an increase of complications. Conclusions—The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation is not a negative prognostic marker in this setting.

2013 - Indicazioni cliniche per l'utilizzo della cardio RM. A cura del Gruppo di lavoro della Sezione di Cardio-Radiologia della SIRM [Articolo su rivista]
Di Cesare, E; Cademartiri, F.; Carbone, I.; Carriero, A.; Centonze, M.; De Cobelli, F.; De Rosa, R.; Di Renzi, P.; Esposito, A.; Faletti, R.; Fattori, R.; Francone, M.; Giovagnoni, A.; La Grutta, L.; Ligabue, Guido; Lovato, L.; Marano, R.; Midiri, M.; Romagnoli, A.; Russo, V.; Sardanelli, F.; Natale, L.; Bogaert, J.; De Roos, A.
abstract

Cardiac magnetic resonance (CMR) is considered an useful method in the evaluation of many cardiac disorders. Based on our experience and available literature, we wrote a document as a guiding tool in the clinical use of CMR. Synthetically we describe different cardiac disorders and express for each one a classification, I to IV, depending on the significance of diagnostic information expected. © 2012 Springer-Verlag Italia.

2013 - Inverse correlation between vascular calcification and bone mineral density in human immunodeficiency virus-infected patients [Articolo su rivista]
Antonio, Bellasi; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rochira, Vincenzo; Antonello, Santoro; Mussini, Cristina; Guaraldi, Giovanni; Paolo, Raggi
abstract

HIV-infected individuals suffer from acceler- ated aging, which manifests as premature cardiovascular and bone disease. However, little is known of the association of these two disorders in the HIV population. Our objective was to investigate the association between a marker of ath- erosclerosis (coronary artery calcium [CAC]) and low bone mineral density (BMD) in a cross-sectional cohort of HIV- infected patients. The study was conducted at the University of Modena and Reggio Emilia, Italy. A total of 636 con- secutive middle-aged, HIV-infected subjects were recruited between January 2006 and December 2010. All patients underwent CAC and BMD assessment. Patients were cate- gorized according to a CAC score\100 or[100 units based on previous literature that identified this cut-point as a marker of increased risk. Low femoral and lumbar spine BMD was defined as \25th percentile value for the study cohort. Logistic regression and bootstrap analysis were used to assess the independent association between CAC and BMD. The main outcome measure was a CAC score[100. Patients with CAC [ 100 were older and more likely to be men, diabetic, and overweight. Patients with CAC \ 100 had better renal function and a lower cardiovascular risk profile. After adjusting for age, sex, traditional and HIV- specific risk factors, vitamin D level, and PTH level, there was a significant association between CAC [ 100 and low BMD for the femur (OR = 2.33, 95 % CI 1.09–4.99; p = 0.02) but not for the spine. Bootstrap analyses con- firmed these findings. In summary, CAC was independently associated with low femoral BMD in HIV-infected patients. Future studies should test whether therapies that attenuate cardiovascular risk in HIV favorably impact bone health.

2013 - MR quantitative biomarkers of non-alcoholic fatty liver disease: technical evolutions and future trends [Articolo su rivista]
Ligabue, Guido; Besutti, Giulia; Scaglioni, Riccardo; Stentarelli, Chiara; Guaraldi, Giovanni
abstract

Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis as the earliest manifestation and hallmark, and ranges from benign fatty liver to non-alcoholic steatohepatitis (NASH). Liver biopsy (LB) is considered the reference standard for NAFLD diagnosis, grading and characterization, but it is limited by its invasiveness and observer-dependence. Among imaging surrogates for the assessment of hepatic steatosis, MR is the most accurate. (1)H MR spectroscopy (MRS) provides a quantitative biomarker of liver fat content (LFC) called proton density fat fraction (PDFF), but it is time-consuming, not widely available and limited in sample size. Several MR imaging (MRI) techniques, in particular fat suppression and in-opposed phase techniques, have been used to quantify hepatic steatosis, mainly estimating LFC from water and fat signal intensities rather than proton densities. Several technical measures have been introduced to minimize the effect of confounding factors, in particular a low flip angle, a multiecho acquisition and a spectral modeling of fat with multipeak reconstruction to address respectively T1 effect, T2* effect, and the multifrequency interference effects of fat protons, allowing to use MRI to estimate LFC based on PDFF. Tang et al. evaluated MRI-estimated PDFF, obtained by applying the above-mentioned technical improvements, in the assessment of hepatic steatosis, using histopathology as the reference standard. The identification of PDFF thresholds, even though to be further explored and validated in larger and more diverse cohorts, is useful to identify steatosis categories based on MRI-based steatosis percentages. MRI, with the new refined techniques which provide a robust quantitative biomarker of hepatic steatosis (PDFF) evaluated on the whole liver parenchyma, is a promising non-invasive alternative to LB as the gold standard for steatosis diagnosis and quantification.

2013 - Preoperative predictors of a successful surgical treatment in the management of parapneumonic empyema [Articolo su rivista]
Stefani, Alessandro; Aramini, B.; Dellacasa, G.; Ligabue, Guido; Kaleci, Shaniko; Casali, C.; Morandi, Uliano
abstract

Background: Video-assisted thoracoscopic surgery (VATS) and thoracotomy are the main surgical options for treating parapneumonic empyema. The choice of either operation depends on many preoperative features, including the patient's condition, clinical and radiologic findings, and pleural fluid characteristics. The identification of the combination of those preoperative findings that will allow surgeons to select the appropriate approach for a successful operation (VATS or thoracotomy) could be of great interest in clinical settings. Methods: We retrospectively reviewed a series of 97 patients who had undergone successful VATS or thoracotomy for parapneumonic empyema; in all cases, the operation had begun through VATS and was changed to a thoracotomy if a complete decortication was needed. Preoperative clinical, radiologic, and laboratory features were compared between the two groups to search for differences that might serve as predictive factors for either operation. Perioperative findings were also analyzed. Results: The operation was accomplished by VATS in 40 patients (41%), and conversion to thoracotomy was necessary in 57 (59%). Significant predictive factors for conversion were a prolonged delay from diagnosis to operation, the presence of fever and of pleural thickness on computed tomography (CT) images. The 25 patients who presented with these three features were cured by thoracotomy. The operative time and postoperative complication rate were significantly higher for the thoracotomy patients. Conclusions: Some preoperative features can help the surgeon to better select patients for the appropriate operation. Delayed operation, fever, and pleural thickness can be used to predict the likelihood of conversion to thoracotomy. © 2013 The Society of Thoracic Surgeons.

2013 - Prevalence and predictors of preclinical coronary heart disease in post-menopause period [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Besutti, Giulia; Scaglioni, Riccardo; Stentarelli, Chiara; Menozzi, Marianna; Garlassi, Elisa; Ligabue, Guido; Mussini, Cristina; P., Raggi
abstract

There are very few longitudinal studies of change in coronary artery calcium (CAC) across the menopause period, when it is expected there would be a significant increase in coronary heart disease. CAC>0 identifies preclinical coronary artery disease. We aimed to evaluate risk factors for detectable CAC among HIV-infected women across the menopause period.

2013 - Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax. [Articolo su rivista]
Casali, C.; Stefani, Alessandro; Ligabue, Guido; P., Natali; B., Aramini; Torricelli, Pietro; Morandi, Uliano
abstract

Background: The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial. Methods: We evaluated patients conservatively treated for PSP who underwent chest HRCT scan in a single-institution retrospective longitudinal study. Absolute risk values and positive and negative predictive values of recurrence based on HRCT findings were the primary end points. Results: We analyzed 176 patients. Ipsilateral and contralateral recurrence developed in 44.8% and 12% of patients, respectively. The risk of recurrence was significantly related to the presence of blebs or bullae, or both, at HRCT. The risk of ipsilateral recurrence for patients with or without blebs and bullae was 68.1% and 6,1%, respectively (positive predictive value, 68.1%; negative predictive value, 93,9%). The risk of contralateral pneumothorax for patients with or without blebs and bullae was 19% and 0%, respectively (positive predictive value, 19%; negative predictive value, 100%). The risk of ipsilateral recurrence was directly related to the dystrophic severity score: recurrence risk increased by up to 75% in patients with bilateral multiple lesions. Multivariate analysis showed that a positive HRCT was significantly related to ipsilateral recurrence. Conclusions: The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral. © 2013 The Society of Thoracic Surgeons.

2012 - Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM) [Articolo su rivista]
Di Cesare, E.; Carbone, I.; Carriero, A.; Centonze, M.; De Cobelli, F.; De Rosa, R.; Di Renzi, P.; Esposito, A.; Faletti, R.; Fattori, R.; Francone, M.; Giovagnoni, A.; La Grutta, L.; Ligabue, G.; Lovato, L.; Marano, R.; Midiri, M.; Natale, L.; Romagnoli, A.; Russo, V.; Sardanelli, F.; Cademartiri, F.
abstract

Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific societies describing the proper use and clinical indications of CCT; in particular, there are no complete guidelines. This document reflects the position of the Working Group of the Cardiac Radiology Section of the Italian Society of Radiology concerning the indications for CCT. © Springer-Verlag 2012.

2012 - Ectopic fat is linked to prior cardiovascular events in men with HIV. [Articolo su rivista]
Orlando, Gabriella; Guaraldi, Giovanni; Zona, Stefano; Carli, Federica; Bagni, Pietro; Meschiari, Marianna; Cocchi, Stefania; Scaglioni, Riccardo; Ligabue, Guido; P., Raggi
abstract

Epicardial Adipose Tissue (EAT) has been associated with adverse cardiovascular events in the general population. We studied the association of general adiposity measures (body mass index, waist circumference) and ectopic adipose tissue [visceral adipose tissue (VAT); liver fat (LF); EAT) with prevalent cardiovascular disease (CVD) (prior myocardial infarction, coronary revascularization, stroke, peripheral vascular disease] in 583 HIV-infected men. VAT, EAT, and LF (liver/spleen attenuation ratio < 1.1) were measured by computed tomography. Patients' mean age was 48.5 ± 8.1 years, prior CVD was present in 33 (5.7%) patients. Factors independently associated with CVD on multivariable analyses were age [incidence-rate ratio (IRR) = 1.07, 95% confidence interval (CI): 1.02 to 1.12], smoking (IRR = 2.70, 95% CI: 1.22 to 6.01), Center for Disease Control group C (IRR = 3.09, 95% CI: 1.41 to 6.76), EAT (IRR = 1.13, 95% CI: 1.04 to 1.24, per 10 cm), LF (IRR = 1.17, 95% CI: 1.04 to 1.32), and VAT (IRR = 1.05, 95% CI: 1.00 to 1.10, per 10 cm). Ectopic fat but not general adiposity measures were associated with prevalent CVD in men with HIV.

2012 - Erectile Dysfunction Is Not a Mirror of Endothelial Dysfunction in HIV-Infected Patients. [Articolo su rivista]
Guaraldi, Giovanni; Beggi, M; Zona, Stefano; Luzi, K; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rochira, Vincenzo; Rossi, Rosario; Modena, Maria Grazia; Bouloux, P.
abstract

Introduction.  The penis has been compared to a barometer of endothelial health, erectile dysfunction (ED) being an early sign of endothelial dysfunction. Aim.  The aim of the study was to investigate the extent of the association between ED and endothelial dysfunction in patients with human immunodeficiency virus (HIV) infection on antiretroviral therapy. Methods.  In this observational cross-sectional study, we evaluated the prevalence and factors associated with ED in a cohort of 133 HIV-infected men. Main Outcome Measures.  The International Index of Erectile Function, ultrasound assessment of brachial artery flow mediated dilatation (FMD), and multi-slice computed tomography for coronary artery calcifications (CAC) as surrogates of endothelial dysfunction, the Adult Treatment Panel III criteria to diagnose metabolic syndrome (MS), plasma total testosterone (hypogonadism), and a visual analogue scale (VAS) of aesthetic satisfaction of the face and of the body (psychological distress associated with lipodystrophy). Results.  Thirty-nine (29.32%) patients had mild ED, 14 (10.52%) patients had moderate ED, and 26 (19.55%) patients had severe ED. Prevalence of ED ranged from 45% to 65%, respectively, in patients less than 40 and more than 60 years old. MS was present in 20 (25%) patients with ED and 13 (24%) patients without ED (P value = 0.87). Prevalence of ED neither appeared to be associated with MS as a single clinical pathological entity nor with the numbers of its diagnostic components. FMD < 7% was present in 25 (32%) patients with ED and 18 (33%) patients without ED (P value = 0.83), and CAC > 100 was present in 8 (10%) patients with ED and 5 (9%) patients without ED (P value = 0.87). A stepwise multivariable logistic regression analysis was used to find predictors of ED. Independent predictors were VAS face (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.73-0.99, P = 0.049) and age per 10 years of increase (OR = 1.73, 95% CI 1.02-2.94, P = 0.04). Conclusions.  Age constituted the most important risk factor for ED, which was related to aesthetic dissatisfaction of the face leading to negative body image perception. Guaraldi G, Beggi M, Zona S, Luzi K, Orlando G, Carli F, Ligabue G, Rochira V, Rossi R, Modena MG, and Bouloux P. Erectile dysfunction is not a mirror of endothelial dysfunction in HIV-infected patients.

2012 - In vivo 3 T MR diffusion tensor imaging for detection of the fibre architecture of the human uterus: a feasibility and quantitative study [Articolo su rivista]
Fiocchi, Federica; Nocetti, L; Siopis, Elena; Currà, Serena; Costi, T; Ligabue, Guido; Torricelli, Pietro
abstract

The aim of this study was to investigate the feasibility of depicting fibre architecture of human uteri in vivo using 3 T MR diffusion tensor imaging (MR-DTI) with a three-dimensional (3D) tractography approach. Quantitative results were provided.

2012 - Levosimendan in a case of severe peri-myocarditis associated with influenza A/H1N1 virus. [Articolo su rivista]
S., Busani; A., Pasetto; Ligabue, Guido; V., Malavasi; R., Lugli; Girardis, Massimo
abstract

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2012 - Low Muscle Mass in HIV+ Patients: Prevalence, Predictors, and Clinical Implication. [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Zona, Stefano; A., Silva; Orlando, Gabriella; Carli, Federica; A., Santoro; N., Crupi; Ligabue, Guido; Mussi, Chiara; L., Ferruci
abstract

In HIV+ patients, muscle mass measured as fat free mass index (FFMi = FFM/h2) in DXA has never been characterized in large epidemiological cohorts. We aimed: to describe the prevalence of low muscle mass using t- and z-score, per age decades, defined as <–2 SD from the mean FFMi for an Italian Caucasian population, respectively, for the same age or in the age strata 30 to 39 years; to identify predictors of FFMi change; and to assess the association between FFMi and all-cause mortality in a large HIV+ cohort.

2012 - Magnetic resonance for quantitative assessment of liver steatosis: a new potential tool to monitor antiretroviral-drug-related toxicities. [Articolo su rivista]
Guaraldi, Giovanni; Besutti, Giulia; Stentarelli, Chiara; Zona, Stefano; Nocetti, L; Loria, Paola; Ballestri, Stefano; Losi, L; Torricelli, Pietro; Ligabue, Guido
abstract

BACKGROUND: There is an increasing need for new diagnostic tools to monitor antiretroviral drug-related toxicities. Magnetic resonance (MR) imaging and MR spectroscopy are non-invasive diagnostic methods used in the detection and quantification of liver fat. The aim of this study was to compare sensitivity and specificity of different MR techniques in the quantitative assessment of liver steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection.METHODS: Sequentially evaluated patients with suspected steatosis who were referred for liver biopsy at our tertiary care site were eligible. MR liver fat content (LFC) was estimated by T2-weighted and fat-suppressed T2-weighted spin-echo, dual-phase T1-weighted gradient-echo, multiecho gradient-echo and (1)H spectroscopy. Association between LFC and histological steatosis percentage was calculated by using univariate linear regressions and Pearson's coefficient. Respective receiver operating characteristic (ROC) curves were used to compare specificity and sensitivity of MR methods in diagnosis (cutoff 5%) and in quantitative evaluation (cutoff 33%) of steatosis.RESULTS: A total of 28 patients were identified: 12 refused or had contraindications for liver biopsy and 16 had biopsies plus MR. LFC and histological steatosis percentage were strongly associated (fat-suppressed r=0.86 [P&lt;0.001], dual-phase r=0.88 [P&lt;0.001], multiecho r=0.95 [P&lt;0,001] and spectroscopy r=0.84 [P=0.01]). MR techniques had high sensitivity and specificity in diagnosis and quantitative assessment of steatosis (areas under ROC curves ranging from 0.88 to 0.98).CONCLUSIONS: This pilot study confirms that MR may be a sensitive non-invasive alternative to biopsy for the quantitative assessment of liver fat and a potential end point to monitor antiretroviral-drug-related toxicities.

2012 - Parallel increase of subclinical atherosclerosis and epicardial adipose tissue in patients with HIV. [Articolo su rivista]
Zona, Stefano; P., Raggi; Bagni, Pietro; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, Riccardo; Rossi, Rosario; Modena, Maria Grazia; Guaraldi, Giovanni
abstract

BACKGROUND: Epicardial adipose tissue (EAT) may contribute to the development of coronary atherosclerosis via paracrine secretion of inflammatory cytokines.METHODS: This is a prospective, observational study of 240 consecutive HIV-infected patients receiving antiretroviral therapy. All patients underwent 2 sequential chest computed tomographic scans to assess the change in coronary artery calcium (CAC), a marker of subclinical atherosclerosis, and EAT volume. Patients with known cardiovascular disease were excluded. Factors independently associated with EAT change were explored using multivariable linear regression analyses. The association between EAT increase and CAC progression was explored using logistic regression analyses.RESULTS: Two hundred forty patients were included. Patients' mean age was 47.5 ± 8 years, and 68% were men. The median interval between computed tomographic scans was 18.7 months (interquartile range 10-27 months). Men showed a larger increase in EAT (5 ± 14.2 cm(3)) than did women (-0.45 ± 8.8 cm(3), P = .007). Factors independently associated with change in EAT were CD4(+) recovery (β = 0.43, CI 0.05-0.82) and male gender (β = 5.65, CI, 1.05-10.26). Change in EAT was independently associated with CAC progression (odds ratio 1.04, 95% CI 1.004-1.88, P = .030) after adjusting for traditional cardiovascular risk factors.CONCLUSIONS: In this cohort of patients with HIV receiving antiretroviral therapy, male gender and CD4(+) were independent predictors of EAT increase, and there was a parallel progression of CAC and EAT. Abnormal immunoreactivity associated with T-lymphocyte recovery should be further studied as a determinant of atherosclerosis progression in HIV-infected patients.

2012 - Progression of coronary artery calcium in men affected by human immunodeficiency virus infection. [Articolo su rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Fiocchi, Federica; Rossi, Rosario; Modena, Maria Grazia; P., Raggi
abstract

Cardiovascular risk is increased in HIV infected patients. We assessed progression of coronary artery calcium (CAC) in patients with HIV infection to identify factors that may help explain progression of atherosclerosis. Prospective, observational study of 132 HIV-infected men receiving chronic antiretroviral therapy (ART); we measured traditional atherosclerosis risk factors and assessed progression of CAC on sequential 64-slice CT scans at an average interval of 11 months (range 6–36). CAC score progression was defined as absolute and percentage change from baseline. During follow-up 45 patients (34%) showed absolute progression of CAC and 34 of them showed >15% yearly progression, a threshold previously associated with a high risk of myocardial infarction. Age, LDL cholesterol, visceral abdominal fat and current T-helper (CD4+) cell count were significantly associated with absolute CAC progression. Progression of subclinical atherosclerosis in HIV patients is associated with traditional coronary risk factors as well as HIV related factors such as the CD4+ cell count. Therefore, immunologic perturbations secondary to HIV infection may contribute to atherosclerosis progression.

2012 - Role of diffusion-weighted magnetic resonance imaging in prostate cancer evaluation [Articolo su rivista]
Rinaldi, Daniele; Fiocchi, Federica; Ligabue, Guido; Bianchi, Giampaolo; Torricelli, Pietro
abstract

Purpose: The authors analysed the role of diffusion-weighted imaging (DWI) as an additional tool in magnetic resonance (MR) evaluation of prostate cancer. Materials and methods: Forty-one patients with suspected prostate cancer underwent MR imaging (1.5 Tesla). A DWI sequence was added to the standard morphological protocol, with a maximum b value of 1,000 s/mm2. Diffusion maps were obtained, and the apparent diffusion coefficient (ADC) was calculated by drawing a region of interest (ROI) over healthy tissue and areas suspicious for malignancy. Histology was considered the gold standard. Results: The areas correctly classified by MR imaging (42/51) had a low signal intensity on T2-weighted imaging and low ADC value (0.99±0.15 mm2/s; p<0.01) compared with the healthy peripheral zone (PZ) (1.73±0.27 mm2/s; p<0.01). Nine areas classified as suspicious for malignancy on T2-weighted sequences showed high ADC (1.44±0.06 mm2/s; p<0.01) and were confirmed to be disease free by subsequent histological examination. The accuracy of morphofunctional MR imaging was 81.6% compared with 73.7% of the morphological analysis alone. Conclusions: The addition of DWI to the standard protocol increases the overall diagnostic performance of MR imaging in detecting prostatic cancer. Thus, DWI can help the clinician determine the most appropriate management strategy for the patient.

2011 - Coronary artery calcification is associated with femoral but not with lumbar spine mineral density [Abstract in Rivista]
Antonio, Bellasi; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Cocchi, Stefania; Ligabue, Guido; Rochira, Vincenzo; Bagni, Pietro; Paolo, Raggi; Guaraldi, Giovanni
abstract

Calcium within the coronary is associated with low BMD

2011 - Coronary artery calcification is associated with femoral but not with lumbar spine mineral density [Abstract in Atti di Convegno]
Antonio, Bellasi; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Cocchi, Stefania; Ligabue, Guido; Rochira, Vincenzo; Bagni, Pietro; Paolo, Raggi; Guaraldi, Giovanni
abstract

Coronary artery calcification is associated with reduced BMD in HIV-infected patients.

2011 - Detection of localized chronic type A aortic dissection: a multimodality imaging approach. [Articolo su rivista]
Malagoli, A.; Barbieri, A.; Veronesi, B.; Pacini, D.; Ligabue, Guido; Modena, Maria Grazia
abstract

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2011 - EAT volume is an independent risk factor of cardiovascular disease in HIV-infected patients [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Raggi, P; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, R; Besutti, G; Rossi, Rosario; Modena, Maria Grazia
abstract

Epicardial adipose tissue volume (EAT) is increased in HIV infected patients. EAT may contribute to coronary artery atherosclerosis via paracrine secretion of proinflammatory cytokines, plying a role in the development of cardiovascular disease (CVD). The aim of the study was to evaluate EAT associated factors and the relationship between EAT and occult CVD and predictors of EAT change over time.

2011 - Ectopic fat is a surrogate marker of CVD in patients with HIV. [Abstract in Atti di Convegno]
Orlando, Gabriella; Zona, Stefano; Carli, Federica; P., Bagni; M., Menozzi; S., Cocchi; R., Scaglioni; Ligabue, Guido; P., Raggi; Guaraldi, Giovanni
abstract

The aim of this study was to evaluate the association between general adiposity and ectopic fat measurements; Epicardial adipose tissue with prevalent cardiovascular disease defined as prior myocardial infarction, coronary revascularization, stroke, peripheral vascular disease in male patients with HIV infection with or without klipodystrophy.

2011 - Epicardial Adipose Tissue Volume is an Independent Risk Factor of CVD in HIV-infected Patients [Abstract in Atti di Convegno]
Zona, Stefano; Raggi, P.; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Scaglioni, R.; Besutti, G.; Rossi, Rosario; Modena, Maria Grazia; Guaraldi, Giovanni
abstract

Epicardial adipose tissue (EAT) volume is increased in HIV-infected patients. EAT may contribute to coronary artery atherosclerosis via paracrine secretion of proinflammatory cytokines, playing a role in the development of cardiovascular disease (CVD). The aim of the study was to evaluate EAT-associated factors and the relationship between EAT and occult CVD and predictors of EAT change over time.

2011 - Epicardial adipose tissue is an independent marker of cardiovascular risk in HIV-infected patients. [Articolo su rivista]
Guaraldi, Giovanni; Scaglioni, R.; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Besutti, G.; Bagni, P.; Rossi, Rosario; Modena, Maria Grazia; Raggi, P.
abstract

BACKGROUND: Epicardial adipose tissue (EAT) is increased in HIV-infected patients. The aim of this study was to evaluate the association between EAT and coronary artery calcium (CAC) a marker of atherosclerosis; furthermore, we investigated the association of EAT with HIV infection, antiretroviral treatment (ART), and lipodystrophy.METHODS: This was a cross-sectional study of 876 consecutive HIV-infected ART experienced patients. Patients underwent CAC imaging with multidetector computed tomography (CT) for atherosclerosis screening and risk of cardiovascular events (CAC score &gt;100); EAT was measured in the same CT images. Factors independently associated with EAT were explored in a multivariable backward stepwise linear regression analysis. Multivariable logistic regression was used to evaluate the association of EAT and CAC score greater than 100.RESULTS: Patients' mean age was 47.2 ± 8 years, 68% were men. EAT was associated with central fat accumulation and mixed lipodystrophy phenotypes. Factors independently associated with EAT were: age [β = 0.6, confidence interval (CI) 0.2-1.0], male sex (β = 6.6, CI 0.5-12.7), visceral adipose tissue (β = 0.12, CI 0.08-0.17), waist circumference (β = 0.7, CI 0.04-1.3), current CD4 (β = 0.6, CI 0.1-1.2, per 50 cells), total cholesterol (β = 0.1, CI 0.02-0.15), and cumulative exposure to ART (months) (β = 0.05, CI 0.00-0.11). EAT (per 10 cm) was associated with CAC greater than 100 (odds ratio = 1.10, CI 1.02-1.19) after adjustment for age, male sex, and diabetes.CONCLUSION: We showed an association between EAT and central fat accumulation and mixed form lipodystrophy phenotypes as well as traditional risk factors for atherosclerosis. EAT may be a useful marker of cardiovascular risk as shown by its association with CAC greater than 100.

2011 - HR-MAS NMR SPECTROSCOPY FOR CHARACTERIZATION OF STEATOSIC LIVER: FAT QUANTIFICATION FOR A SPECTROSCOPIC DIFFERENTIATION BETWEEN STEATOSIS AND STEATOHEPATITIS [Abstract in Atti di Convegno]
Righi, Valeria; Stentarelli, Chiara; Guaraldi, Giovanni; Zona, Stefano; Ligabue, Guido; Besutti, Giulia; Loria, Paola; Luisa, Losi; Luca, Nocetti; Vitaliano, Tugnoli; Schenetti, Luisa; Mucci, Adele
abstract

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. The NAFLD includes non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) [1]. The mechanisms of NAFL to NASH transition remain to be clarified [2]. NAFLD appears to originate from the dysregulation of hepatic lipid metabolism as a part of the metabolic syndrome accompanied by visceral obesity, dyslipidemia, atherosclerosis and insulin resistance. A recent study has also demonstrate that high prevalence of steatosis is correlated to HCV-related chronic hepatitis [3]. High Resolution Magic Angle Spinning (HR-MAS) NMR is a useful tool for the metabolic characterization of intact tissues [4] and can be used to support the clinical diagnosis. The first aim of this study is to characterize the NAFL and NASH metabolism using HR-MAS NMR Spectroscopy. The second one is to evaluate the possible transition from NAFLD to NASH quantifying the liver fat content (LFC), both in ex-vivo and in-vivo NMR Spectroscopy. Patients with indication for steatosis underwent in-vivo 1H MR Spectroscopy analysis and liver biopsy. Histopathological analysis provided steatosis percentage, steatosis grade and fibrosis. A fragment of biopsy specimen was used for HR-MAS analysis, to obtain metabolic tissue characterization. Univariate linear regression analysis and Pearson r coefficient were used to study the relationship between histological steatosis percentage and LFC, estimated through HR-MAS analysis and in-vivo Spectroscopy. Similar high associations were found between LFC estimated by HR-MAS and histological steatosis percentage (r=0,71; p=0,006) and between LFC estimated by in-vivo Spectroscopy and histological steatosis percentage (r=0,79; p=0,002). HR-MAS spectra showed a high tissue metabolic heterogeneity, with particular regard to the content of free glucose, alanine, glutamine/glutamate and phospholipids. Fibrotic liver showed a higher presence of small metabolites such as choline. HR-MAS NMR Spectroscopy, well estimates the fatty infiltration of the liver. Future research on HR-MAS spectral heterogeneity may allow to find biochemical metabolic indicators of steatosis progression to be used in the differentiation between steatohepatitis and steatosis through in-vivo MR Spectroscopy.[1] Contos M. J. and Sanyal A. J., The clinicopathologic spectrum an management of nonalcoholic fatty liver disease. Adv Anat Pathol, 9, 37-51 (2002).[2] Reid A. E., Nonalcoholic steatohepatitis . Gastroenterol, 121, 710-23 (2001).[3] Scheuer P. J., Ashrafzaddeh P., Sherlock S., Brown D., Disheiko G. M., the pathology of hepatitis C. Hepatology, 25, 567-71. (1992).[4] Righi V., Durante C., Cocchi M., Calabrese C., Di Febo G., Lecce F., Pisi A., Tugnoli V., Mucci A. and Schenetti L., Discrimination of healthy and neoplastic human colon tissues by ex vivo HR-MAS NMR spectroscopy and chemometric analyses. J of Proteome Res, 8, 1859-69 (2009).

2011 - Human immunodeficiency virus infection is associated with accelerated atherosclerosis. [Articolo su rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Fiocchi, Federica; M., Menozzi; Rossi, Rosario; Modena, Maria Grazia; P., Raggi
abstract

Objectives Cardiovascular risk is increased in HIV-infected individuals compared with the general population, making HIV disease an ideal model to investigate the pathogenesis and natural history of atherosclerosis. In this pilot study, we compared the progression of coronary artery calcium (CAC) between HIV-infected and uninfected patients. Methods Atherosclerosis progression was assessed in 25 HIV-infected men and 13 HIV-negative controls by means of sequential CAC scans using CT. A CAC score progression ≥15%/year was used as a surrogate marker of increased risk of cardiovascular events. Results During a median follow-up of 11 months, a CAC score increase ≥15%/year was detected in 14 HIV-infected patients (56%) and 4 HIV-negative individuals (31%). HIV infection, age and hypercholesterolaemia were independently associated with a CAC score increase ≥15%/year in an adjusted Cox regression model. Conclusions HIV infection, age and hypercholesterolaemia were independently associated with CAC progression. HIV as well as traditional risk factors contribute to accelerate atherosclerosis in HIV-infected patients.

2011 - MR evaluation of PDMS injections in head and neck tissues: a pilot study [Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Ligabue, Guido; Grammatica, Alberto; Bergamini, Giuseppe; Marchioni, Daniele; Ghidini, Angelo; Genovese, Elisabetta; Presutti, Livio
abstract

To describe the magnetic resonance (MR) appearance of polydimethylsiloxane (PDMS) injections in the head and neck region.Retrospective review of MR images from a case series.MR images of 10 patients, who underwent PDMS injections at our department, were reviewed. Data from imaging were collected and analyzed.After injection, PDMS can be identified in MR images, particularly in T2-weighted images in the early stages. Its MR characteristics are similar to silicone in other regions, but with time, its appearance can change.The integration of PDMS with tissues may also be reflected in changes in MR appearance, as a result of an increased amount of fibrous tissue in the region injected. Radiologists and ENT specialists may benefit from knowledge of the MR characteristics and variability in appearance of PDMS in human tissues for improving image interpretation.

2011 - Multiecho MR sequences and high-resolution magic angle spinning (HRMAS)ex-vivo spectroscopy in the qualitative analysis and differentiationbetween steatohepatitis and steatosis [Abstract in Rivista]
Besutti, Giulia; Ligabue, Guido; L., Nocetti; F., Fiocchi; Stentarelli, Chiara; Mucci, Adele; Loria, Paola; Guaraldi, Giovanni; Torricelli, Pietro
abstract

Purpose: To compare multiecho gradient-echo MR (magnetic resonance) sequencesin the differentiation between steatohepatitis and steatosis and to describeHR-MAS spectra of liver biopsy showing steatohepatitis or steatosis.Methods and Materials: Fourteen patients with indication for biopsy assessmentof steatosis underwent liver biopsy (reference standard) and MR imaging. Liverbiopsy of both viral and metabolic steatosis were classified using NAFLD activityscore (NAS) which depicts the degree of necro-inflammatrory activity allowing todifferentiate between steatohepatitis and steatosis. Besides liver fat content (LFC),multiecho sequences were also used to calculate water and fat relaxation times(T2*), which are influenced by microenvironmental characteristics, so potentiallyassociated with necro-inflammatory activity. Relation between each multiechoparameter (LFC/T2*water/T2*fat) and NAS was estimated using univariate linearregression and Pearson coefficient. A fragment of biopsy specimen was analysedthrough HR-MAS to obtain metabolic tissue characterisation.Results: Association was found between: NAS and LFCmulti (r = 0.7; p = 0.006),NAS and T2*fat (r = -0.73, p = 0.063, ns, T2*fat was available for 7 patients only).No correlation was found between NAS and T2*water. HR-MAS spectra showedtissue metabolic heterogeneity, with particular regard to the contents of free glucose,alanine, glutamine/glutamate and phospholipids.Conclusion: This pilot study describes multiecho parameters associated withhistological necro-inflammatory activity, allowing to study the potential capability ofMR to differentiate between steatohepatitis and steatosis. Description of HR-MASspectral heterogeneity in NAFLD and NASH may allow to find biochemical indicatorsof steatosis progression to be used in differentiating between steatohepatitisand steatosis in spectra acquired with in vivo MR Spectroscopy too.

2011 - Persistent Chest Pain in Absence of Angiographic Significant Coronary Artery Disease is Associated with Permanent Myocardial Perfusion Defects in Magnetic Resonance Imaging in Postmenopausal Women [Articolo su rivista]
Modena, Maria Grazia; Nuzzo, Annachiara; Rossi, Rosario; Lammirato, Anna; Fiocchi, Federica; Ligabue, Guido; Torricelli, Pietro; Romagnoli, Renato
abstract

We studied a population of post-menopausal women with persistent chest pain (PChP) in order to investigate the relationship between myocardial perfusion at rest and during a stress test using magnetic resonance imaging (MRI). Our goals were to document whether transient myocardial perfusion is induced by dipyridamole infusion and if perfusion defects are also present at rest. The study population consisted of 45 consecutive women (mean age 57.6±8.7 years), who reported chest pain symptoms. PChP was defined as self-reported continuing chest pain after one year. We compared the results of the perfusion MRI studies in subgroups with and without obstructive coronary artery disease (CAD). The latest tools and technologies of Synapse™ Cardiovascular – Fujifilm's cardiovascular (CV) image and information management system – helped us to achieve clear and comprehensive outcomes. In the group of women with PChP and non-obstructive CAD, 16 of 34 (48%) showed a well-evident left ventricular perfusion defect at baseline (four in one segment; eight in two segments and four in three or more segments). The localisation of the perfusion defects – seen using Synapse Cardiovascular – were anteroapical (n=6); septal (n=10); and inferoor inferolateral (n=4). These defects were ‘permanent’ or ‘fixed’, i.e. were present at rest and were neither induced nor modified by the administration of dipyridamole. In any of the women with CAD we found these anomalies. ‘Fixed’ perfusion defects at MRI – probably due to permanent damage of the coronary microcirculation – suggest a disease state typical for post-menopausal women with PChP.

2011 - Role of blebs and/or bullae detected by High Resolution Computed Tomography (HRCT) in predicting recurrence after a first episode of primary spontaneous pneumothorax. [Abstract in Atti di Convegno]
Aramini, B; Casali, C; Stefani, A; Natali, P; Ligabue, G.; Torricelli, P. and Morandi U.
abstract

Role of blebs and/or bullae detected by High Resolution Computed Tomography (HRCT) in predicting recurrence after a first episode of primary spontaneous pneumothorax.

2011 - Role of carcinoembryonic antigen, magnetic resonance imaging, and positron emission tomography-computed tomography in the evaluation of patients with suspected local recurrence of colorectal cancer [Articolo su rivista]
Fiocchi, Federica; Iotti, Valentina; Ligabue, Guido; Malavasi, Norma; Luppi, Gabriele; Bagni, Bruno; Torricelli, Pietro
abstract

The role of carcinoembryonic antigen (CEA), magnetic resonance imaging (MRI), and positron emission tomography (PET)-computed tomography (CT) in detection of local recurrence of colorectal cancer is evaluated in 71 patients, selected due to suspected relapse at CT follow-up. Recurrence was confirmed by histology in 18 cases and excluded in 25 cases. Sensitivity, specificity, positive and negative predictive values, and accuracy were as follows: 44.4%, 92.5%, 66.7%, 83.1%, and 80.3% for CEA; 88.9%, 73.6%, 53.3%, 95.1%, and 77.5% for MRI; and 94.4%, 73.6%, 54.8%, 97.5%, and 78.9% for PET-CT. A diagnostic protocol integrating CEA and dedicated imaging studies is to be advocated.

2011 - Sensitivity and specificity of visceral and epicardial adipose tissue values in the prediction of occult cardiovascular disease in HIV-infected patients. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Bagni, Pietro; Rossi, Rosario; Modena, Maria Grazia; Falutz, J; Raggi, P.
abstract

Visceral adipose tissue and epicardial adipose tissue have been shown to be associated with the presence of occult cardiovascular disease identified with coronary artery calcium >100. The clinical relevance of VAT and EAT values are not known. The aim of this study was to identify sensitivity and specificity of different VAt and EAT values associated with occult CVD.

2011 - Vitamin D3 Supplementation Decreases the Risk of Diabetes Mellitus among Patients with HIV Infection [Abstract in Atti di Convegno]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; C., Stentarelli; M., Menozzi; E., Garlassi; C., Giovanardi; P., Tebas
abstract

Type 2 diabetes mellitus (DM), insulin resistance, and hypovitaminosis D are common among individuals living with HIV. Low vitamin D has been associated with insulin resistance and DM in the general population and more recently in the HIV-infected population. Our objective was to examine whether use of vitamin D3 (Cholecalciferol) supplementation could prevent the development of DM among patients with HIV infection.

2011 - Vitamin D3 supplementation decreases the risk of diabetes mellitus among patients with HIV infection. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Stentarelli, Chiara; Menozzi, Marianna; Garlassi, Elisa; Giovanardi, C; Tebas, P.
abstract

Type 2 diabetes mellitus (DM), insulin resistance and hypovitaminosis D are common among individuals living with HIV. Low vitamin D (VitD) has been associated with insulin resistance and DM in the general population and more recently in the HIV infected population. Our objective was to examine if the use of VitD3 supplementation could prevent the development of DM among patients with HIV infection.

2010 - A multicenter randomized study to evaluate intracoronary abciximab with the ClearWay catheter to improve outcomes with Lysis (IC ClearLy): trial study design and rationale. [Articolo su rivista]
Sardella, G; Sangiorgi, Gm; Mancone, M; Colantonio, R; Donahue, M; Politi, L; Ducci, Cb; Carbone, I; Francone, M; Ligabue, Guido; Fiocchi, F; Di Roma, A; Benedetti, G; Lucisano, L; Stio, Re; Agati, L; Modena, Maria Grazia; Genuini, I; Fedele, F; Gibson, M.
abstract

BACKGROUND: Percutaneous coronary intervention (PCI) is a highly effective therapy for acute ST-elevation myocardial infarction. Adjunctive therapy with platelet glycoprotein (GP) IIb/IIIa inhibitor can result in increased vessel patency and improved outcomes in ST-elevation myocardial infarction patients undergoing PCI. The investigation of novel dosing and delivery strategies of this therapy may help to further improve outcomes.METHODS: IC-Clearly is a randomized, open-label, multicenter trial, with the purpose of evaluating the effectiveness of an intracoronary bolus dose of abciximab delivered using the ClearWay RX catheter vs. an intravenous bolus of abciximab for ST-elevation myocardial infarction with angiographically visible thrombus (thrombus grade >or=2). A total of 150 patients will be randomized 1: 1 to treatment of the culprit artery with intracoronary abciximab (75 patients) or intravenous abciximab (75 patients) in addition to a maintenance infusion regimen of abciximab administered intravenously for 12 h after PCI. The number of patients included in this study is based on the estimation of sample size needed to identify a statistically significant difference in the primary endpoints between the two groups. The primary endpoint chosen to evaluate this hypothesis is infarct size assessed by cardiac magnetic resonance. Clinical outcomes will be assessed for each patient through hospital discharge and at 30-day follow-up.CONCLUSION: The purpose of this study is to evaluate whether an intracoronary bolus of abciximab delivered with the ClearWay RX catheter prior to the 12 h post-PCI intravenous infusion regimen of abciximab will result in significant additional clot resolution in vivo and improved myocardial perfusion when compared with an intravenous bolus of abciximab on top of the 12 h post-PCI intravenous infusion regimen of abciximab as per standard practice. The primary endpoint chosen to evaluate this hypothesis is infarct size as assessed by cardiac magnetic resonance.

2010 - Contrast-enhanced MRI and PET-CT in the evaluation of patients with suspected local recurrence of rectal carcinoma. [Articolo su rivista]
Fiocchi, F; Iotti, V; Ligabue, Guido; Pecchi, A; Luppi, G; Bagni, B; Rivasi, Francesco; Torricelli, Pietro
abstract

This study aimed to evaluate the role of contrast-enhanced magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) in the assessment of local recurrence of rectal cancer.Among 200 patients scheduled for CT follow-up, 60 (48 low risk; 12 high risk) were selected due to CT findings suspicious for or suggestive of local recurrence. Patients underwent contrast-enhanced MRI and PET-CT within 2 weeks. Biopsy was considered the gold standard in 39 cases and follow-up at 6 and 12 months in the remaining 21.Local recurrence was confirmed by histology in 15 cases (7 low risk; 8 high risk) and was excluded in 21 cases by long-term follow-up and in 24 by histology. Sensitivity, specificity, positive and negative predictive value and accuracy were 86.7%, 68.9%, 48.1%, 93.9% and 73.3% for contrast-enhanced MRI and 93.3%, 68.9%, 50%, 96.9% and 75% for PET-CT.Contrast-enhanced MRI and PET-CT can help in the detection of local recurrence of rectal cancer, even though their roles in early detection remains debatable, as the value of these techniques in current surveillance protocols is still to be defined.

2010 - Erectile dysfunction does not mirror sub-clinical atherosclerosis in HIV infected males. [Abstract in Rivista]
Guaraldi, Giovanni; K., Luzi; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rochira, Vincenzo; Rossi, Rosario; Esposito, Roberto; P., Raggi
abstract

In the general population erectile dysfunction (ED) and coronary artery disease share the same risk factors and endothelial dysfunction appear to be the common denominator. ED appears to be one of the earliest signs of systemic vascular disease and might be considered as an early marker for subclinical cardiovascular disease. We hypothesised ED as a nirror of sub-clinical atherosclerosis in HIV infected patients.

2010 - Lipodystrophy and anti-retroviral therapy as predictors of sub-clinical atherosclerosis in human immunodeficiency virus infected subjects. [Articolo su rivista]
Guaraldi, Giovanni; C., Stentarelli; S., Zona; G., Orlando; F., Carli; Ligabue, Guido; A., Lattanzi; G., Zaccherini; Rossi, Rosario; Modena, Maria Grazia; N., Alexopoulos; F., Palella; P., Raggi
abstract

Although anti-retroviral therapy (ART) prolonged survival in HIV-infected persons, an increase in cardiovascular disease has also been observed. A frequent complication of ART is the development of lipodystrophy (LD) with its multiple phenotypes that may be associated with cardiovascular disease. We assessed the contribution of chronic HIV infection, ART use and LD to the presence of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging. METHODS: Observational cross-sectional study of 372 HIV-infected patients receiving ART who attended a cardiometabolic clinic (48.2+/-8-year old; 74% men). All patients underwent CAC surveillance with computed tomography and the Agatston score was used to quantitate CAC. Presence of CAC was defined as a score >10. Multivariable logistic regression was used to evaluate associations between HIV clinical factors, ART and LD with the presence of CAC. FINDINGS: CAC was found in 134 patients (36%) with a median CAC score of 50 (range 10; 1243). Lipoatrophy alone (OR 3.82, 95% CI: 1.11; 13.1), fat accumulation alone (OR 7.65, 95% CI: 1.71; 37.17) and mixed lipodystrophy phenotypes (OR 4.36, 95% CI: 1.26; 15.01) were strongly associated with presence of CAC after adjusting for age, sex, hypertension and cumulative exposure to ART. CONCLUSION: CAC is common among long-term ART users. The association between CAC and LD underscores the potential atherosclerosis risk inherent with ART and the need to undertake routine cardiovascular surveillance in patients treated with these drugs.

2010 - MR techiniques in the quantitative assessment of liver steatosis [Abstract in Rivista]
Besutti, Giulia; L., Nocetti; Ligabue, Guido; Scaglioni, Riccardo; Stentarelli, Chiara; Zona, Stefano; Loria, Paola; S., Ballestri; L., Losi; Torricelli, Pietro; Guaraldi, Giovanni
abstract

To compare sensitivity and specificity of different magnetic resonance (MR) techiniques in the quantitative assessment of liver steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection.

2010 - MR techniques in the qualitative analysis of liver steatosis: the potential in the differentiation between steatohepatatis and steatosis [Abstract in Rivista]
Besutti, Giulia; L., Nocetti; Stentarelli, Chiara; Zona, Stefano; Scaglioni, Riccardo; Loria, Paola; S., Ballestri; V., Righi; Mucci, Adele; L., Losi; Torricelli, Pietro; Guaraldi, Giovanni; Ligabue, Guido
abstract

To evaluate multiecho MR techniques in the differentiation between steatohepatitis and steatosis, using liver biopsy as the reference standard, in patients with and without HIV infection.

2010 - Non-alcoholic Fatty Liver Disease: a HR-MAS analysis [Abstract in Atti di Convegno]
F., Filace; Righi, Valeria; Stentarelli, Chiara; Guaraldi, Giovanni; V., Borghi; Zona, Stefano; Ligabue, Guido; G., Busetti; Loria, Paola; Ballestri, Stefano; L., Losi; L., Nocetti; Schenetti, Luisa; Mucci, Adele
abstract

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronicliver disease. The NAFLD includes non-alcoholic fatty liver (NAFL) andnon-alcoholic steatohepatitis (NASH). The mechanisms of NAFLD to NASH transition remain to be clarified. NAFLD appears to originate from the dysregulation of hepatic lipid metabolism as a part of the metabolicsyndrome accompanied by visceral obesity dyslipidemia, atherosclerosis, and insulin resistance. High Resolution Magic Angle Spinning (HR-MAS) NMR is a useful tool for the metabolic characterization of intact tissues and can be used to support the clinical diagnosis. The aim of this study is to characterized the NAFLD and NASH metabolism using HR-MAS NMR Spectroscopy, and to evaluate the possible transition from NAFLD to NASH. Liver needle biopsies were collected for the HR-MAS and histological analyses. Preliminary HR-MAS NMR results show a higher amount of lipids in the biopsies from patients with 30-50% of steatosis, whereas lipids and of small metabolites are present when the liver is affected from a market fibrosis.

2010 - Risonanza magnetica cardiaca [Monografia/Trattato scientifico]
Ligabue, Guido; Fiocchi, Federica
abstract

Valvulopatie

2010 - Sinus venosus atrial septal defect: the importance of multimodality approach [Articolo su rivista]
Malagoli, A; Barbieri, A; Pacini, D; Ligabue, Guido; Fiocchi, F; Modena, Maria Grazia
abstract

A multidisciplinary approach to congenital heart diseases in adults is a primary element for modern medicine. The diagnosis of a sinus venosus atrial septal defect is a typical example of disease that requires the different skills of the cardiologist, cardiac surgeon and radiologist

2009 - ANTIRETROVIRAL THERAPY AND LIPODYSTROPHY AS PREDICTORS OF SUB-CLINICAL ATHEROSCLEROSIS [Abstract in Rivista]
Guaraldi, Giovanni; N., Alexopoulos; Stentarelli, Chiara; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; A., Lattanzi; Rossi, Rosario; Modena, Maria Grazia; F., Palella; P., Raggi
abstract

Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HIV)-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging.

2009 - Abstract: P784 ANTIRETROVIRAL THERAPY AND LIPODYSTROPHY AS PREDICTORS OF SUB-CLINICAL ATHEROSCLEROSIS [Abstract in Rivista]
Guaraldi, Giovanni; N., Alexopoulos; Stentarelli, Chiara; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; A., Lattanzi; Rossi, Rosario; Mc, Modena; F., Palella; P., Raggi
abstract

Although antiretroviral therapy (ART) has prolonged survival in HIV-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of subclinical atherosclerosis as evaluated by coronary artery calcium imaging.

2009 - CORONARY AGEING IN HIV INFECTED PATIENTS [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; N., Alexopoulos; Ligabue, Guido; F., Fiocchi; Rossi, Rosario; Modena, Maria Grazia; F., Palella; P., Raggi
abstract

The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected patients based on the extent of coronary artery calcium (CAC) and to iden-tify the variables associated with it.

2009 - Chronic total coronary occlusion in patients with intermediate viability: value of low-dose dobutamine and contrast-enhanced 3-T MRI in predicting functional recovery in patients undergoing percutaneous revascularisation with drug-eluting stent. [Articolo su rivista]
Fiocchi, F; Sgura, F; Di Girolamo, A; Ligabue, Guido; Ferraresi, S; Rossi, Rosario; D'Amico, Roberto; Modena, Maria Grazia; Torricelli, Pietro
abstract

PURPOSE: Myocardial viability was evaluated by magnetic resonance imaging (MRI) in patients with chronic total coronary occlusion (CTO) treated with a drug-eluting stent. Change in left ventricular ejection fraction (LVEF) was analysed. MATERIALS AND METHODS: Twenty-three patients with CTO underwent delayed-enhancement (DE) and low-dose dobutamine MRI (LD). Diastolic wall thickness (DWT), dobutamine-induced systolic wall thickening (SWT) and DE transmural extension were quantitatively assessed in vessel-related segments, calculating the contribution of viable tissue to SWT, expressed as viability index (VI)=[SWTx(100 - DE)]/100. Patients with transmural enhancement were excluded from revascularisation. At 6 months follow-up, patients underwent coronary angiography (CA) and MRI. Functional recovery was defined as a 2-mm increase in SWT. RESULTS: Transmural enhancement (mean DE 62.88+/-37.18] was present in three patients. Mean DWT, SWT, VI and DE of recanalised patients were 8.03+/-2.35, 2.64+/-1.56, 1.77+/-1.48 mm and 41.97+/-30.32. Revascularisation was successful in 14/16. Follow-up CA showed patency of treated vessels. Functional recovery was achieved in 13 patients. Functional recovery showed significant correlation with SWT (beta 1,779, p=0.015), and even higher correlation with VI (beta 2.032, p=0.011). LVEF improved significantly [Delta 95% confidence interval (CI) -4.47, p=0.0203). CONCLUSIONS: Invasive CTO treatment has beneficial effects on myocardial contractility that can be predicted by VI, and on LVEF.

2009 - Coronary ageing in hiv-infected patients [Abstract in Rivista]
Alexopoulos, N; Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Fiocchi, F; Rossi, Rosario; Modena, Mc; Palella, F; Raggi, P.
abstract

The objectives of this study were to assess the coronary age of a cohort of HIV infected patients based on the extent of coronary artery calcium and to identify the variables associated with it.

2009 - Coronary aging in HIV-infected patients [Articolo su rivista]
Guaraldi, G.; Zona, S.; Alexopoulos, N.; Orlando, G.; Carli, F.; Ligabue, G.; Fiocchi, F.; Lattanzi, A.; Rossi, R.; Modena, M. G.; Esposito, R.; Palella, F.; Raggi, P.
abstract

BACKGROUND: Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated aging processes. We investigated whether the vascular age of a cohort of stable HIV-infected patients receiving antiretroviral therapy (ART) was increased and sought out predictors of increased vascular age. METHODS: In this cross-sectional study, 400 HIV-infected patients (mean age, 48 years) attending a cardiometabolic clinic underwent cardiac computed tomography imaging to identify coronary artery calcium (CAC). Vascular age was estimated on the basis of the extent of CAC by means of previously published equations. RESULTS: Increased vascular age was observed in 162 patients (40.5%), with an average increase of 15 years (range, 1-43 years) over the chronological age. In univariable analyses, chronological age, male sex, systolic blood pressure, duration of ART, fasting glucose level, fasting serum triglyceride level, total cholesterol level, low-density and high-density lipoprotein cholesterol levels, hypertension, and the presence of the metabolic syndrome were associated with increased vascular age. In multivariable linear regression analyses, current CD4+ cell count was the only predictor of increased vascular age (beta = 0.51; P = .005). CONCLUSIONS: Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4+ cell count. If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4+ cell count may become a marker of increased risk of atherosclerosis development.

2009 - Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease) [Articolo su rivista]
R., Marano; F. D., Cobelli; I., Floriani; C., Becker; C., Herzog; M., Centonze; G., Morana; G. F., Gualdi; Ligabue, Guido; G., Pontone; C., Catalano; D., Chiappino; M., Midiri; G., Simonetti; F., Marchisio; L., Olivetti; R., Fattori; L., Bonomo; A. D., Maschio; N. I., M.
abstract

This was a prospective, multicenter study designed to evaluate the utility of MDCT in the diagnosis of coronary artery disease (CAD) in patients scheduled for elective coronary angiography (CA) using different MDCT systems from different manufacturers. Twenty national sites prospectively enrolled 367 patients between July 2004 and June 2006. Computed tomography (CT) was performed using a standardized/optimized scan protocol for each type of MDCT system (> or =16 slices) and compared with quantitative CA performed within 2 weeks of MDCT. A total of 284 patients (81%) were studied by 16-slice MDCT systems, while 66 patients (19%) by 64-slice MDCT scanners. The primary analysis was on-site/off-site evaluation of the negative predictive value (NPV) on a per-patient basis. Secondary analyses included on-site evaluation on a per-artery and per-segment basis. On-site evaluation included 327 patients (CAD prevalence 58%). NPV, positive predictive value (PPV), sensitivity, specificity, and diagnostic accuracy (DA) were 0.91 (95% CI 0.85-0.95), 0.91 (95% CI 0.86-0.95), 0.94 (95% CI 0.89-0.97), 0.88 (95% CI 0.81-0.93), and 0.91 (95% CI 0.88-0.94), respectively. Off-site analysis included 295 patients (CAD prevalence 56%). NPV, PPV, sensitivity, specificity, and DA were 0.73 (95% CI 0.65-0.79), 0.93 (95% CI 0.87-0.97), 0.73 (95% CI 0.65-0.79), 0.93 (95% CI 0.87-0.97), and 0.82 (95% CI 0.77-0.86), respectively. The results of this study demonstrate the utility of MDCT in excluding significant CAD even when conducted by centers with varying degrees of expertise and using different MDCT machines.

2009 - Moving from risk factor assessment to atherosclerosis imaging to select the most appropriate patient for primary prevention [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; A., Roverato; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rossi, Rosario; Modena, Maria Grazia; P., Raggi
abstract

All HIV-infected adults should undergo coronary heart disease risk assessment with Framingham Risk Score /FRS) to guide preventive treatment intensity. The European Hypertension Guidelines (ESH-ESC) and the FRS are examples of algorithms used to identify people who qualify for primary prevention: clinical decision making is usually most uncertain in the intermediate risk category (10-20% 10year-risk of events) an in this group imaging for sub-clinical atherosclerosis has been shown to improve risk prediction. The purpose of this study was to identify people who qualify and not qualify for primary prevention for CVD according to ESH-ESC, NCEP.FRS and CAC-FRS across coronary calcium score strata in all HIV infected patients and in the subset of female and young patients (<55 yrs males and <65 if females)

2009 - Progression of subclinical atherosclerosis in HIV-infected patients [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Luzi, K; Esposito, R; Raggi, P.
abstract

Progression of subclinical atherosclerosis can accurately be assessed by sequential coronary artery calcium imaging on multidirector CT. Advancing atherosclerosis is associated with a high risk of cardiovascular events.

2009 - Relationship Between Arterial Stiffness, Assessed Using Pulse Wave Velocity and Coronary Artery Calcification Score as Assessed by 64 Multislice Computed Tomography [Abstract in Atti di Convegno]
DELLE DONNE, Grazia; Marchese, Procolo; DI GIROLAMO, Andrea; Fiocchi, Federica; Ligabue, Guido; Romagnoli, Renato; Rossi, Rosario; Modena, Maria Grazia
abstract

Relationship Between Arterial Stiffness, Assessed Using Pulse Wave Velocity and Coronary Artery Calcification Score as Assessed by 64 Multislice Computed Tomography

2009 - Survival into sixth decade of untreated pulmonary atresia with ventricular septal defect and major aorto-pulmonary collaterals: a magnetic resonance imaging study. [Articolo su rivista]
C., Ratti; L., Grassi; Ligabue, Guido; G. D., Casa; A., Barbieri; M., Gavioli; B., Bompani
abstract

A 56-year-old male with a history of untreated pulmonary atresia with ventricular septal defect diagnosed during childhood was referred to our institution for congestive heart failure. We describe the MR imaging findings that documented the presence of multiple aorto-pulmonary collaterals arising from the abdominal aorta and from the internal mammary artery supplying both pulmonary arteries. This is the oldest known surviving case documented in medical literature.

2009 - The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection [Articolo su rivista]
Rossi, Rosario; Nuzzo, A.; Guaraldi, Giovanni; Orlando, G.; Squillace, N.; Ligabue, Guido; Fiocchi, F.; Di Girolamo, A.; Romagnoli, R.; Modena, Maria Grazia
abstract

Patients with HIV infection have an increased mortality, largely attributable to coronary artery disease (CAD),1-3 and there is increasing evidence that these patients have more extensive coronary calcification than age-matched control subjects.4,5 The assessment of the risk to develop CAD is a challenge in patients with HIV infection because there are many aspects that contribute to generate it. It is well known that smoking habit is more frequent in patients with HIV infection; however, a citotoxic direct effect on myocardial cells (mediated by HIV) and the inflammatory reaction associated with HIV infection may play a role in the atherosclerotic process. In addition, the treatment with combination antiretroviral therapy (cART), despite the positive modification of the natural history of HIV infection, is associated with a variety of metabolic abnormalities that determine an increase of CAD risk. Therefore, there is the need to stratify the risk of coronary events in HIV patients, taking into account all the components cited above.

2009 - Vascular age as a marker of premature biological ageing in HIV-infected patients [Abstract in Atti di Convegno]
Guaraldi, G; Alexopoulos, N; Zona, S; Orlando, G; Carli, F; Ligabue, G; Rossi, R; Modena, Mg; Palella, F; Raggi, P.
abstract

Vascular age as a marker of premature biological ageing in HIV-infected patients

2009 - Visceral fat but not general adiposity is a predictor of sub-clinical atherosclerosis in HIV-infected patients with lipodystrophy. [Abstract in Rivista]
Guaraldi, Giovanni; Zona, Stefano; A., Roverato; Orlando, Gabriella; Carli, Federica; Ligabue, Guido; Rossi, Rosario; Modena, Maria Grazia; F. J., Palella; P., Raggi
abstract

General and visceral adiposity are associated with risk of cardiovascular disease. HIV lipodystrophy offers a unique patho-physiological model to study visceral adiposity, best described in the abdominal fat accumulation or mixed phenotypes, not necessarily associated with general adiposity. The object of this study was to evaluate the association of general adiposity and visceral adiposity with presence and extent of subclinical atherosclerosis as evaluated by coronary artery calcium imaging in HIV infected patients.

2008 - 3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer. [Articolo su rivista]
Torricelli, Pietro; Ferraresi, S; Fiocchi, F; Ligabue, Guido; Jasonni, Vm; DI MONTE, I; Rivasi, Francesco
abstract

The objective of our study was to evaluate the diagnostic accuracy of 3-T MRI in determining the depth of myometrial infiltration in patients with endometrial cancer.Fifty-two patients (43 postmenopausal) with histopathologically proven endometrial carcinoma underwent preoperative 3-T MRI. The following sequences were performed: axial T1 fast spin-echo (FSE); axial, parasagittal, and paracoronal T2 FSE; paracoronal 3D T1 inversion recovery gradient-echo after contrast administration; and parasagittal fat-suppressed T1 FSE. All patients underwent a hysterectomy. The MRI findings were compared with histopathology results. The quantity and degree of artifacts were evaluated.. MRI performed on a 3-T unit was in agreement with histopathology in assessing the depth of invasion in 86.4\% (44/52) of the patients with a mean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 83.5\%, 93.9\%, 77.8\%, 92.2\%, and 89.7\%, respectively. Performance values were also assessed for single stages of myometrial infiltration. For the detection of an intramucosal lesion (MRI, 12/52; histopathology, 6/52), sensitivity was 100\%; specificity, 86.9\%; PPV, 50\%; NPV, 100\%; and accuracy, 88.5\%. For the detection of myometrial infiltration that was less than 50\% (MRI, 12/52; histopathology, 16/52), sensitivity was 62.5\%; specificity, 94.4\%; PPV, 83.3\%; NPV, 85\%; and accuracy, 84.6\%. For the detection of myometrial infiltration that was greater than 50\% (MRI, 28/52; histopathology, 30/52), sensitivity was 93.3\%; specificity, 100\%; PPV, 100\%; NPV, 91.7\%; and accuracy, 96.2\%. The following artifacts were found: abdominal wall movement, nine patients (not affecting image quality); peristalsis, 16 patients (two deeply affecting, one affecting, and 13 scarcely affecting); magnetic susceptibility artifact, four patients (not affecting); chemical shift, 20 patients (four scarcely affecting and 16 not affecting); and dielectric effect, six patients (four deeply affecting and two affecting).In evaluating the depth of myometrial infiltration in patients with endometrial cancer, 3-T MRI showed high diagnostic accuracy-equivalent to that of 1.5-T MRI reported in the literature. Artifacts did not significantly affect image quality.

2008 - 3-Tesla MRI for the evaluation of myocardial viability: a comparative study with 1.5-Tesla MRI [Articolo su rivista]
Ligabue, Guido; Fiocchi, F; Ferraresi, S; Barbieri, A; Rossi, Rosario; Modena, Maria Grazia; Romagnoli, R; Torricelli, Pietro
abstract

PURPOSE: We compared 3-Tesla (3-T) and 1.5-Tesla (1.5-T) cardiac magnetic resonance imaging (MRI) for the assessment of myocardial viability in nearly identical experimental conditions. MATERIALS AND METHODS: Thirty-five patients (mean age 63+/-11; 94.2% men) submitted to primary coronary angioplasty underwent both 3-T and 1.5-T cardiac MRI, which was considered the gold standard. Comparison was performed on the basis of the same viability imaging protocol, which included resting cine-MR [balanced fast-field echo (B-FFE) sequence] followed by contrast-enhanced MR to evaluate perfusion and delayed enhancement (DE). We then performed functional index measurements and visual estimation of kinesis, perfusion and DE referring to a 5-point scale. Image quality was assessed on the basis of signal to noise ratio (SNR) and contrast to noise ratio (CNR). RESULTS: We found nonsignificant differences between the two scanners (P=NS) in measuring the functional and viability parameters. Myocardial SNR was significantly higher with 3-T MRI compared with 1.5-T MRI (61.3% gain). Even though a loss of CNR was recorded in B-FFE and in first-pass perfusion sequences (12.4% and 23.7%, respectively), on DE images, we quantified the increase of SNR and CNR of infarction of 387.8% and 330%, respectively. CONCLUSIONS: We found that 3-T MRI showed high concordance with 1.5-T MRI in the evaluation of functional and viability parameters and provided better evidence of damaged myocardium.

2008 - Association between arterial stiffness and aortic valve calcium score as assessed by 64 multislice computed tomography [Abstract in Atti di Convegno]
DELLE DONNE, Grazia; Marchese, Procolo; Di Girolamo, A; Fiocchi, F; Ligabue, G; Rossi, R; Romagnoli, R; Modena, Mg
abstract

Association between arterial stiffness and aortic valve calcium score as assessed by 64 multislice computed tomography

2008 - Cardiac delayed enhancement distribution in extralysosomial glycogen storage disease [Articolo su rivista]
Fiocchi, F; Ricci, C; Ligabue, Guido; Reggianini, L; Modena, Maria Grazia; Cenacchi, G; Torricelli, Pietro
abstract

We describe magnetic resonance (MR) aspect of cardiac glycogenesis in a 49-years old man, presented a progressively declining cardiac function and negative coronary angiography. Delayed enhancement MR confirmed non-ischemic pattern with unusual diffuse distribution of Gadolinium. Cardiac biopsy revealed a Glycogen Storage Disease, extralysosomial type. Cardiac MR with analysis of delayed enhancement distribution is an emerging tool that can discriminate between ischemic and non-ischemic diseases; however to identify the precise aetiology of a non-ischemic distribution, myocardial biopsy is still needed

2008 - Echocardiographic diastolic dysfunction and magnetic resonance infarct size in healed myocardial infarction treated with primary angioplasty [Articolo su rivista]
Barbieri, A; Bursi, F; Politi, L; Rossi, L; Fiocchi, F; Ligabue, Guido; Pingitore, A; Positano, V; Torricelli, Pietro; Modena, Maria Grazia
abstract

BACKGROUND: After acute myocardial infarction (MI) the severity of diastolic dysfunction by echocardiography represents an independent prognostic marker. However, the mechanisms whereby diastolic dysfunction portends an increased risk after MI are not fully understood. We investigated the relationship between echocardiographic diastolic dysfunction severity and infarct size quantitatively measured by contrast-enhanced magnetic resonance (ce-MR). METHODS: Cross-sectional prospective study. We quantified "healed" infarct size by ce-MR measuring the percentage of delayed enhancement with respect to left ventricular mass and diastolic function by Doppler echocardiography. Both exams were scheduled at least 1 month after a first acute ST segment elevation MI (STEMI) successfully treated with primary angioplasty and stenting. To increase the specificity, individual echocardiographic parameters were integrated to grade global diastolic function in 4 grades: normal diastolic function, impaired relaxation with normal, or near-normal filling pressures; impaired relaxation with moderate elevation of filling pressures, and impaired relaxation with marked elevation of filling pressures, "restrictive filling." RESULTS: We prospectively enrolled 52 patients (mean age 62 +/- 13 years, 77% men). ce-MR and echocardiography were performed 48 +/- 15 days after the MI. There was a significant but modest correlation between diastolic function grade and infarct size (r = 0.423, P = 0.002), which was independent of global and regional systolic function and persisted after further adjustment for age, sex, body surface area, left ventricular mass, end-diastolic volumes, and sphericity index (all P < 0.05). Among single echocardiographic variables, infarct size correlated best with tissue Doppler velocities Em (r =-0.307, P = 0.03), Am (r =-0.39, P = 0.005), and flow propagation velocity (r =-0.34, P = 0.015). CONCLUSIONS: In healed STEMI successfully treated with primary angioplasty and stenting, diastolic function grade was independently albeit weakly correlated with infarct size. Therefore, the increased risk of diastolic dysfunction after MI is not fully explained by infarct size

2008 - Evolution of Non-alcoholic Fatty Liver Disease in HIV-infected Patients: Incidence, Characteristics, and Predictors [Abstract in Atti di Convegno]
Guaraldi, Giovanni; N., Squillace; C., Stentarelli; G., Orlando; D'Amico, Roberto; Ligabue, Guido; F., Fiocchi; S., Zona; Esposito, Roberto; F., Palella
abstract

Non-alcoholic fatty liver disease (NAFLD) occurs among persons without chronic viral hepatitis or significant alcohol consumption. It presents often in the context of cardiovascular risk factors. Our objectives were to assess the incidence and predictors of NAFLD in HIV-infected HAART-experienced patients.

2008 - Follow-up of Unprotected Left Main Coronary Artery Stent Patency by 64-Slice Computed Tomography. Comparison Between Coronary Angiography, 64 Slice-CT and Intravascular Ultrasound (IVUS) [Abstract in Atti di Convegno]
Di Girolamo, A; Sgura, F; Chiurlia, E; Fiocchi, F; Ligabue, G; Rossi, R; Monopoli, D; Politi, L; Guerri, E; Modena, Mg
abstract

Follow-up of Unprotected Left Main Coronary Artery Stent Patency by 64-Slice Computed Tomography. Comparison Between Coronary Angiography, 64 Slice-CT and Intravascular Ultrasound (IVUS)

2008 - Maximum persisting single lead ST elevation after primary angioplasty: a good predictor of left ventricular dilatation assessed by magnetic resonance imaging [Articolo su rivista]
Barbieri, A; Bursi, F; Politi, L; Rossi, L; Fiocchi, F; Ligabue, Guido; Manicardi, C; Torricelli, Pietro; Modena, Maria Grazia
abstract

AIMS: To determine the frequency and predictors of left ventricular dilatation assessed by magnetic resonance imaging among patients with a first acute myocardial infarction treated with successful primary angioplasty and stent. METHODS AND RESULTS: Cine magnetic resonance imaging and late enhancement imaging were prospectively performed in 42 patients 1 month and more than 1 year after successful early reperfusion of a first acute ST elevation myocardial infarction (age 61 +/- 13 years, 76% men, 55% anterior myocardial infarction, and mean symptom-to-balloon time 199 +/- 130 min). Both at the 1-month and at the 15-month magnetic resonance imaging examinations, 57% of patients had left ventricular dilatation (end-systolic volume indexed &gt; 36 ml/m2, values above the upper 95th percentile based on magnetic resonance imaging reference values for left ventricular size in normal participants). The most accurate predictor of left ventricular dilatation was maximum persisting single lead ST elevation 60 min after reperfusion (area under the curve 0.81, P = 0.001). Maximum single lead ST elevation was significantly and independently associated with larger end-systolic volume indexed (beta = 0.35, P = 0.040) after adjusting for muscle and brain isoenzyme of creatine kinase and echocardiographic wall motion score index. CONCLUSION: More than half of patients with a first acute myocardial infarction have left ventricular dilatation despite successful primary coronary angioplasty. Maximum persisting single lead ST elevation 60 min after mechanical reperfusion represents a simple tool for predicting left ventricular dilatation.

2008 - Nonalcoholic Fatty Liver Disease in HIV-Infected Patients Referred to a Metabolic Clinic: Prevalence, Characteristics, and Predictors [Articolo su rivista]
Guaraldi, Giovanni; Squillace, N.; Stentarelli, Chiara; Orlando, Gabriella; D'Amico, Roberto; Ligabue, Guido; Fiocchi, Federica; Zona, Stefano; Loria, Paola; Esposito, Roberto; Palella, F.
abstract

BACKGROUND: The prevalence and predictors of nonalcoholic fatty liver disease (NAFLD) in human immunodeficiency virus (HIV)-infected highly active antiretroviral therapy-experienced patients and the association of NAFLD with risk of cardiovascular disease and subclinical atherosclerosis are unknown. METHODS: We performed a cross-sectional observational study. NAFLD was defined by liver-spleen attenuation values of <1.1 on computed tomography in persons who had neither evidence of chronic viral hepatitis nor a significant history of alcohol consumption. RESULTS: We enrolled 225 patients; 163 (72.4%) were men. Mean (+/-SD) HIV infection duration was 145 +/- 60 months, and mean (+/-SD) body mass index (calculated as weight in kilograms divided by the square of height in meters) was 23.75 +/- 3.59. NAFLD was diagnosed in 83 patients (36.9% of the total cohort). The following variables were significantly associated with NAFLD in univariate analyses: sex, waist circumference, body mass index, cumulative exposure to nucleoside reverse-transcriptase inhibitors, visceral adipose tissue, homeostasis model assessment of insulin resistance index, serum alanine and aspartate aminotransferase levels, and ratios of total serum cholesterol to high-density lipoprotein cholesterol. Coronary artery calcium scores and a diagnosis of diabetes were not associated with NAFLD. In multivariable logistic regression analyses, factors associated (P<0.001) with NAFLD were higher serum alanine to aspartate ratio (odds ratio, 4.59; 95% confidence interval, 2.09-10.08), male sex (odds ratio, 2.49; 95% confidence interval, 1.07-5.81), greater waist circumference (odds ratio, 1.07; 95% confidence interval, 1.03-1.11), and longer nucleoside reverse-transcriptase inhibitor exposure (odds ratio, 1.12 per year of exposure; 95% confidence interval, 1.03-1.22). CONCLUSIONS: NAFLD is common among HIV-infected persons who have the traditional risk factors for NAFLD (elevations in serum alanine level, male sex, and increased waist circumference) apparent. Exposure to nucleoside reverse-transcriptase inhibitors was an independent risk factor for NAFLD, with an 11% increase in the odds ratio for each year of use.

2008 - Subclinical coronary artery atherosclerosis and endothelial dysfunction are not predictors of erectile dysfunction in HIV-infected males [Abstract in Rivista]
Zona, Stefano; Luzi, Kety; Murri, R.; Granata, A.; Orlando, Gabriella; Squillace, Nicola; Ligabue, Guido; Rochira, Vincenzo; Rossi, Rosario; Guaraldi, Giovanni
abstract

To evaluate the association between erectile dysfunction and subclinical coronary artery atherosclerosis to endothelial dysfunction in HIV-infected people.

2007 - Biofilm on artificial surfaces [Articolo su rivista]
Cappelli, Gianni; Ricardi, Marco; Ravera, Federica; Ligabue, Guido; M., Ballestri; D., Bonucchi; Bondi, Moreno
abstract

Biofilms are microbial communities quite different from planktonic cells and most of common microbiological concepts had to be updated in recent years. The peculiar capacity to resist to disinfectants and antibiotics results in biofilms being a public health problem mainly when modern medical devices are used. All artificial surfaces used in medicine may be prone to biofilm attachment and could therefore represent a cause of acute or chronic infectious diseases. Uremic patients are at higher risk from biofilms as not only traditional causes, such as indwelling catheters, but also hemodialysis apparatuses contribute to bacteria] exposure. Chemical or physical disinfections have been demonstrated partially active on sessile microorganisms and biofilm avoidance remains the goal to assure an adequate quality of dialytic treatment

2007 - Come quantificare l’estensione dell’infarto sulle immagini di delayed enhancement in risonanza magnetica: paragone tra approccio visuale e quantitativo. // How to quantify infarct size on delayed-enhancement MR images: a comparison between visual and quantitative approach. [Articolo su rivista]
Ligabue, Guido; Fiocchi, F; Ferraresi, S; Barbieri, A; Romagnoli, R; Torricelli, Pietro
abstract

Come quantificare l’estensione dell’infarto sulle immagini di delayed enhancement in risonanza magnetica: paragone tra approccio visuale e quantitativo. // How to quantify infarct size on delayed-enhancement MR images: a comparison between visual and quantitative approach.

2007 - Comparison of 64-slice computed tomography with conventional coronary angiography for the detection of in-stent restenosis in the left main coronary artery [Abstract in Atti di Convegno]
Chiurlia, E; Sgura, Fa; Di Girolamo, A; Guerri, Elisa; Fiocchi, F; Ligabue, G; Modena, Mg
abstract

Comparison of 64-slice computed tomography with conventional coronary angiography for the detection of in-stent restenosis in the left main coronary artery

2007 - Does 16-slice multidetector computed tomography improve stent patency and in-stent restenosis evaluation? [Articolo su rivista]
Ligabue, Guido; Fiocchi, F; Ferraresi, S; Rossi, Rosario; Modena, Maria Grazia; Ratti, C; Torricelli, Pietro; Romagnoli, R.
abstract

To assess the value of multidetector computed tomography (MDCT) in the non-invasive evaluation of stents.We studied 88 patients (142 stents): 48 with 1.2-mm MDCT, 40 with 0.6-mm MDCT considering accuracy in assessing the vessel lumen, stent patency and intra-stent restenosis. Coronary angiography comprised the gold standard.Occlusion was detected, respectively, in three of 72 versus four of 70 cases. Patency was assessed in all cases. In-stent restenosis was diagnosed in two of eight cases with thin-slice MDCT.0.6-mm MDCT allows a better visualization of stent lumen and in-stent restenosis versus 1.2-mm MDCT.

2007 - Role of low-dose dobutamine and contrast enhanced cardiac MRI to predict functional recovery in patients with chronic coronary total occlusion and benefits of percutaneous revascularization. MRI, coronary angiography and clinic follow up at 6 months after successful PCI intervention [Abstract in Atti di Convegno]
Sgura, Fa; Di Girolamo, A; Fiocchi, F; Guerri, E; Ligabue, G; Leuzzi, C; Modena, M.
abstract

Role of low-dose dobutamine and contrast enhanced cardiac MRI to predict functional recovery in patients with chronic coronary total occlusion and benefits of percutaneous revascularization. MRI, coronary angiography and clinic follow up at 6 months after successful PCI intervention

2006 - Comparative evaluation between external phased array coil at 3 T and endorectal coil at 1.5 T - Preliminary results [Articolo su rivista]
Torricelli, Pietro; Cinquantini, F; Ligabue, Guido; Bianchi, Giampaolo; Sighinolfi, P; Romagnoli, R.
abstract

Objective: The aim of this study was to compare the image quality and the diagnostic accuracy of endorectal coil 1.5 T MRI (erMRI) and phased-array coil 3 T MRI (3-T MRI) in the pretherapeutic staging of prostate cancer. Methods: Twenty-nine consecutive patients, with pathological proven prostate cancer, have been examined in the same week with both erMRI and 3-T MRI. Two radiologists independently evaluated the image quality focusing on the following points: cancer tissue conspicuity, capsular infiltration and tumor involvement of seminal vesicles, neuro-vascular bundles, and apex. The radiologists assigned to each one of the above findings an image-quality score ranging from 1 to 5 (with 1 meaning not visible, 2 poorly visible, 3 fairly visible, 4 well visible with some artifacts, and 5 clearly visible without artifacts). Afterwards a comparative evaluation of the mean score obtained respectively by erMRI and 3 T MRI was done. Twenty-two of these 29 patients underwent radical prostatectomy. Assuming as gold standard the pathological report from the resected specimen, we compared the diagnostic accuracy of 3TMRI and erMRI in differentiating between tumors confined within the prostate gland (stage &lt;= T2) and tumors extending through the prostatic capsule (stages T3 and T4). Results: erMRI's image quality was found to be statistically significantly better than 3 T MRI's in evaluating tumor conspicuity, capsular infiltration, and seminal vesicles involvement. On the other hand, considering apex and NVB involvement no statistically significant difference was found between the 2 techniques. On the diagnosis of intracapsular or extracapsular tumor spread 3 T MRI and erMRI showed a comparable performance of sensitivity (75% vs. 83%), specificity (90% vs. 90%), positive predictive value (90% vs. 90%), and negative predictive value (75% vs. 81%). Conclusions: During preoperative prostate cancer staging, 3 T MRI, despite a slightly worse image quality, can provide comparable diagnostic information to erMRI.

2006 - Coronary calcification in cardiovascular risk stratification [Articolo su rivista]
Ratti, C; Chiurlia, E; Grimaldi, T; Malagoli, A; Ligabue, Guido; Modena, Maria Grazia
abstract

The correlation between coronary calcifications and subclinical atherosclerotic disease has been well known for some years now. Today we are able to quantify coronary calcium deposits, the calcium score, by means of new imaging techniques such as electron beam computed tomography and multislice spiral computed tomography. A large number of studies performed using these methods has confirmed the association between coronary calcifications and atherosclerotic disease and has opened up the possibility of early diagnosis of any subclinical atherosclerotic disease in various subpopulations such as diabetics and nephropatics. The etiopathogenesis of coronary calcium has not yet been made clear; it appears to be an active process similar to bone formation that involves cells similar to those involved in the reabsorption of bone matrix. The calcium score, therefore, provides physicians with a further diagnostic tool able to better determine cardiovascular risk patients and supplements the Framingham risk score. International guidelines have not yet illustrated with any precision in which ambits to apply screening for the quantification of coronary calcium and consequently, for the time being, the use of such methods must be restricted to cases in which the possibility of any benefit can be scientifically shown. This review represents the state of the art on coronary calcification and its role in clinical practice.

2006 - Le neovesciche ileali nei pazienti sottoposti a cistectomia radicale. Valutazione con TC multidetettore (MD-TC) dei quadri normali e delle complicanze [Reconstructed urinary bladder following radical cystectomy for bladder cancer. Multidetector CT evaluation of normal findings and complications] [Articolo su rivista]
Caproni, N; Ligabue, Guido; Mami, E; Torricelli, Pietro
abstract

Purpose. The aim of this paper is to report the normal and pathological multidetector computed tomography (MDCT) findings in the morphofunctional evaluation of the orthotopic ileal reservoir in patients treated with radical cystectomy for transitional cell carcinoma. Materials and methods. During a clinical and imaging follow-up of 43 months, 30 patients (27 men and three women) with prior cystectomy and urinary reconstruction with an orthotopic ileal neobladder [six Studer and 24 Paduan Heal Bladder (VIP)] underwent multislice CT scan with multiplanar reconstruction (MPR), volume rendering and virtual endoscopic evaluation of the contrast-filled neobladder. The following CT data were considered: neobladder position within the pelvis, neobladder capacity, sphericity index, vesico-urethral angle, vesico-ureteral reflux, pseudo-diverticular herniation, visualisation of ileal folds and parietal thickness. The CT scan results were correlated with those of the urodynamic assessment (uroflowmetry and enterocystometry). Results. Right-sided dislocation was observed in 12/30 neobladders (six VIP and six Studer); mean capacity was around 254 ml; six VIP were spherical whereas the others were oval. The vesico-urethral angle was less than 90 degrees in five patients (normal range: 90 degrees-170 degrees). One patient had grade-3 unilateral, passive, vesico-ureteral reflux and nine patients had active or passive bilateral reflux. One patient had pseudo-diverticular herniation. The ileal folds in the afferent limb of the neobladder could be visualised in all six patients with Studer neobladders. Mean parietal thickness was 3.59 mm (SD 1.34 mm). Increased endoluminal pressure, evaluated by uroflowmetry, was associated with lateralisation of the new reservoir during straining in nine patients, with decreased neobladder capacity in six patients, vesico-ureteral reflux in five patients and pseudo-diverticular herniation in one case. Decreased urinary flow was correlated with vesico-urethral angle less than 90 degrees in four patients and with low sphericity index in five patients. No significant correlation was found between parietal thickness, presence of ileal folds and urodynamic data. Absorbed dose due to the two additional scans of our CT protocol was 10 mSv for 4-row CT and 15 mSv for 16-row CT. Conclusions. MDCT of the contrast-filled neobladder is useful for the morphological and, in part, functional evaluation of the neobladder during postoperative follow-up and helps detect surgical complications. Radiation protection concerns do not, however. support the routine use of the method, even if the MDCT data are in part correlated to the urodynamic data and may in many cases provide a morphological explanation to the presence of functional alterations.

2006 - Multislice computed tomography for assessing coronary calcification and the aetiology of dilated cardiomyopathy [Abstract in Rivista]
Rossi, R; Nuzzo, Anna Chiara; Ligabue, Guido; Pecchi, Ar; Romagnoli, R; Modena, Maria Grazia
abstract

ND

2006 - Screening for silent ischemia with coronary artery calcium and nuclear stress testing in nondiabetic patients prior to kidney transplant. [Articolo su rivista]
E., Ferramosca; A. D., Felice; C., Ratti; Ligabue, Guido; D., Ibrahim; Modena, Maria Grazia; R., Romagnoli; B., Bagni; A., Albertazzi; P., Raggi
abstract

Whether coronary artery calcium (CAC) screening in pretransplant patients may help predict silent myocardial ischemia is unknown. Accordingly, we performed CAC imaging on 46 nondiabetic patients awaiting kidneytransplant. All patients underwent multidetector computed tomography imaging for CAC quantification, and a vasodilator myocardial perfusion stress (MPS) test was performed only in patients with a total CAC score>300 or>100 in a single coronary artery. The mean patient's age was 46+/-14 years and the median dialysis vintage was 33 months (interquartile range 19-53). The median CAC score was 82 (interquartile range 0-700) and correlated with patients' age (p=0.006) and dialysis vintage (p=0.02). Nineteen patients qualified for MPS, but 5 refused the test. Of the remaining 14 patients, 7 patients had normal scans and 7 showed a minimal perfusion defect in the inferoposterior segment of the left ventricle. At the time of writing, 12 patients have undergone successful kidney transplantation without untoward complications. CAC screening does not appear to be associated with silent ischemia in pretransplant patients. Though CAC is extensive in dialysis patients, calcium may be associated with nonobstructive atherosclerotic lesions or calcification of the media layer of the vessel wall.

2005 - Correlation between coronary calcification and endothelial dysfunction in asymptomatic subjects at risk of coronary artery disease [Abstract in Rivista]
Rossi, Rosario; Turco, V; Ratti, C; Ligabue, Guido; Romagnoli, R; Modena, Maria Grazia
abstract

Annual Congress of the American College of Cardiology

2005 - Non-invasive diagnosis of acute ischemic bowel disease detected as hepatic portal venous gas during intra-aortic balloon percutaneous counterpulsation [Articolo su rivista]
Grimaldi, T; Barbieri, A; Ratti, C; Ligabue, Guido; Romagnoli, R; Modena, Maria Grazia
abstract

The authors report a very unusual case of non-invasive diagnosis of acute ischemic bowel disease detected as hepatic portal venous gas during intra-aortic balloon percutaneous counterpulsation. A 64-year-old man with acute ST-elevation myocardial infarction complicated by cardiogenic shock was treated with percutaneous angioplasty and intra-aortic balloon percutaneous counterpulsation. The post-procedural period was complicated by severe abdominal pain. Abdominal computed tomography revealed hepatic portal venous gas. Multiple kidney and splenic ischemic areas were also identified. Colonoscopy showed signs referring to acute ischemic colitis. Computed tomography detection of hepatic portal venous gas has permitted the non-invasive diagnosis of bowel necrosis.

2005 - Non-invasive, three-dimensional visualization of coronary artery bypass grafts by multislice spiral computed tomography [Articolo su rivista]
Ratti, C; Barbieri, A; Ligabue, Guido; Grimaldi, T; Chiurlia, E; Rossi, Rosario; Modena, Maria Grazia
abstract

...

2004 - Different post-processing protocols in routine cardiac multislice CT examination [Articolo su rivista]
Ligabue, G.
abstract

2004 - Noninvasive assessment of coronary artery bypass graft patency by multislice computed tomography. [Articolo su rivista]
Rossi, Rosario; E., Chiurlia; C., Ratti; Ligabue, Guido; R., Romagnoli; Modena, Maria Grazia
abstract

Follow-up of coronary artery bypass after cardiac surgery is routinely performed by means of X-ray coronary angiography. However, this is an invasive procedure, expensive and includes ionizing radiation exposure, hospitalization and a small risk of complications. Multislice computed tomography is a noninvasive diagnostic tool that permits the visualization of the cardiac structures, including the coronary arteries. The purpose of our study was to compare multislice computed tomography with conventional angiography for the evaluation of graft patency following cardiac surgery.Forty-seven asymptomatic patients (44 men and 3 women, mean age 67 +/- 7 years) who had undergone coronary bypass surgery at least 10 years previously, were retrospectively investigated by means of ECG-gated multislice computed tomography, within 6 months of coronary angiography.Overall, 116 out of the possible 127 (91.4\%) grafts were assessable at computed tomography, including 87 saphenous vein grafts, 26 left internal mammary artery, 2 right internal mammary artery, and 1 gastroepiploic artery. Coronary angiography showed that 79 of 116 grafts (68.1\%) were patent and that 37 (31.9\%) were occluded. All grafts which were patent and occluded at coronary angiography were correctly identified at multislice computed tomography, with a sensitivity and specificity of 100\%.Multislice computed tomography with retrospective gating permits an accurate and noninvasive evaluation of coronary artery bypass patency, and could replace conventional angiography for the follow-up of asymptomatic, stable patients.

2004 - Noninvasive evaluation of coronary artery stents patency after PTCA: role of Multislice Computed Tomography. [Articolo su rivista]
Ligabue, Guido; Rossi, Rosario; C., Ratti; M., Favali; Modena, Maria Grazia; R., Romagnoli
abstract

Restenosis of a coronary artery treated with stent implantation is a well-known process that can compromise over time the success of a coronary angioplasty and, accordingly, treated patients must undergo periodic controls. We have recently witnessed a shift towards a greater use of Multi-slice CT (msCT) in the study of coronary disease without its precise indications and limits having yet been underlined. The purpose of our study is to assess the role of msCT in the follow-up of patients treated with coronary angioplasty.Forty-eight patients, for a total of 72 lesions, who underwent treatment with a slotted tube stent implant, had an msCT examination 1 week before scheduled coronary angiography, and the results were compared. 34 stents/72 (47.2\%) were inserted on the left anterior descending; 21/72 (29.2\%) on the right coronary; 17/72 (23.6\%) on the circumflex artery or obtuse marginal branches.The observation of the opacification of the vessel located distally to treated segments allowed us to assess the patency of all stents. Coronary angiography identified a significant intrastent restenosis or a stent occlusion in 12 of the 72 stents analysed (16.7\%). msCT enabled easier visualization of the lumen of the treated artery and its differentiation from the stent struts in the ones located on the left anterior descending artery than those on the circumflex (28 stents out of 34 [82.4\%] vs 13/17 [76.5\%]; p&lt;0.05), and on the right coronary artery, which were difficult to evaluate (11/21 [52.4\%]). We were also able to visualize the lumen of 14/15 stents with a calibre over 3.5 mm [93.3\%] vs 35/45 stent with dimensions between 3.1 e 3.4 mm [77.8\%], and only 4 stents &lt;3 mm/12 [33.3\%]. On multivariate analysis, the characteristics that were significantly and independently associated with accurate visualization of the lumen of a stented vessel were location on the proximal anterior descending artery (OR 4.03 [IC 95\%: from 2.34 to 8.05]; p&lt;0.0001) and stent size of &gt;3.5 mm (OR 2.97 [IC 95\%: from 1.67 to 4.86]; p&lt;0.01).The msCT technology available at present makes the study of smaller stents and those positioned on the right coronary artery and circumflex rather complex; on the other hand msCT appears a promising study method for stents greater then 3.5 mm and for those positioned on the proximal segment of the left anterior descending artery.

2004 - Three-Tesla cardiac magnetic resonance imaging in a Marfan patient with asymptomatic aortic dissection. [Articolo su rivista]
Chiurlia, E.; Menozzi, M.; Ligabue, Guido; Romagnoli, Renato; Modena, Maria Grazia
abstract

ND

2003 - Associazione di calcificazioni arteriose mammarie, valutate con mammografia e calcificazioni arteriose coronariche quantificate con Tomografia Computerizzata multistrato in una popolazione di donne in postmenopausa [Articolo su rivista]
Pecchi, Annarita; Rossi, Rosario; Coppi, Francesca; Ligabue, Guido; Modena, Maria Grazia; Romagnoli, Renato
abstract

Purpose. To assess the correlation between the presence and extent of breast arterial calcifications (BAC) detected at mammography and the extent of coronary atherosclerosis, as evaluated by multislice computed tomography (MSCT) coronary calcium quantification in a population of post-menopausal women. Materials and methods. Seventy-four post-menopausal women aged under 65 years who had undergone mammography at our Department were studied by MSCT for coronary calcium quantification. The mammograms were screened for vascular calcifications which were graded according to severity and extension. The presence of coronary artery calcifications was assessed by MSCT using the «Smart Score» cardiac reconstruction software. The data obtained were analyzed using the statistical package SPSS (version 10.1) for Windows. Results. The presence and severity of breast arterial calcifications showed a strong correlation with coronary calcifications in both models. Discussion and conclusions. The study demonstrated that the presence of BAC is strongly correlated with the amount of coronary calcium detected by MSCT and therefore with the extent of coronary atherosclerosis. Moreover, there is a linear correlation between BAC severity and coronary calcium content, each incremental increase in BAC severity being associated with an average increase in coronary calcium content. Therefore, the presence and severity of BAC may provide indirect qualitative and quantitative information on the calcium present in the coronaries. As mammography is increasingly used as a screening test for breast carcinoma, breast arterial calcifications may represent an important sign with epidemiological and clinical significance for primary prevention.

2003 - Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease [Articolo su rivista]
Fabbri, Leonardo; M., Romagnoli; L., Corbetta; G., Casoni; K., Busljetic; G., Turato; Ligabue, Guido; A., Ciaccia; M., Saetta; A., Papi
abstract

To determine whether patients with fixed airflow obstruction have distinct pathologic and functional characteristics depending on a history of either asthma or chronic obstructive pulmonary disease (COPD), we characterized 46 consecutive outpatients presenting with fixed airflow obstruction by clinical history, pulmonary function tests, exhaled nitric oxide, sputum analysis, bronchoalveolar lavage, bronchial biopsy, and high-resolution computed tomography chest scans. Subjects with a history of COPD (n = 27) and subjects with a history of asthma (n = 19) had a similar degree of fixed airflow obstruction (FEV1: 56 +/- 2 versus 56 +/- 3% predicted) and airway hyperresponsiveness (PC20FEV1: 2.81 [3.1] versus 1.17 [3.3]). Subjects with a history of asthma had significantly more eosinophils in peripheral blood, sputum, bronchoalveolar lavage, and airway mucosa; fewer neutrophils in sputum and bronchoalveolar lavage fluid; a higher CD4+/CD8+ ratio of T cells infiltrating the airway mucosa; and a thicker reticular layer of the epithelial basement membrane. They also had significantly lower residual volume, higher diffusing capacity, higher exhaled nitric oxide, lower high-resolution computed tomography scan emphysema score, and greater reversibility to bronchodilator and steroids. In conclusion, despite similar fixed airflow obstruction, subjects with a history of asthma have distinct characteristics compared with subjects with a history of COPD and should be properly identified and treated.

2003 - Evaluation of coronary artery disease by multislice spiral computed tomography in dialysis patients [Abstract in Atti di Convegno]
Ferramosca, E; Malaguti, V; Di Felice, A; Magistroni, R; Ratti, C; Modena, Mg; Ligabue, G; Romagnoli, R; Bagni, B; Albertazzi, A.
abstract

Evaluation of coronary artery disease by multislice spiral computed tomography in dialysis patients

2003 - Quantificazione del calcio coronarico (calcium score) attraverso l'utilizzo di nuove tecniche di imaging e suo ruolo prognostico in vari sottogruppi di pazienti [Articolo su rivista]
Ratti, Carlo; Grimaldi, Teresa; Ligabue, Guido; Favali, Marco; Bursi, Francesca; Rossi, Rosario; Modena, Maria Grazia; Romagnoli, Renato
abstract

Coronary artery disease is the first cause of mortality in industrialized countries notwithstanding the diagnostic and therapeutic progresses. Electron beam computed tomography and multislice computed tomography with calcium score software seem to have an important role in the early diagnosis of coronary artery disease. Coronary calcium is associated with a high probability of subclinical atherosclerosis. In particular the area of calcification has a positive correlation with the histologically analyzed area of the atheromatous burden plaque. The pathophysiological mechanism may be that the calcium adherent to the plaque makes unstable the plaque with possible rupture. Several studies have analyzed the predictive value of calcium score in various subgroups of patients (asymptomatic, with chest pain, with diabetes) and they have confirmed the presence of large calcific deposits in subjects with a high cardiovascular risk. The correlation of the other risk factors with calcium score is unclear and whether this is due to genetic predisposition requires further investigation. © 2003 CEPI Srl.

2003 - Type IV dual left anterior descending coronary artery evaluated using multislice computed tomography: Anatomy of a rare coronary anomaly [Articolo su rivista]
Chiurlia, Emilio; Ligabue, Guido; Ratti, Carlo; Modena, Maria Grazia
abstract

Images in cardiovascular medicine Type IV dual left anterior descending coronary artery evaluated using multislice computed tomography: anatomy of a rare coronary anomaly

2001 - Pulse inversion US with echographic contrast media (Levovist®) in the evaluation of hepatic metastases [Articolo su rivista]
Giovagnoni, A.; Martegani, A.; Aiani, L.; Ligabue, G.; Romagnoli, R.; Del Favero, C.
abstract

Purpose. To evaluate if Pulse Inversion Harmonic Imaging with contrast agent injection (Levovist) is able to determine an increase of echogenicity in normal hepatic parenchyma, and to compare its capability to detect metastatic focal lesions with that of standard US and spiral CT. To define and standardize the technical and methodological aspects of this new technique. Material and methods. A selected group of 72 patients (42 males and 30 females) with clinical and instrumental suspect of hepatic metastatic lesions was included in the prospective study. Each patient was examined by conventional ultrasound (US), Pulse Inversion Harmonic Imaging (PI) and spiral-CT (spCT). US examination was performed using an HDI 5000 (ATL, Bothell, USA) equipped with a broadband probe (5,0-2,0 MHz). 2.5 g Levovist® (Schering AG-Berlin) was administered intravenously, at concentration of 300 mg/ml and a flow rate of 7 ml/min. Video clips obtained with the acquired images before and after contrast medium administration were transferred to a magnet optic disk unit. Examinations were evaluated by an experienced radiologist blindly on a workstation that allowed a qualitative-quantitative analysis. SpCT images were evaluated separately by another experienced radiologist. US images were evaluated qualitatively (number of lesions, site of lesion, diameter of the smallest lesion detectable) and quantitatively (increase in parenchymal echogenicity 20″, 40″, 60″ and 5′ after the injection of contrast agent). Results. In all cases examined, the echogenicity of normal hepatic parenchyma increased after contrast agent administration, reaching a peak of about 250% (1DS) at 60 s and decreasing gradually in 5 minutes. Conventional US detected 195 focal lesions, CT 231, and US with pulse inversion technique and contrast agent (US-PI) 287. Mean differences among the number of lesions detected by the different techniques per each patient were also calculated. Wilcoxon Signed Rank Test showed a statistically significant difference between US-PI and US (p&lt;.0001), CT and US (p=.0052) and US-PI and CT (p=.0121). US-PI detected the smallest lesions, which went undetected by the CT and conventional US examinations. Discussion and conclusions. In 10 cases (14.3%) contrast enhanced US-PI demonstrated the presence of a number of lesions greater than 5 (diffuse metastatization and inoperability) in comparison to that detected by spCT). The greater echogenicity of normal hepatic parenchyma using pulse inversion technique after Levovist infusion allowed to better demonstrate hepatic metastases. This technique showed a higher identification rate of small lesions in comparison to basal examination and to spiral CT. Contrast enhanced US-PI demonstrated a remarkable increase in echogenicity of hepatic parenchyma in portal phase. The technique significantly improves the detection of focal lesions allowing visualization of smaller lesions compared to CT and US. These results indicate that the technique could be used in the staging of liver metastasis. However, large multicentric trials are required to validate US-PI and better define its role in the work-up of patients with neoplastic disorder.

1999 - Cine risonanza magnetica con dobutamina dopo infarto del miocardio [Articolo su rivista]
Giovagnoni, Andrea; Ligabue, Guido; Rossi, Rosario; Muia, Nicola; Modena, Maria Grazia; Romagnoli, Renato
abstract

Purpose: Dobutamine Cine MRI is a new diagnostic imaging technique in the pretreatment (revascularization) assessment of myocardial infarction patients. We report the results of a comparative study of the diagnostic yield of dobutamine Cine MRI with that of stress echocardiography in the assessment of viable myocardium. We also propose a new method for analysis of Cine MR images, employing digital subtraction, aimed at decreasing subjectivity in the quantitative assessment of myocardial wall thickening. Materials and methods. Twenty-six patients (21 men and 5 women) with a history of myocardial infarction who were scheduled for revascularization were submitted to stress echocardiography and dobutamine Cine MRI to evaluate contractile recovery of the segments considered akinetic or hypokinetic at baseline echocardiography. Dobutamine was administered in growing doses (5, 10, 15 γ/kg/min). We considered 16 segments of the left ventricle in each patient. We performed a quantitative analysis of systolic wall thickening on individual Cine MR frames both by manual measurements and by digital subtraction. Results. In the 416 segments studied, we found 307 normokinetic, 64 scarred and 45 viable segments with stress echocardiography, versus 302 normokinetic, 83 scarred and 31 viable segments with dobutamine MRI. Wall thickening analysis on Cine MR images showed 268 normal, 68 scarred and 80 viable segments, versus 274 normal, 58 scarred and 84 viable segments with digital subtraction. Three months after revascularization 15 patients were examined to check contractile recovery of the segments considered as viable. Echocardiography had 79% sensitivity and 97% specificity, while Cine MRI had 96% and 86%, respectively. Quantitative assessment of systolic wall thickening by Cine MRI and digital subtraction had 96% sensitivity and 91% specificity, with no statistically significant differences between the two techniques. In patients with anteroseptal wall myocardial infarction stress echocardiography had 75% sensitivity and 97% specificity. In the subgroup of 13 patients with diaphragmatic or inferior wall infarction echocardiography sensitivity dropped to 68%, versus 96% of Cine MRI, but its specificity was higher namely 97% versus 86%. Conclusions. In anteroseptal infarction, echocardiography permits to distinguish viable myocardium and scarred myocardial tissue with good sensitivity and specificity, but Cine MRI performs better. In infero-lateral or diaphragmatic infarction, Cine MRI has much higher sensitivity than stress echocardiography and thus makes the technique of choice to evaluate viable myocardium in these sites. The digital subtraction technique is as accurate as manual measurements, but reduces the error rate and permits quicker evaluation, particularly in subendocardial thickening.

1997 - Correlations between the FAB phenotype and differentiation potential in leukemic myelopoiesis [Relazione in Atti di Convegno]
Manfredini, R.; Trevisan, F.; Grande, A.; Tagliafico, E.; Montanari, M.; Pignatti, E.; Ligabue, G.; Barbieri, D.; Ferrari, Se.
abstract