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

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2021 - Body composition and inflammation impact in non-small cell lung cancer patients treated by first-line immunotherapy [Articolo su rivista]
Baldessari, Cinzia; Pecchi, Annarita; Marcheselli, Raffaella; Guaitoli, Giorgia; Bonacini, Riccardo; Valoriani, Filippo; Torricelli, Pietro; Reverberi, Linda; Menozzi, Renata; Pugliese, Giuseppe; Vitale, Maria Giuseppa; Sabbatini, Roberto; Bertolini, Federica; Barbieri, Fausto; Dominici, Massimo

Lay abstract Inflammation and malnutrition in cancer patients may affect the immune system and response to therapy. We noticed an increase in inflammation and visceral fat and a decrease in muscle and subcutaneous fat during therapy. No variation showed a significant correlation with survival. Muscle mass, adipose tissue and body mass index do not confirm any prognostic impact or relationship with response to therapy. More interesting results were observed with parameters related to inflammation. Probably, for the best treatment choice, a combination of clinical and biological factors will be necessary. Further studies with a multidimensional approach are needed to propose the best treatment and the best support to everyone.Tweetable abstract Body composition, nutritional and inflammatory status changed during first-line immunotherapy on NSCLC patients. Inflammation has interesting prognostic implications. Combined with other factors, these clinical characteristics may be important to optimize the care of patients.Background: Immunotherapy changed the landscape of non-small cell lung cancer (NSCLC). Efforts were made to implement its action. This study aims to describe body composition, nutritional and inflammatory status in NSCLC patients treated by first-line immunotherapy, their correlation, variation and impact. Patients and methods: We retrospectively analyzed 44 consecutive patients who received pembrolizumab treatment. Results: During the therapy, inflammation and visceral fat increased, whereas muscle and subcutaneous fat decreased. Parameters related to inflammation had an interesting prognostic impact. High numbers of white blood cells remained significantly correlated with a high risk of death in multivariate model. Conclusion: For the best treatment choice, a combination of clinical and biological factors will be most likely be necessary. Prospective and larger studies with a multidimensional approach are needed.

2021 - Clinical-diagnostic relevance of breast 'incidentaloma' detected during 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography: Correlation with radiological imaging and histopathology [Articolo su rivista]
Panareo, S.; Urso, L.; Nieri, A.; Caracciolo, M.; Valpiani, G.; Torricelli, P.; Frassoldati, A.; Cittanti, C.; Rollo, M.; Bartolomei, M.

Aim: This study aims to study the clinical-diagnostic relevance of incidental breast uptake ('incidentaloma') on 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan performed for other indications and to correlate it with radiological imaging and histopathology. Materials and Methods: We retrospectively evaluated 3675 FDG-PET scans, identifying 43 patients with breast 'incidentaloma.' Thirty of these findings were further investigated with clinical examination, mammography (MMX), UltraSound (US) and/or magnetic resonance (MR). Cases suspected for malignancy underwent US-guided macro-biopsy (USMB) or MR-guided biopsy. Correlations between FDG-PET, radiology findings, age, and histopathology were evaluated. Results: patients who performed both US and MMX were 19. Ten consequently underwent USMB, one MR-guided biopsy, the remaining 8 were not further investigated. Nine patients had a diagnosis of malignancy. Among 11 patients who performed only US and consequently, USMB 6 had a diagnosis of malignancy. Histopathology of the 22 patients with both morphological and glucometabolic alterations showed different types of benign or malignant neoplasia, with a cumulative 68.2% incidence of malignancy. Seven lesions showed a SUV max >2.5, while the remaining 15 a SUV max <2.5. There was no statistically significant correlation between SUV max and histology, therefore SUV max parameter should not be used to discriminate between benign and malignant findings. No significant correlation between patient age and tumor characterization was found. Conclusions: incidental mammary uptake during an FDG-PET scan may represent a clue suggesting to investigate PET findings. In this subset of patients, early diagnosis may lead to a change in clinical management with a favorable impact on prognosis and a significant reduction in healthcare costs.

2021 - Dynamic angiopoietin-2 assessment predicts survival and chronic course in hospitalized patients with COVID-19 [Articolo su rivista]
Villa, E.; Critelli, R.; Lasagni, S.; Melegari, A.; Curatolo, A.; Celsa, C.; Romagnoli, D.; Melegari, G.; Pivetti, A.; Di Marco, L.; Casari, F.; Arioli, D.; Turrini, F.; Zuccaro, V.; Cassaniti, I.; Riefolo, M.; de Santis, E.; Bernabucci, V.; Bianchini, M.; Lei, B.; de Maria, N.; Carulli, L.; Schepis, F.; Gozzi, C.; Malaguti, S.; Del Buono, M.; Brugioni, L.; Torricelli, P.; Trenti, T.; Pinelli, G.; Bertellini, E.; Bruno, R.; Camma, C.; D'Errico, A.

This study examined the association between dynamic angiopoietin-2 assessment and COVID-19 short- and long-term clinical course. We included consecutive hospitalized patients from 1 February to 31 May 2020 with laboratory-confirmed COVID-19 from 2 Italian tertiary referral centers (derivation cohort, n 5 187 patients; validation cohort, n 5 62 patients). Serum biomarker levels were measured by sandwich enzyme-linked immunosorbent assay. Lung tissue from 9 patients was stained for angiopoietin-2, Tie2, CD68, and CD34. Cox model was used to identify risk factors for mortality and nonresolving pulmonary condition. Area under the receiver operating characteristic curve (AUROC) was used to assess the accuracy of 3- and 10-day angiopoietin-2 for in-hospital mortality and nonresolving pulmonary condition, respectively. Three-day angiopoietin-2 increase of at least twofold from baseline was significantly associated with in-hospital mortality by multivariate analysis (hazard ratio [HR], 6.69; 95% confidence interval [CI], 1.85-24.19; P 5 .004) with AUROC 5 0.845 (95% CI, 0.725-0.940). Ten-day angiopoietin-2 of at least twofold from baseline was instead significantly associated with nonresolving pulmonary condition by multivariate analysis (HR, 5.33; 95% CI, 1.34-11.77; P # .0001) with AUROC 5 0.969 (95% CI, 0.919-1.000). Patients with persistent elevation of 10-day angiopoietin-2 levels showed severe reticular interstitial thickening and fibrous changes on follow-up computed tomography scans. Angiopoietin-2 and Tie2 were diffusely colocalized in small-vessel endothelia and alveolar new vessels and macrophages. Angiopoietin-2 course is strongly associated with COVID-19 in-hospital mortality and nonresolving pulmonary condition. Angiopoietin-2 may be an early and useful predictor of COVID-19 clinical course, and it could be a relevant part of disease pathogenesis. Angiopoietin-2 blockade may be a COVID-19 treatment option.

2021 - Identification of Sclerostin as a Putative New Myokine Involved in the Muscle-to-Bone Crosstalk [Articolo su rivista]
Magarò, Maria Sara; Bertacchini, Jessika; Florio, Francesca; Zavatti, Manuela; Potì, Francesco; Cavani, Francesco; Amore, Emanuela; De Santis, Ilaria; Bevilacqua, Alessandro; Reggiani Bonetti, Luca; Torricelli, Pietro; Maurel, Delphine B.; Biressi, Stefano; Palumbo, Carla

Bone and muscle have been recognized as endocrine organs since they produce and secrete “hormone-like factors” that can mutually influence each other and other tissues, giving rise to a “bone–muscle crosstalk”. In our study, we made use of myogenic (C2C12 cells) and osteogenic (2T3 cells) cell lines to investigate the effects of muscle cell-produced factors on the maturation process of osteoblasts. We found that the myogenic medium has inhibitory effects on bone cell differentiation and we identified sclerostin as one of the myokines produced by muscle cells. Sclerostin is a secreted glycoprotein reportedly expressed by bone/cartilage cells and is considered a negative regulator of bone growth due to its role as an antagonist of the Wnt/β-catenin pathway. Given the inhibitory role of sclerostin in bone, we analyzed its expression by muscle cells and how it affects bone formation and homeostasis. Firstly, we characterized and quantified sclerostin synthesis by a myoblast cell line (C2C12) and by murine primary muscle cells by Western blotting, real-time PCR, immunofluorescence, and ELISA assay. Next, we investigated in vivo production of sclerostin in distinct muscle groups with different metabolic and mechanical loading characteristics. This analysis was done in mice of different ages (6 weeks, 5 and 18 months after birth) and revealed that sclerostin expression is dynamically modulated in a muscle-specific way during the lifespan. Finally, we transiently expressed sclerostin in the hind limb muscles of young mice (2 weeks of age) via in vivo electro-transfer of a plasmid containing the SOST gene in order to investigate the effects of muscle-specific overproduction of the protein. Our data disclosed an inhibitory role of the muscular sclerostin on the bones adjacent to the electroporated muscles. This observation suggests that sclerostin released by skeletal muscle might synergistically interact with osseous sclerostin and potentiate negative regulation of osteogenesis possibly by acting in a paracrine/local fashion. Our data point out a role for muscle as a new source of sclerostin.

2021 - Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy [Articolo su rivista]
Baldessari, C.; Guaitoli, G.; Valoriani, F.; Bonacini, R.; Marcheselli, R.; Reverberi, L.; Pecchi, A.; Menozzi, R.; Torricelli, P.; Bertolini, F.; Barbieri, F.; Dominici, M.

Background and aims: Body composition and balance of nutritional and inflammatory status are important for the immune system. Alterations of these aspects may impact on response, outcome and toxicities of immunotherapy. In this review we try to clarify some definitions and tools used for the assessment of the different aspects of nutritional disorders, body composition and inflammatory status with a focus on lung cancer. Methods: We primary investigate the definitions of malnutrition, cachexia, sarcopenia and overweight. Secondary, tools used to measure body composition, nutritional and inflammatory status, mainly in lung cancer are reviewed. Results: All these features, in the time of precision medicine may improve assessment and selection of patients, incorporating also early palliative care in standard therapy. Conclusions: A multimodal approach based on nutrition assessment and physical exercise should be evaluated to improve aspects of the immune response against cancer and to propose the best treatment to every patient.

2021 - Prostatic artery embolization for the management of benign prostatic hyperplasia/lower urinary tract symptoms in elderly patients unfit for surgery: Our initial experience [Articolo su rivista]
Amato, Marco; Eissa, Ahmed; Puliatti, Stefano; Di Chiacchio, Giuseppe; Malossi, Marcello; Fiocchi, Federica; Torricelli, Pietro; Sighinolfi, Mari A Chiara; Milandri, Riccardo; Zoeir, Ahmed; Gameel, Tarek; Micali, Salvatore; Bianchi, Giampaolo; Rocco, Bernardo

To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery.

2021 - Proximal Splenic Artery Embolization to Treat Refractory Ascites in a Patient With Cirrhosis [Articolo su rivista]
Caporali, C.; Turco, L.; Prampolini, F.; Quaretti, P.; Bianchini, M.; Saltini, D.; Miceli, F.; Casari, F.; Felaco, D.; Garcia-Pagan, J. C.; Trebicka, J.; Senzolo, M.; Guerrini, G. P.; Di Benedetto, F.; Torricelli, P.; Villa, E.; Schepis, F.

2020 - Case report of a patient who survived after cardiac arrest and cardiogenic shock by anaphylactic reaction to gadolinium during magnetic resonance imaging [Articolo su rivista]
Biagioni, Emanuela; Coloretti, Irene; Disalvo, Fabrizio; Andreotti, Alberto; Sani, Francesco; Torricelli, Pietro; Gelmini, Roberta; Girardis, Massimo

We report the case of a young adult which survived to anaphylactic shock caused by gadolinium-based contrast agent (GBCA) contrast agent infusion. The patient had no comorbidities and previous history of allergic reactions to contrast agents and underwent elective magnetic resonance imaging (MRI) for parotid swelling. Seven years before he received intravenous GBCA administration during an MRI, which exact chemical composition is unknown, without any allergic reaction. After intravenous injection of GBCA for MRI the patient developed anaphylactic shock, causing respiratory failure, cardiac arrest, and cardiogenic shock after return of spontaneous circulation. Because of the rarity of the described event, this report has the aim to raise awareness in the healthcare personnel of the possibility of these life-threatening adverse reactions from GBCAs also in a patient without history of allergy to contrast agents and suggest a possible clinical management of these patients.

2020 - Incidence of nephrogenic systemic fibrosis after administration of gadoteric acid in patients on renal replacement treatment [Articolo su rivista]
Alfano, Gaetano; Fontana, Francesco; Ferrari, Annachiara; Solazzo, Andrea; Perrone, Rossella; Giaroni, Francesco; Torricelli, Pietro; Cappelli, Gianni

Nephrogenic system fibrosis (NSF) is a rare complication detected in patients with renal insufficiency exposed to gadolinium-based contrast agents (GBCAs). The aim of our study is to evaluate the prevalence of NSF in a cohort of patients on renal replacement treatment who underwent GBCA-enhanced magnetic resonance imaging (MRI).

2020 - Magnetic resonance imaging performed before and after preoperative chemoradiotherapy in rectal cancer: predictive factors of recurrence and prognostic significance of MR-detected extramural venous invasion [Articolo su rivista]
Prampolini, Francesco; Taschini, Stefania; Pecchi, Annarita; Sani, Francesco; Spallanzani, Andrea; Gelsomino, Fabio; Kaleci, Shaniko; Torricelli, Pietro

Purpose: To evaluate the role of magnetic resonance imaging (MRI) performed before and after neoadjuvant chemoradiotherapy (nCRT) in predicting risk of recurrence in rectal cancer and to investigate the prognostic significance of MR-detected extramural venous invasion (mr-EMVI) and of its regression after nCRT. Methods: During 2005–2016, 87 patients with rectal cancer underwent pre- and post-nCRT MRI before surgery. Two radiologists independently reviewed MR examinations retrospectively, assessing T stage, nodal involvement, circumferential resection margin (CRM) status, and mr-EMVI. All four parameters assessed in pre- and post-nCRT MRI were correlated with the risk of recurrence. Correlation with disease-free survival (DFS) was investigated for significant predictive factors in pre-nCRT MRI and for mr-EMVI and its possible regression in post-nCRT MRI. Results: 15 of 87 patients developed recurrence, with a relapse-rate of 17.2%. Statistical analysis showed a significant correlation between CRM involvement and mr-EMVI assessed in pre-nCRT MRI and the risk of recurrence; 3 years-DFS in patients positive for these two parameters was significantly shorter compared with negatives. In post-nCRT MRI, all four parameters correlated significantly with recurrence: mr-EMVI affected significantly 3 years-DFS and its regression after nCRT correlated with a trend toward improvement of survival outcomes, although not statistically significant. Conclusions: CRM involvement and mr-EMVI assessed in pre-nCRT MRI should be considered early predictive factors of recurrence in rectal cancer. MRI performed after nCRT has a significant value in predicting risk of recurrence: mr-EMVI confirmed to be a poor prognosis predictor and its regression or persistence after nCRT could have influences on treatment and follow-up strategies.

2020 - MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women [Articolo su rivista]
Fiocchi, Federica; Monelli, Filippo; Besutti, Giulia; Casari, Federico; Petrella, Elisabetta; Pecchi, Annarita; Caporali, Cristian; Bertucci, Emma; Busani, Stefano; Botticelli, Laura; Facchinetti, Fabio; Torricelli, Pietro

To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI.

2019 - Breast ultrasonography (BU) in the screening protocol for women at hereditary-familial risk of breast cancer: has the time come to rethink the role of BU according to different risk categories? [Articolo su rivista]
Cortesi, Laura; Canossi, Barbara; Battista, Rachele; Pecchi, Annarita; Drago, Antonella; Dal Molin, Chiara; Toss, Angela; De Matteis, Elisabetta; Marchi, Isabella; Torricelli, Pietro; Cascinu, Stefano

This article evaluates the breast cancer (BC) screening efficacy of biannual ultrasound (US) in three different risk categories. In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with high risk (HR) or intermediate risk (IR) received mammography (MMG), ultrasound, (US) and Magnetic Resonance Imaging (MRI), scheduled according to the risk categories. Single and combined sensitivity were evaluated in specific groups of risk and the US performance at six-monthly interval was notably considered. Among 2,313 asymptomatic women at different risk (136 mutation carriers, 1,749 at HR and 428 at IR) 211 developed a BC, of which 193 (91.5%) were screen detected BC (SDBC) and 18 (8.5%) were interval BC (IBC). The SDBC detection rate (DR) was 11.2 per 1.000 person-years (37.9, 8.5 and 16.1 for BRCA, HR and IR, respectively); 116 BC were detected by MMG (DR = 6.6 × 1,000 persons-years), 62 by US (DR = 3.6 × 1,000 persons-years) and 15 by MRI, that was applied only in 60 BRCA women (DR = 37 × 1,000 persons-years). At the six-monthly US, 52 BC were detected (DR = 3.0 × 1,000 persons/years), of which 8 were BRCA-related. The most sensitive technique was MRI (93.7%) followed by MMG (55%) and US (29.4%). Combined sensitivity for MMG plus US was 100% in HR and 80.4% for IR women (p < 0.01). In BRCA mutated patients, MRI alone with annual US performed after six months, could be offered. In HR patients, MMG plus biannual US provide the most sensitive diagnosis and for IR group an annual MMG could be sufficient.

2019 - Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: The InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device) [Articolo su rivista]
Manfredi, A.; Cassone, G.; Cerri, S.; Venerito, V.; Fedele, A. L.; Trevisani, M.; Furini, F.; Addimanda, O.; Pancaldi, F.; Della Casa, G.; D'Amico, R.; Vicini, R.; Sandri, G.; Torricelli, P.; Celentano, I.; Bortoluzzi, A.; Malavolta, N.; Meliconi, R.; Iannone, F.; Gremese, E.; Luppi, F.; Salvarani, C.; Sebastiani, M.

Background: Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High-resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients. The aim of the present investigation was to validate the diagnostic accuracy of VECTOR in a larger population of RA patients, compared with that of the reference standard of HRCT, from a multicentre study. Methods: To avoid X-ray exposure, we enrolled 137 consecutive RA patients who had recently undergone HRCT. Lung sounds of all patients were recorded in 4 pulmonary fields bilaterally with a commercial electronic stethoscope (ES); subsequently, all HRCT images were blindly evaluated by a radiologist, and audio data were analysed by means of VECTOR. Results: Fifty-nine of 137 patients showed ILD (43.1%). VECTOR correctly classified 115/137 patients, showing a diagnostic accuracy of 83.9% and a sensitivity and specificity of 93.2 and 76.9%, respectively. Conclusions: VECTOR may represent the first validated tool for the screening of RA patients who are suspected for ILD and who should be directed to HRCT for the diagnosis. Moreover, early identification of RA-ILD could contribute to the design of prospective studies aimed at elucidating unclear aspects of the disease.

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

no abstract

2019 - Impact of body composition parameters on tumor response to neoadjuvant chemotherapy in operable breast cancer patients. [Poster]
Palumbo, Patrizia; Draisci, Stefano; Barbolini, Monica; Nasso, Cecilia; Isca, Chrystel; Bocconi, Alessandro; Balduzzi, Sara; Pecchi, Annarita; Galetti, Silvia; Torricelli, Pietro; Piacentini, Federico; Moscetti, Luca; Cascinu, Stefano; Omarini, Claudia

Fat tissue promotes cancer progression by increasing cell proliferation, cell survival and metastatic processes. Adipose tissue determines a dysregulation of several metabolic pathways by a continuous crosstalk between fat tissue and cancer cells. Moreover, influence of adipose tissue on cancer development depend on the type of fat too BMI cannot account for differences in fat distribution and cannot distinguish between adipose tissue and muscles Computed tomography (CT) imaging can be a useful tool for a directly measure of body fat distribution distinguishing among visceral, subcutaneous, internal fat tissue (mostly in the liver) and skeletal muscles mass. Patients treated with neoadjuvant chemotherapy for early BC at the Modena Cancer Center from 2005 to 2017 we collected. According to BMI score, patients were categorized in two main classes: normal weight (BMI < 25) and overweight (BMI ≥ 25) (Table 1) Using Advance workstation (General Electric), software ADW server 3.2 or 4.7. we calculated body composition parameters (BCPs) from pre-treated CT scan images. BCPs considered are: subcutaneous fat area (SFA, cm2), visceral fat area (VFA, cm2), lumbar muscle cross-sectional area (LMCA, m2) and liver steatosis (L/S ratio) BMI score and BCPs value were correlated with pathological complete response (pCR) and survival outcomes. All analyses were performed using STATA 14 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP). pre-treatment CT scan imagine available for BCPs analysis 55% of the women had BMI < 25 versus 45% with BMI >25 Overweight was significantly associated with postmenopausal status, older age and hormonal receptor positive BC (Table 1) Menopausal status was associated with higher VFA, presence of fatty liver disease and obesity disease compared to pre-menopausal one (Table 2). No association between BMI classes and pCR was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 35% normal VFA vs 20% high VFA, no steatosis 32% vs steatosis 13%; p<0.05) ( Figure 1) Neither BMI classes nor BCPs significantly influenced overall survival and relapse free survival. The evaluation of BCPs is the best way to assess the real body composition Menopausal status is associated with higher VFA, presence of fatty liver disease and obesity disease Visceral adiposity as well as liver steatosis were negative predictive factors for pCR in BC patients treated with neoadijuvant chemotherapy .

2019 - Predictive Role Of Body Composition Parameters In Operable Breast Cancer Patients Treated With Neoadjuvant Chemotherapy. [Articolo su rivista]
Omarini, C; Palumbo, P; Pecchi, A; Draisci, S; Balduzzi, S; Nasso, C; Barbolini, M; Isca, C; Bocconi, A; Moscetti, L; Galetti, S; Tazzioli, G; Torricelli, P; Cascinu, S; Piacentini, F.

BACKGROUND: Fat tissue is strongly involved in BC tumorigenesis inducing insulin resistance, chronic inflammation and hormonal changes. Computed tomography (CT) imaging instead of body mass index (BMI) gives a reliable measure of skeletal muscle mass and body fat distribution. The impact of body composition parameters (BCPs) on chemosensitivity is still debated. We examined the associations between BCPs and tumor response to neoadjuvant chemotherapy (NC) in patients treated for operable breast cancer (BC). METHODS: A retrospective review of BC patients treated with NC in Modena Cancer Center between 2005 and 2017 was performed. BCPs, such as subcutaneous fat area (SFA), visceral fat area (VFA), lumbar skeletal muscle index (LSMI) and liver-to-spleen (L/S) ratio were calculated by Advance workstation (General Electric), software ADW server 3.2 or 4.7. BMI and BCPs were correlated with pathological complete response (pCR) and survival outcomes. RESULTS: 407 patients were included in the study: 55% with BMI < 25 and 45% with BMI ≥ 25. 137 of them had pre-treatment CT scan imagines. Overweight was significantly associated with postmenopausal status and older age. Hormonal receptor positive BC was more frequent in overweight patients (p<0.05). Postmenopausal women had higher VFA, fatty liver disease and obesity compared to premenopausal patients. No association between BMI classes and tumor response was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 36% normal VFA vs 20% high VFA, p= 0.048; no steatosis 32% vs steatosis 13%, p=0.056). Neither BMI classes nor BCPs significantly influenced overall survival and relapse-free survival. CONCLUSION: Visceral adiposity as well as steatosis were closely involved in chemosensitivity in BC patients treated with NC. Their measures from clinically acquired CT scans provide significant predictive information that outperform BMI value. More research is required to evaluate the relationship among adiposity site and survival outcomes.

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.

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

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 - 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

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.

2018 - Imaging features of uterine and ovarian fibromatosis in Nevoid Basal Cell Carcinoma Syndrome [Articolo su rivista]
Cassar Scalia, Ambra; Farulla, Antonino; Fiocchi, Federica; Alboni, Carlo; Torricelli, Pietro

Gorlin-Goltz Syndrome also known as Nevoid Basal Cell Carcinoma Syndrome is an autosomal dominant multisystem disorder. It is characterized by basal cell carcinomas, odontogenic keratocysts, skeletal abnormalities and in a minority of female patients bilateral calcified ovarian fibromas. It is challenging to radiologically assess ovarian fibromas as they have similar imaging patterns to some malignant ovarian lesions. However, it is vitally important to differentiate between benign and malignant lesions to determine patients' suitability for fertility-sparing surgery. This report describes a case of a 25 year-old patient with Gorlin-Goltz Syndrome and bilateral ovarian fibromas.

2018 - Multi-phase postmortem CT angiography (MPMCTA): experiences of the Forensic Radiology Unit in the University Hospital of Modena - Italy [Poster]
Amorico, M. G.; Drago, A.; Procicchiani, D.; Tore, E.; Vecchio, S.; Santunione, A. L.; Dominguez, A.; Silingardi, E.; Torricelli, P.

The collaboration between forensic science and radiology has been lasting and proficuous, and both the disciplines now learn from and support each other. Since the first use of conventional radiology in forensic science, every new technology developed in clinical radiology has been gradually absorbed in the forensic use. Multi-phase postmortem CT angiography (MPMCTA) is increasingly being recognized as a valuable adjunct medico-legal tool to investigate the vessels of the head, thorax and abdomen. We present the expreriences of the Forensic Radiology Unit of the University of Modena and Reggio Emilia.

2018 - Non-surgical Management of Blunt Splenic Trauma: A Comparative Analysis of Non-operative Management and Splenic Artery Embolization—Experience from a European Trauma Center [Articolo su rivista]
Cinquantini, Francesco; Simonini, E.; Di Saverio, S.; Cecchelli, Claudia; Kwan, S. H.; Ponti, F.; Coniglio, C.; Tugnoli, G.; Torricelli, P.

Purpose: The objective of our study was to retrospectively compare the outcomes of non-operative management (NOM) and splenic artery embolization (SAE) in the management of hemodynamically stable patients with splenic injuries. Materials and Methods: In a 5-year period, 109 patients were recorded; 60/109 were treated with NOM and 49/109 with SAE. For each patient, the following parameters were assessed: Glasgow coma scale, injury severity score, American Association for the Surgery of Trauma splenic injury grade, transfusion requirements, hemoglobin level, presence of a splenic vascular lesion (SVL) and amount of hemoperitoneum (Bessoud scale). Different SAE techniques (proximal, distal, combined) with different materials were employed. Clinical success was defined as spleen conservation at 30 days; failure was defined as spleen re-bleeding within 30 days, requiring splenectomy. Student’s t test or Chi-square analysis and the Kaplan–Mayer curve were used to analyse each group’s results and compare them with those of the other group. Results: In the SAE group, AAST splenic injury grade was higher and serum hemoglobin levels were lower. The SAE group had significantly more SVL and hemoperitoneum compared to the NOM group. The clinical success rate was not significantly different between groups (NOM = 95%, SAE = 87.8%; p = 0.16). Sixty-six percent of NOM failures were related to inadequate patient selection, while 67% of SAE failures were due to technical/procedural issues. Conclusion: Our study observed a high splenic salvage rate with the use of SAE as an adjunct to NOM, and suggests that it may be further improved with appropriate patient selection and an improved embolization technique.

2018 - Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis [Articolo su rivista]
Schepis, Filippo; Vizzutti, Francesco; Garcia-Tsao, Guadalupe; Marzocchi, Guido; Rega, Luigi; De Maria, Nicola; Di Maira, Tommaso; Gitto, Stefano; Caporali, Cristian; Colopi, Stefano; De Santis, Mario; Arena, Umberto; Rampoldi, Antonio; Airoldi, Aldo; Cannavale, Alessandro; Fanelli, Fabrizio; Mosconi, Cristina; Renzulli, Matteo; Agazzi, Roberto; Nani, Roberto; Quaretti, Pietro; Fiorina, Ilaria; Moramarco, Lorenzo; Miraglia, Roberto; Luca, Angelo; Bruno, Raffaele; Fagiuoli, Stefano; Golfieri, Rita; Torricelli, Pietro; Di Benedetto, Fabrizio; Saverio Belli, Luca; Banchelli, Federico; Laffi, Giacomo; Marra, Fabio; Villa, Erica

Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. METHODS: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites (based on need for at least 1 large-volume paracentesis by 4 weeks after TIPS placement), incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. RESULTS: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (46%) than controls (73%) during the first year after the procedure (P=.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to the nominal diameter in hemodynamically relevant sites (such as portal and hepatic vein vascular walls). CONCLUSION: In prospective, non-randomized study of patients with cirrhosis, we found under-dilation of PTFE-SGs during TIPS placement to be feasible, associated with lower rates of PSE, and effective

2017 - Lesion volume predicts prostate cancer risk and aggressiveness: validation of its value alone and matched with prostate imaging reporting and data system score [Articolo su rivista]
Martorana, Eugenio; Pirola, Giacomo Maria; Scialpi, Michele; Micali, Salvatore; Iseppi, Andrea; Bonetti, Luca Reggiani; Kaleci, Shaniko; Torricelli, Pietro; Bianchi, Giampaolo

Objective: To demonstrate the association between magnetic resonance imaging (MRI) estimated lesion volume (LV), prostate cancer detection and tumour clinical significance, evaluating this variable alone and matched with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score. Patients and methods: We retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal prostate MRI/ultrasonography fusion-targeted biopsy between January 2014 and February 2016. Suspicious lesions were delineated using a ‘region of interest’ and the system calculated prostate volume and LV. Patients were divided in groups considering LV (≤0.5, 0.5–1, ≥1 mL) and PI-RADS score (1–5). We considered clinically significant prostate cancer as all cancers with a Gleason score of ≥3 + 4 as suggested by PI-RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t-test. MRI LV and HTV concordance was verified using a Bland–Altman plot. The chi-squared test and logistic and ordinal regression models were used to evaluate difference in frequencies. Results: The MRI LV and PI-RADS score were associated both with prostate cancer detection (both P < 0.001) and with significant prostate cancer detection (P < 0.001 and P = 0.008, respectively). When the two variables were matched, increasing LV increased the risk within each PI-RADS group. Prostate cancer detection was 1.4-times higher for LVs of 0.5–1 mL and 1.8-times higher for LVs of ≥1 mL; significant prostate cancer detection was 2.6-times for LVs of 0.5–1 mL and 4-times for LVs of ≥1 mL. There was a positive correlation between MRI LV and HTV (r = 0.9876, P < 0.001). Finally, Bland–Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations include its monocentric and retrospective design and the limited cohort. Conclusions: This study demonstrates that PI-RADS score and the MRI LV, independently and in combination, are associated with prostate cancer detection and with tumour clinical significance.

2017 - L'imaging TC nella valutazione post-mortem delle vittime del territorio in EMilia [Articolo su rivista]
Baldoni, F.; Procicchiani, Diego; Amorico, Mg.; Tidaro, R. Tata C.; Pizzirani, M.; Santunione, A. L.; Camatti, Jessika; Silingarsi, E.; Torricelli, P.

Lo sviluppo delle moderna tecniche di diagnostica per immagini ha portato ad una revisione delle consolidate metodologie nel campo dell'indagine medico-legale. In quest'ottica si inserisce ,l'adozione, oltre al tradizionale impiego di routinari rilievi radiografici, di modalità diagnostiche più sofisticate ed avanzate quali la TC multistrato (TCMS). Nella nostra esperienza la TCMS, adottata per lo studiodi pazienti deceduti in un mass disaster quale il terremoto che ha colpito l'Emilia nel 2012, insieme alla ricognizione esterna di cadavere effettuata dal patologo forense, si è dimostrata utile per lo studio, l'identificazione e la valutazione delle lesioni riportate dalle vittime in seguito al crollo di edifici industriali

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

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 - Interstitial pneumonia with autoimmune features and undifferentiated connective tissue disease: Our interdisciplinary rheumatology-pneumology experience, and review of the literature [Articolo su rivista]
Ferri, Clodoveo; Manfredi, Andreina; Sebastiani, Marco; Colaci, Michele; Giuggioli, Dilia; Vacchi, Caterina; Della Casa, Giovanni; Cerri, Stefania; Torricelli, Pietro; Luppi, Fabrizio

Background: Interstitial lung diseases (ILDs) are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the lungs, varying from idiopathic interstitial pneumonias to secondary variants, including the ILDs associated to connective tissue diseases (CTDs). In addition, a number of patients are recognized as unclassifiable ILD (U-ILD), because of the inability to reach a definite diagnosis; some of them show autoimmune manifestations not fulfilling the classification criteria of a given CTD. The term interstitial pneumonia with autoimmune features (IPAF) has been recently proposed for this particular ILD subset. Methods: Here, we report our experience resulting from the integrated - pneumology/rheumatology - approach to patients with suspected ILDs or CTDs referred to our university-based Center for the Rare Pulmonary Diseases and Rheumatology Unit, from January 2009 to June 2015, with particular attention to the above-mentioned U-ILD, IPAF, and undifferentiated connective tissue disease (UCTD). The comparative analysis of these clinical variants was carried out; moreover, the observed findings were compared with the results of the updated review of the literature. Results: After the first clinical assessment, the U-ILD were identified in 50 patients; afterwards, on the basis of clinico-serological and radiological findings U-ILD group was subdivided into 2 subgroups, namely U-ILD without any clinical extra-thoracic manifestations and/or immunological alterations (15 pts) and IPAF according to the above-mentioned classification criteria (35 pts). Patients with either IPAF or U-ILD were compared with a series of 52 stable UCTD (disease duration ≥. 3. years), followed at our Rheumatology Unit. Some important differences were evidenced among the 3 series of U-ILD, IPAF, and UCTD: firstly, female gender was more frequent in patients with UCTD (86%) or IPAF (69%) compared with U-ILD (60%) or idiopathic pulmonary fibrosis (24%; p = 0.001). In addition, UCTD patients were younger and showed longer disease duration. More interestingly, both UCTD and IPAF series show a comparable prevalence of various clinical manifestations, with the exception of the interstitial lung involvement detectable in a very small percentage of UCTD patients.Concordantly, the review of the literature evidenced two main subsets of U-ILD, one is characterized by isolated unclassifiable interstitial pneumonia and another one composed by subjects with clinically prevalent lung involvement in the setting of not definite CTD, the recently proposed IPAF. Conclusion: We hypothesize that IPAF and UCTD might represent two clinical variants of the same systemic autoimmune disorders. The marked difference regarding the prevalence of ILD, which is the clinical hallmark of IPAF but very rare in UCTD, may at least in part reflect a selection bias of patients generally referred to different specialist centers, i.e. pneumology or rheumatology, according to the presence/absence of clinically dominant ILD, respectively. Well-integrated, interdisciplinary teams are recommended for the assessment and management of these patients in the clinical practice. Finally, the cooperation between multidisciplinary groups with different experiences may be advisable for a validation study of the proposed nomenclature and classification criteria of these indefinable ILD/CTD variants.

2016 - Manuale di diagnostica per immagini. Per il corso di laurea di medicina e chirurgia [Monografia/Trattato scientifico]
Torricelli, Pietro; Zompatori, Maurizio


2015 - Defecographic functional evaluation of rectal akinesia [Articolo su rivista]
Morandi, C.; Martellucci, J; Genovese, Maurilio; Torricelli, Pietro


2015 - Improvement of survival in patients with intermediate stage (BCLC-B) hepatocellular acrcinoma complicating liver cirrhosis by combination therapy with radiofrequency ablation and transcatheter chemioembolization [Abstract in Rivista]
Ventura, Paolo; Santis, Mario De; Venturelli, Giorgia; Gangi, Pietro Di; Marcacci, Matteo; Fiorini, Massimo; Cuoghi, Chiara; Famiglietti, Elena; Torricelli, Pietro; Pietrangelo, Antonello

Efficacia del trattamento combinato di radiofrequenza e chemioembolizzazione vs. chemioembolizzaione semplice in pazienti selezionati con HCC in stadio intermedio (BCLC score). Approccio con Propensity score matching

2015 - investigation of erthquake related deaths using post-mortem multi detector computed tomography [Abstract in Atti di Convegno]
Santunione, Anna Laura; Perini, Andrea; Radheshi, Erjon; Amorico, Maria Grazia; Tata, Cristina; Torricelli, Pietro; Silingardi, Enrico

Purpose: Post-mortem Multi-Detector Computed Tomography (MDCT) is now recognized as a valuable adjunct medicolegal tool. Beside its application for identification purposes, MDCT is used to assist pathologists in determining cause of death. Compared to conventional radiography MDCT offers advantages in detecting blunt force injury, and can quickly provide a guide to lethal injuries. Therefore, the use of MDCT for earthquake-related deaths is an obvious choice, as blunt force injuries are common in such victims. The purpose of this study was to evaluate the impact of MDCT on the assessment of causes of death, in a case series of fatal injuries after the 2012 Modena earthquake. Methods and materials: 12 medicolegal cases underwent full-body CT-scan and external examination. The circumstances of death were collected and reviewed. Conventional autopsy was not authorized by the local Prosecutor for all cases. Results: In all cases, post-mortem MDCT and external examination revealed lesions consistent with fatal blunt force injuries, and the absence of contrary evidence that could support another cause of death. These findings together with the circumstantial data were sufficient to assess cause and manner of death. Conclusions: The results of this study confirm that post-mortem MDCT provides an important contribution to determining cause of death, especially when autopsy is not performed. Therefore, radiologists with experience in post-mortem imaging are needed to support forensic pathologists in establishing causes of death, without necessarily having to perform conventional autopsy.

2015 - Morbidity and Mortality in Patients with Idiopathic Pulmonary Fibrosis Undergoing Diagnostic Surgical Lung Biopsy [Abstract in Atti di Convegno]
Zelent, Gabriele; Cerri, Stefania; Sghedoni, Enrico; Montanari, Gloria; Taddei, Sofia; Aramini, Beatrice; Rossi, Giulio; Stefani, Alessandro; Torricelli, Pietro; Morandi, Uliano; Luppi, Fabrizio

Morbidity and Mortality In Patients With Idiopathic Pulmonary Fibrosis Undergoing Diagnostic Surgical Lung Biopsy.

2015 - Post-transplantation hepatocellular carcinoma recurrence: Patterns and relation between vascularity and differentiation degree [Articolo su rivista]
Pecchi, Annarita; Besutti, Giulia; de Santis, Mario; DEL GIOVANE, Cinzia; Nosseir, Sofia; Tarantino, Giuseppe; DI BENEDETTO, Fabrizio; Torricelli, Pietro

Aim: To evaluate the relationship between hepatocellular carcinoma (HCC) vascularity and grade; to describe patterns and vascular/histopathological variations of post-transplantation recurrence. Methods: This retrospective study included 165 patients (143 men, 22 women; median age 56.8 years, range 28-70.4 years) transplanted for HCC who had a follow-up period longer than 2 mo. Pre-transplantation dynamic computed tomography or magnetic resonance examinations were retrospectively reviewed, classifying HCC imaging enhancement pattern into hypervascular and hypovascular based on presence of wash-in during arterial phase. All pathologic reports of the explanted livers were reviewed, collecting data about HCC differentiation degree. The association between imaging vascular pattern and pathological grade was estimated using the Fisher exact test. All follow-up clinical and imaging data were reviewed for evidence of recurrence. Recurrence rate was calculated and imaging features of recurrent tumor were collected, classifying early and late recurrences based on timing (< or ≥ 2 years after transplantation) and intrahepatic, extrahepatic and both intrahepatic and extrahepatic recurrences based on location. All intrahepatic recurrences were classified as hypervascular or hypovascular and the differentiation degree was collected where available. The presence of variations in imaging enhancement pattern and pathological grade between the primary tumor and the intrahepatic recurrence was evaluated and the association between imaging and histopatholgical variations was estimated by using the χ2 test. Results: Of the 163 patients with imaging evidence of viable tumor, 156 (95.7%) had hypervascular and 7 (4.3%) hypovascular HCC. Among the 125 patients with evidence of viable tumor in the explanted liver, 19 (15.2%) had grade 1, 56 (44.8%) grade 2, 40 (32%) grade 3 and 4 (3.2%) grade 4 HCC, while the differentiation degree was not assessable for 6 patients (4.8%). A significant association was found between imaging vascularity and pathological grade (P = 0.035). Post-transplantation recurrence rate was 14.55% (24/165). All recurrences occurred in patients who had a hypervascular primary tumor. Three patients (12.5%) experienced late recurrence; the location of the first recurrence was extrahepatic in 14 patients (58.3%), intrahepatic in 7 patients (29.2%) and both intrahepatic and extrahepatic in 3 patients (12.5%). Two patients had a variation in imaging characteristics between the primary HCC (hypervascular) and the intrahepatic recurrent HCC (hypovascular), while 1 patient had a variation of histopathological characteristics (from moderate to poor differentiation), however no association was found between imaging and histopathological variations. Conclusion: A correlation was found between HCC grade and vascularity; some degree of variability may exist between the primary and the recurrence imaging/histopathological characteristics, apparently not correlated.

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

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 - HRCT Patterns Of Usual Interstitial Pneumonia In Rheumatoid Lung [Abstract in Rivista]
Tonelli, Roberto; Sverzellati, Nicola; DELLA CASA, Giovanni; Spagnolo, Paolo; Cerri, Stefania; Manfredi, Andreina Teresa; Sebastiani, Marco; Cocconcelli, Elisabetta; DEL GIOVANE, Cinzia; Balduzzi, Sara; Richeldi, Luca; Torricelli, Pietro; Ferri, Clodoveo; Luppi, Fabrizio

RATIONALE. Interstitial lung disease (ILD) is a well-recognized complication of rheumatoid arthritis (RA) and can present with different patterns on high-resolution computed tomography (HRCT) of the chest. It has been recently shown that a definite HRCT usual interstitial pneumonia (UIP) pattern is highly specific and moderately sensitive for a histopathologic UIP pattern. The aims of the present study were: i) to evaluate the prevalence of the UIP pattern on HRCT in patients with RA-ILD, as compared with patients with idiopathic pulmonary fibrosis (IPF) and ii) to assess the level of agreement between two experienced chest radiologists in detecting the UIP pattern in the two groups of patients. METHODS. 30 patients with RA and at least one chest HRCT showing interstitial changes were retrospectively identified from a single-center cohort of RA patients. Fifty-two patients with IPF based on current diagnostic criteria served as diseased controls. For patients who had more than one HRCT the more recent HRCT was selected. Two experienced thoracic radiologists (radiologist A and B) blinded to patient diagnosis scored all HRCT images independently. Radiologic patterns were categorized as definite UIP, possible UIP or inconsistent with UIP according to the most current international guidelines. The prevalence of the different patterns was assessed for both groups and compared by using the chi square test. The concordance between radiologists was determined using the Cohen kappa score. RESULTS. Radiologist A detected 4 definite UIP (13%), 10 possible UIP (33%) and 16 inconsistent with UIP patterns (53%) among patients with RA-ILD and 16 definite UIP (30%), 24 possible UIP (46%) and 12 inconsistent with UIP patterns (23%) among patients with IPF (chi square 0.016). Radiologist B identified 6 definite UIP (20%), 9 possible UIP (30%) and 15 inconsistent with UIP patterns (50%) in the RA-ILD group and 23 definite UIP (44%), 16 possible UIP (30%) and 13 inconsistent with UIP patterns (25%) in the IPF group (chi square 0.036). Diagnostic agreement in UIP pattern detection was 71.2% (κ= 0.57) for the IPF group and 76.7% (κ =0.62) for the RA-ILD group. CONCLUSIONS. A definite UIP pattern can be identified in chest HRCT of a sizeable fraction of patients with RA-ILD. Moreover, the possible UIP pattern appears to be almost equally distributed in patients with RA-ILD and IPF. Of note, the level of agreement between two experienced chest radiologists in detecting the UIP pattern is higher in patients with RA-ILD than in IPF.

Sebastiani, Marco; Manfredi, Andreina Teresa; Tonelli, Roberto; Spagnolo, Paolo; Campomori, Federica; Vacchi, Caterina; Cocconcelli, Elisabetta; Cerri, Stefania; Colaci, Michele; Luppi, Fabrizio; DELLA CASA, Giovanni; Sverzellati, N; Torricelli, Pietro; Richeldi, Luca; Ferri, Clodoveo


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

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 - Combination of radiofrequency ablation and transcatheter arterial chemoembolization improves survival in advanced hepatocellular carcinoma complicating liver cirrhosis [Poster]
Ventura, Paolo; M., De Santis; Bonetti, Francesco; Venturelli, Giorgia; P., Di Gangi; M., Marcacci; Torricelli, Pietro; Pietrangelo, Antonello

Background: Treatment of hepatocellular carcinoma (HCC) still remains a controversial issue. In particular, for patients with HCC status exceeding the criteria for “curative” options (advanced HCC) there is no defined standard of therapy. Aim: To evaluate efficacy of combined treatment with radiofrequency ablation (RFA) and transcatether arterial chemio-embolization (TACE) in advanced HCC. Materials and Methods: We performed a retrospective study to compare the cumulative survival rate of patients with advanced HCC treated with combined therapy (simultaneous application of TACE and RFA) [RFA-TACE group, n=35] vs. those treated only by TACE [TACE group, n=36] or those treated only by conservative option [Control group, n=36]. HCC was confirmed by imaging and/or histology. All patients were monitored at one-three months after treatment and every six months by imaging to check for treatment success and/or HCC recurrence. In order to minimize possible bias due to the retrospective design, a propensity score approach was used in analysing the results. Results: The median survival time were 31 months for TACE-RFA group, 21 months for patients in TACE group and 10 months in control group, respectively. The 6-month survival rate was 96%, 90% and 78% in TACE-RFA group, TACE group and control group, respectively; the 1-year survival rate was 89%, 75% and 20.3%. At 3 years from HCC diagnosis, 6% of control group patients were alive, versus 34% and 45% of TACE and TACE-RFA group, respectively. Survival rates difference between groups were significant (p=0.011 and p<0.001 TACE and Controls with respect to TACE-RFA group). Treatment allocation (HR 2.14, p=0.022), and complete treatment response were important independent predictors (HR 3.25, p=0.018) of survival. Conclusion: Based on the results of this study we conclude that the combination of RFA and TACE may represent a promising approach for the treatment of advanced HCC complicating liver cirrhosis. nevertheless, a better definition of patient’s characteristics and technical approaches together with larger scale-randomized trials are needed.

2012 - E-learning in radiology: An Italian multicentre experience [Articolo su rivista]
Carriero, A; Bonomo, L.; Calliada, F.; Campioni, P.; Colosimo, C.; Cotroneo, A.; Cova, M.; Ettorre, G. C.; Fugazzola, C.; Garlaschi, G.; Macarini, L.; Mascalchi, M.; Meloni, G. B.; Midiri, M.; Mucelli, R. Pozzi; Rossi, C.; Sironi, S.; Torricelli, Pietro; Beomonte, B. Zobel; Zompatori, M.; Zuiani, C.

Objective: The aim of this study was to design, deliver and evaluate an e-learning teaching programme for post-graduate radiodiagnostics training that would involve various post-graduate schools throughout Italy. Materials and methods: All of the Directors of Italian post-graduate schools of radiodiagnostics were sent an e-mail on 27 September 2010 informing them of our willingness to set up an e-learning project for the academic year 2010-2011 in the form of single-subject teaching seminars. The proposed subjects were the semeiotics of the various organs and apparatuses in the context of "Urgent/Emergency Pathology". After having received registrations, a calendar of lessons was planned to be held between 10 November 2010 and 12 October 2011. The validity of the project was tested by means of a multiple-choice questionnaire covering the technical and didactic quality of the entire project, to be completed by the students. Results: Fifty-one percent of the universities in Italy participated in the project: Trieste, Udine, Verona, Milan-Bicocca, Novara, Varese, Genoa, Sassari, Rome Campus, the Catholic University of Rome, Chieti, Foggia, Catania, Modena, Florence, Palermo, Bologna, Pavia, Parma and Ferrara. The lessons were attended by a total of 10,261 post-graduate medical students, for an average of 513.1 students per lesson. Seventy percent of the students judged the didactic content " excellent", 25% "good", and 5% "satisfactory"; none said it was unsatisfactory. In terms of visual quality (particularly the details of the radiological images proposed in the form of slides and/or video clips), 73% judged it "excellent", 20% "good", 6% "satisfactory", and 1% "poor". The audio quality was judged "excellent" by 71%, "good" by 22%, "satisfactory" by 6% and "poor" by 1%. In relation to judgement of audio and video quality, it has to be underlined that this was greatly affected by the hardware/software configuration and the band speed and technology of the Internet connection. Conclusions: Technological evolution is overcoming all barriers, and technology is also having a positive impact on the approach to teaching. Our multicentre teaching experience merits the following considerations: the quality of the teaching product was certified by the students' judgements of its didactic content and the quality of reception; the economic cost of the teaching had a minimal impact on the post-graduate schools (18 per lesson). In terms of breaking down national barriers, it is to be hoped that the coordination and integration of diagnostic imaging e-learning projects, with the participation of post-graduate schools in different European countries, can be developed not only in a spirit of "cultural sharing" and the exchange of teaching experiences. © 2012 Elsevier Ireland Ltd© 2011 Elsevier Ireland Ltd. All rights reserved.

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

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 - 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

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 - MRI before initial surgery outside of clinical trials: the real world! [Articolo su rivista]
Cortesi, Laura; DE MATTEIS, Elisabetta; Cirilli, C.; Filieri, E.; Pecchi, Annarita; Battista, R.; Canossi, B.; Torricelli, Pietro; Federico, Massimo

Abstract not available

2012 - MRI in high risk women: benefits and problems [Articolo su rivista]
Cortesi, Laura; Pecchi, Annarita; DE MATTEIS, Elisabetta; Filieri, E.; Battista, R.; Canossi, B.; Torricelli, Pietro; Federico, Massimo

Abstract not available

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

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 - E-learning in radiologia: Esperienza multicentrica italiana [Articolo su rivista]
Carriero, A; Beomonte Zobel, B.; Bonomo, L.; Meloni, G.; Cotroneo, A.; Cova, M.; Ettorre, G. C.; Fugazzola, C.; Garlaschi, G.; Macarini, L.; Pozzi Mucelli, R.; Sironi, S.; Torricelli, Pietro; Capaccioli, L.; Zuiani, C.

Purpose: The aim of our work was to design, implement and evaluate an e-learning programme in favour of trainee radiologists enrolled at the many specialty schools located throughout Italy, in the spirit of "sharing culture". Materials and methods: Once a common educational programme and time slot had been identified and planned, the programme was delivered via Internet-based video conferencing once a week for 2-h lectures. Each lecture was followed by interaction between the teaching staff and trainees at the individual sites. The universities involved were Trieste, Udine, Verona, Milano Bicocca, Novara, Varese, Genova, Sassari, Rome "Campus", Rome "Cattolica", Chieti, Foggia, Catania, Modena and Firenze. The University of Rome "Cattolica" participated in the project with two locations: Rome "Policlinico Gemelli" and Rome "Cattolica Campus of Campobasso". Results: Eighteen lectures were conducted, for a total of 36 h. "Transient" connection interruption occurred 13 times for a total of 33 min over 2,160 min of lessons. Video quality and, in particular, details of radiological images shown in slides or moving pictures, were rated as very good by 71% of trainees, good by 24% and satisfactory by 4.5%; no one gave a rating of unsatisfactory. Conclusions: Based on our experience, whereas e-learning in radiology has become established and compulsory, there is the need for legislation that on the one hand protects online teaching activity and on the other allows study and continuing medical education (CME) credits to be recognised. © 2011 Springer-Verlag Italia.

2011 - Magnetic Resonance Imaging and Ultrasonography in Predicting Infiltrating Residual Disease after Preoperative Chemotherapy in Stage II-III Breast Cancer [Articolo su rivista]
Guarneri, Valentina; Pecchi, A; Piacentini, Federico; Barbieri, Elena; Dieci, Mv; Ficarra, G; Tazzioli, Giovanni; Frassoldati, A; Battista, R; Canossi, Barbara; Mauri, C; D'Amico, Roberto; Conte, Pierfranco; Torricelli, Pietro

BACKGROUND: This study was designed to evaluate the accuracy of breast magnetic resonance imaging (MRI) and ultrasonography (US) in predicting the extent of breast residual disease after preoperative chemotherapy. METHODS: Patients withstage II-III invasive breast tumors who received preoperative chemotherapy and were imaged with post-treatment MRI were included. Histopathological verification was available for all patients. The longest diameter of residual tumor measuredwith MRI and US has been compared with the infiltrating residual tumor size at pathologic evaluation. RESULTS: A total of 108 patients were enrolled: 59 were imaged with both MRI and US (MRI group), and 49 were imaged with US only (non-MRI group). The non-MRI group was enrolled as an external control to avoid possible bias in the selection of patients. In the MRI group, the means of the deltas between MRI residual tumor size and pathologic size and between US and pathologic size were 0.16 cm and -0.06 cm respectively (P = not significant). Overall, a discrepancy limited in the interval from -0.5 cm to +0.5 cm compared with the pathologic size was observed in 54% and 51% of the patients with MRI and US, respectively (P = not significant). The linear correlation between the radiological measurement and pathologic tumor size was r = 0.53 for MRI and r = 0.66 for breast US. In the non-MRI group, the mean of the deltas between US residual tumor size and pathologic size was 0.06 cm, and the linear correlation was r = 0.79. CONCLUSIONS: In this series of patients, MRI and US do not show significant differences in predicting the breast residual infiltrating tumor after preoperative chemotherapy.

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

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

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 - Primary adrenal gland carcinosarcoma associated with metastatic rectal cancer: a hitherto unreported collision tumor [Articolo su rivista]
Bertolini, F; Fiocchi, Federica; Giacometti, Marco; Fontana, A; Giberti, Mc; Roncucci, Luca; Luppi, G; Torricelli, Pietro; Rossi, Aldo; Conte, Pierfranco

A collision tumor between renal cancer and adrenal carcinoma is described

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

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 - Role of magnetic resonance imaging in the detection of anastomotic biliary strictures after liver transplantation. [Articolo su rivista]
Pecchi, A.; Santis, M. D.; Gibertini, M. C.; Tarantino, G.; Gerunda, Giorgio Enrico; Torricelli, Pietro; DI BENEDETTO, Fabrizio

Biliary complications after orthotopic liver transplantation (OLT) are the principal cause of morbidity and graft dysfunction, ranging in incidence from 5.8\% to 30\% of cases. Biliary strictures are the most frequent type of late complication. The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) to detect biliary anastomotic strictures among patients undergone OLT with abnormal liver function tests.One hundred twenty-one of 300 patients who underwent OLT were evaluated by MRC for clinically suspected anastomotic biliary strictures. In all patients, we performed various precholangiographic sequences including T1- and T2-weighted and MRC (radial SE 2D and SS-TSE 3D). Magnetic resonance imaging findings were subdivided as absence or presence of an anastomotic stricture. Diagnostic confirmation was obtained by endoscopic retrograde cholangiography (n=32), percutaneous transhepatic cholangiography (n=21) or surgical treatment (n=18).MRC detected 56 anastomotic biliary strictures, 53 of which were confirmed by other imaging modalities. MRC showed two false-negative cases and three false-positive cases. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRC to detect biliary strictures were 96\%, 96\%, 95\%, 97\%, and 96\%, respectively.MRC proved to be a reliable noninvasive technique to visualize the biliary anastomosis and depict biliary strictures after OLT. MRC should be used when a biliary anastomotic stricture is suspected in an OLT patient.

2011 - 3-T MRI with phased-array surface coil in the local staging of rectal cancer [Articolo su rivista]
F., Sani; M., Foresti; A., Parmiggiani; V., D'Andrea; Manenti, Antonio; Amorotti, Claudio; R., Scotti; E., Gallo; Torricelli, Pietro

PURPOSE:This study sought to evaluate the diagnostic accuracy of surface-coil 3T magnetic resonance (MR) imaging in the preoperative study of patients with rectal cancer.MATERIALS AND METHODS:Thirty patients with histologically proven rectal cancer underwent surface-coil 3T MR imaging with sagittal, paracoronal and para-axial T2-weighted turbo spin echo (TSE) sequences. Slice thickness was 3 mm without gap, field of view 24 cm, matrix 400 × 512. Images were assessed for infiltration of the rectal wall, perirectal fat and pelvic structures. Tumours were staged according to the TNM system, and the MR imaging results were correlated with histopathology.RESULTS:In the patients who underwent MR imaging before and after radiotherapy (group 1), the diagnostic accuracy of 3T MR imaging was 88% for T2, 94% for T3 and 88% for T4 cancers. In those who underwent surgical treatment without preoperative radiotherapy (group 2), the diagnostic accuracy was 90% for T2, 87% for T3 and 87% for T4 cancers.CONCLUSIONS:The high signal-to-noise ratio coupled with a large field of view enables surface-coil 3T MR imaging to achieve high levels of diagnostic accuracy in the local staging of rectal cancer, and in particular in assessing infiltration of mesorectum and mesorectal fascia.

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

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 - Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI. [Articolo su rivista]
Caproni, N; Marchisio, F; Pecchi, A; Canossi, B; Battista, R; D'Alimonte, P; Torricelli, Pietro

OBJECTIVE: To evaluate the reliability of contrast-enhanced ultrasound quantitative analysis (CE-US) in characterizing breast lesions, in comparison with MRI. MATERIALS: Thirty-nine patients with breast lesions BI-RADS 3-5 at US or mammography underwent CE-US and MRI. All lesions underwent histological and quantitative enhancement evaluation with both imaging methods. B-mode US, colour/power Doppler US and CE-US were used; an amplitude and phase modulation technique (CPS) read the signals produced by microbubbles and dedicated software produced the following parameters on time/intensity (T/I) curves: peak %, time to peak (TTP), mean transit time (MTT), regional blood volume (RBV) and regional blood flow (RBF). Student's t test was used to calculate the diagnostic accuracy of CE-US parameters compared with histological results. MRI (1.5 T) was performed before and after bolus gadolinium enhancement. Time/intensity curves were generated for all nodules and Fischer's multimodal score was used to classify them. RESULTS: Pathology showed 43 nodules (11 benign; 32 malignant). Peak and RBF were the most significant parameters in differential diagnosis, with p values of 0.02 and 0.004, respectively. Positive predictive value (PPV) of CE-US evaluation was 91%, negative predictive value (NPV) was 73% with a high concordance index (k = 0.59) with MRI. CONCLUSIONS: CE-US quantitative analysis offers an objective and reproducible assessment of lesion vascularisation, with good correlation with the results of MRI.

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

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

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 - Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation. [Articolo su rivista]
Pecchi, Annarita; M. D., Santis; DI BENEDETTO, Fabrizio; Gibertini, Maria Chiara; Gerunda, Giorgio Enrico; Torricelli, Pietro

PURPOSE: The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) in the detection of biliary complications following orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Seventy-eight transplant patients with clinically suspected biliary complications were evaluated with 1.5-T magnetic resonance imaging (MRI) using a surface coil. All patients were imaged with the following sequences: axial T1-weighted and axial and coronal T2-weighted, 2D spin echo (SE) breath-hold radial cholangiography, and coronal 3D single-shot turbo spin echo (SS-TSE) with respiratory triggering. Patients with negative MRI underwent clinical and sonographic followup. When biliary complications were present, diagnostic confirmation was obtained by endoscopic retrograde cholangiopancreatography (ERCP) (n=13), percutaneous transhepatic cholangiography (PTC) (n=20), ultrasonography (n=10) or computed tomography (CT) (n=2). In 11 cases, surgical confirmation was also obtained. RESULTS: MRC detected biliary complications in 44/78 patients, in particular, 42 biliary strictures (37 anastomotic and five intrahepatic), 40 of which were confirmed by other imaging modalities. In 25/37 cases of anastomotic stricture, preanastomotic dilatation of the biliary tract was also demonstrated. Other MRC-detected biliary complications were biliary sludge (n=4), biloma (n=5), and biliary stones (n=3). In four cases, PTC revealed biliary complications that had not been detected with MRC (false negative results). In two cases, MRC showed unconfirmed strictures of the intrahepatic ducts and biliodigestive anastomosis (false positive results). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy of MRC were 93.5\%, 94.4\%, 96.7\%, 89.5\% and 93.9\%, respectively. CONCLUSIONS: Our results confirm that MRC is a reliable technique for depicting biliary anastomoses and detecting biliary complications after OLT. The high diagnostic accuracy of MRC indicates that this examination should be routinely employed in all OLT patients with clinically suspected biliary complications.

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

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 - Contrast-enhanced sonography in early kidney graft dysfunction. [Articolo su rivista]
Benozzi, L; Cappelli, Gianni; Granito, Maria; Davoli, D; Favali, D; Montecchi, Mg; Grossi, A; Torricelli, Pietro; Albertazzi, Alberto

OBJECTIVES: The aim of this study was a comparison of contrast-enhanced sonography (CEUS) and power Doppler ultrasound (US) findings in renal grafts within 30 days posttransplantation. METHODS: A total of 39 kidney recipients underwent CEUS (SonoVue bolus injection) and US examinations at 5 (T0), 15 (T1), and 30 (T2) days after grafting. The results were correlated with clinical findings and functional evolution. Fourteen patients displayed early acute kidney dysfunction: 10 had acute tubular necrosis (acute tubular necrosis [ATN] group); four acute rejection episodes (ARE group); 25 with normal evolution (as control, C group). Renal biopsies were performed to obtain a diagnosis in the four ATN cases and in all ARE patients. Creatinine and estimated glomerular filtration rate were used as kidney function parameters. CEUS analysis was performed both on cortical and medullary regions while US resistivity indexes (RI) were obtained on main, infrarenal, and arcuate arteries. From an analysis of CEUS time-intensity curves, we computed peak enhancement (PEAK), time to peak (TTP), mean transit time (MTT), regional blood flow (RBF) and volume (RBV), and cortical to medullary ratio of these indies (RATIO). RESULTS: An increased RI was present in the ATN and ARE groups as well as a reduced PEAK and RBF. RATIO-RBV and RATIO-MTT were lower than C among ATN cases, while TTP was higher compared to C in ARE. No statistical difference was evidence for RI between ATN and ARE groups. MTT (T0) was significantly related to creatinine at follow-up (T2). CONCLUSIONS: US and CEUS identified grafts with early dysfunction, but only some CEUS-derived parameters distinguished ATN from ARE, adding prognostic information.

2009 - Physical and clinical comparison between a screen-film system and a dual-side reading mammography-dedicated computed radiography system [Articolo su rivista]
Rivetti, S; Canossi, Barbara; Battista, R.; Lanconelli, N.; Vetruccio, Elena; Danielli, C.; Borasi, Gianni; Torricelli, Pietro

Background: Digital mammography systems, thanks to a physical performance better than conventional screen-film units, have the potential of reducing the dose to patients, without decreasing the diagnostic accuracy. Purpose: To achieve a physical and clinical comparison between two systems: a screen-film plate and a dual-side computed radiography system (CRM; FUJIFILM FCR 5000 MA). Material and Methods: A unique feature of the FCR 5000 MA system is that it has a clear support medium, allowing light emitted during the scanning process to be detected on the "back" of the storage phosphor plate, considerably improving the system's efficiency. The system's physical performance was tested by means of a quantitative analysis, with calculation of the modulation transfer function, detective quantum efficiency, and contrast-detail analysis; subsequently, the results were compared with those achieved using a screen-film system (SFM; Eastmann Kodak MinR-MinR 2000). A receiver operating characteristic (ROC) analysis was then performed on 120 paired clinical images obtained in a craniocaudal projection with the conventional SFM system under standard exposure conditions and also with the CRM system working with a dose reduced by 35% (average breast thickness: 4.3 cm; mean glandular dose: 1.45 mGy). CRM clinical images were interpreted both in hard copy and in soft copy. Results: The ROC analysis revealed that the performances of the two systems (SFM and CRM with reduced dose) were similar (P>0.05): the diagnostic accuracy of the two systems, when valued in terms of the area underneath the ROC curve, was found to be 0.74 for the SFM, 0.78 for the CRM (hard copy), and 0.79 for the CRM (soft copy). Conclusion: The outcome obtained from our experiments shows that the use of the dual-side CRM system is a very good alternative to the screen-film system. © 2009 Informa UK Ltd.

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

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

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 - Indications for breast magnetic resonance imaging. Consensus Document "Attualità in Senologia", Florence 2007 [Articolo su rivista]
Sardanelli, F; Giuseppetti, Gm; Canavese, G; Cataliotti, L; Corcione, S; Cossu, E; Federico, Massimo; Marotti, L; Martincich, L; Panizza, P; Podo, F; ROSSELLI DEL TURCO, M; Zuiani, C; Alfano, C; Bazzocchi, M; Belli, P; Bianchi, S; Cilotti, A; Calabrese, M; Carbonaro, L; Cortesi, L; DI MAGGIO, C; DEL MASCHIO, A; Esseridou, A; Fausto, A; Gennaro, M; Girometti, R; Ienzi, R; Luini, A; Manoukian, S; Morassutt, S; Morrone, D; Nori, J; Orlacchio, A; Pane, F; Panzarola, P; Ponzone, R; Simonetti, G; Torricelli, Pietro; Valeri, G.

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.

2008 - Magnetic resonance imaging and ultrasonography in predicting pathologic extent after preoperative chemotherapy in stage II-III breast cancer [Abstract in Rivista]
Guarneri, Valentina; Pecchi, Annarita; Torricelli, Pietro; Piacentini, Federico; A., Frassoldati; C., Mauri; R., Battista; B., Canossi; D'Amico, Roberto; Conte, Pierfranco

Introduction and aims: the main advantage of preoperative chemotherapy (PCT) is tumor down-staging, that can allow either mastectomy in large, inoperable primaries, or breast conserving surgery (BCS) for patients initially candidate to mastectomy. Therefore, an accurate measurement of residual disease after PCT is critical in the optimal surgical planning. Aim of this study is to evaluate the accuracy of breast magnetic resonance imaging (MRI) and ultrasonography (USG) in predicting the extent of breast residual disease. Patients and Methods: patients with stage II-III invasive breast tumor receiving PST and imaged with post-treatment MRI, USG or both were included; deltas were calculated as differences between the longest tumor diameter as measured by MRI and USG and the pathologic size of residual breast tumor. Differences between deltas were tested by using T test for paired data. Results: 45 patients treated with PCT in our Institution were eligible. Patients characteristics were as follows: mean age 50 yrs (range 30-70 yrs); stage IIA 31%, IIB 49%, IIIA-B: 20%. Eighty-nine % of the cases had ductal histology, 69% had ER positivity, and 24% had HER2 over-expression. The mean T size at diagnosis was 3.8 cm (range 1.5-8 cm). PCT type was anthracycline-based (24%) or anthracycline-taxane combination (76%). Forty-four patients have been evaluated after PCT by MRI, 41 by USG, 40 patients by both MRI and USG. The mean T size (range) after PCT was 2 cm (0-6.5 cm) and 1.7cm (0-5cm) as measured by MRI and USG respectively. The mean interval between breast imaging and surgery was 20 days (range 1-63). Type of surgery was mastectomy in 45% and BCS in 55% of the cases; 6 patients (13%) achieved a pathologic complete response (pCR). The mean pathologic T size was 1.98 cm (range 0-6 cm). The mean of the deltas were 0.04 (SD 1.91) and -0.19 (SD 1.53) for MRI and USG respectively (p=0.22). A complete response by MRI was observed in 9 cases: 3 cases were confirmed as pCRs; 2 cases presented with scattered microscopic residual disease. An USG complete response was observed in 8 cases (4 confirmed pCRs). Conclusion: in this series of patients, MRI and USG do not show significant differences in predicting the breast residual tumor after PCT. The major challenge for breast imaging after PCT is represented by scattered residual disease.

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

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 - Radiofrequency ablation combined with transcatheter arterial chemioembolization in the treatment of advanced hepatocellular carcinoma [Abstract in Rivista]
Ventura, Paolo; M., De Santis; Romagnoli, Elisa; Tremosini, Silvia; Zaldini, Piera; E., Boldrini; P., Ballesini; A., Borghi; A., Cristani; Gandolfo, Marco; C., Sardini; I., Venturini; Torricelli, Pietro; M. L., Zeneroli

Background : Treatment of HCC complicating liver cirrhosis still remains a controversial issue, due to both the characteristics of the malignant disease per se and to the problems of underlying associated chronic liver disease. In particular, for patients with HCC not elegible for “curative” options (advanced HCC) (who, despite of surveillance programs, still remain a relevant amount in the clinical practice) there is no standard therapy. Aim: to evaluate efficacy of combined treatment with radiofrequency ablation (RFA) and transcatether arterial chemio-embolization (TACE) in the treatment of advanced hepatocellular carcinoma.Materials and Methods: We compared the treatment efficacy (cumulative survival rate after treatment) in 30 HCC-confirmed (imaging and/or histological proven) patients treated with combined therapy (simultaneous application of TACE and RFA; RFA was performed on to the greatest node in case of multiple nodes) [RFA-TACE group] with HCC-confirmed patients treated only by TACE [TACE group] or by conservative option [Control group]. Patients in TACE and Control groups were chosen as matching more as possible with patients in RFA-TACE group with regard to all possible factors influencing survival. Patients in TACE group could not undergo RFA due to technical (site of tumour, lesion undetectable at ultrasound, etc) and/or refuse of treatment. Control group could not undergo TACE due to portal complete or partial thrombosis or site of tumour. All patients were monitored at one-three months after treatment and every six months by imaging to control for treatment success and neoplasm relapse.Results: Characteristics of the considered groups are resumed in the table below. No patients were lost at follow-up. Survival rates were better in TACE-RFA group than TACE and control group. The median survival time was 16.1 months for TACE-RFA, 12.1 for TACE and 8.4 for Controls. The 6-month, 1-year and 2-years survival rate was 78%, 71% and 47% TACE-RFA group vs. 72%, 66% and 40% and 65%, 55% and 39% in TACE and Control group (p=.025 and p=.002 with respect to TACE-RFA group, i.e significant after Bonferroni correction for multiple comparisons).RFA-TACE (n=30)TACE (n=34)Controls (n=35)Age67±764±868±10Sex (males)22 (73.3%)25 (73.5%)26 (74.3%)Child score6.8±1.56.8±1.37.1±1.9Child group A/B11/1911/2310/25Nodes (mean)3.1±1.23.2 ±1.13.4±1.6Major node dimension3.9±1.53.8±1.63.9±1.8Single / Multiple node8/209/269/26BCLC stage ( B/C)16/1416/1815/20Milan criteria1 2/ 3 17/1315/1915/20Duration of Liver Disease (years) 8.4±4.48.7±3.58.6±3.5Etiology : Viral vs. Nonviral22/828/628/71 2= Single node > 3 and < 5 cm or multiple nodes (max 3) with the greatest ≤ 3 cm; 3= Single node > 5 cm or multiple nodes (more than 3 or up to 3 with the greatest > 3 cm)Conclusion: The combination of RFA and TACE is a promising approach for the treatment of advanced HCC complicating liver cirrhosis, nevertheless a better definition of patient’s characteristics and technical approaches are needed together with large scale-randomized trial for confirmation of results.

2008 - 3T MRI with Phased-Array Coil in Local Staging of Prostatic Cancer [Articolo su rivista]
Torricelli, Pietro; A., Barberini; F., Cinquantini; C., Sighinolfi; A. M., Cesinaro

RATIONALE AND OBJECTIVES: To evaluate the diagnostic accuracy of a 3-T magnetic resonance imaging (MRI) system with a phased-array coil (3T MRI) in the local staging of prostatic cancer. MATERIALS AND METHODS: Between July 2004 and September 2007, 59 patients (mean age 66 years) with a histologic diagnosis of prostatic cancer underwent 3-T MRI with a phased-array coil. A total of 42/59 patients underwent a radical prostatectomy within 3 weeks of the MRI examination. Two radiologists with differing experience in the interpretation of prostatic imaging used a 1-5 scale score to assess extracapsular spread, seminal vesicle and neurovascular bundle infiltration, and prostatic apex involvement. The anatomopathologic examination conducted on histologic macrosections was the reference test used to evaluate the results of 3-T MRI. Interobserver reliability was assessed using the k value. RESULTS: The sensitivity, specificity, and accuracy values obtained by the expert radiologist were 68%, 92%, and 83%, respectively, compared to 50%, 85%, and 71% for the identification of extracapsular spread and 81%, 62%, and 84% compared to 63%, 50%, and 55% for apex involvement. Interobserver reliability was good (k=0.71). Seminal vesicle infiltration was correctly identified in four of five cases and neurovascular bundle infiltration was identified in four of four cases. CONCLUSIONS: Despite presenting diagnostic accuracy values lower than those reported in literature using 1.5-T endorectal coil MRI, the use of 3-T MRI with a phased-array coil could constitute a valid alternative to MRI techniques using endorectal coils in selected patients. Direct comparative studies between the two methods on large caseloads are required to confirm this hypothesis.

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

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

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.

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

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 - 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.

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 - Rectal cancer staging [Articolo su rivista]
Torricelli, Pietro

Endorectal-US is the most suitable imaging technique in the initial staging of rectal cancer and it is mostly accurate in evaluating early stages and in demonstrating the perirectal spread of cancer tissue. CT is not able to demonstrate the layers of the rectal wall and its accuracy in demonstrating the invasion of muscolaris propria and perirectal fat is lower than other techniques, so its use in local staging is not recommended. MRI is mostly accurate in evaluating the mesorectum and the mesorectal fascia which are considered the most relevant prognostic factors for local recurrence. Lymph node evaluation is a challenge for every imaging techniques since lymph node size is not a reliable criterion for diagnosing metastatic involvement. Nuclear medicine has a remarkable role in the work-up of rectal cancer and in the next future the combination of FDG PET in conjunction with a dedicated contrast enhanced CT protocols could become a single-step staging procedure.

2006 - Arteriopatia occlusiva perlferica: Ruolo dell'angio-RM [Articolo su rivista]
Gozzi, M.; Amorico, M. G; Colopi, S.; Favali, M.; Gallo, E.; Torricelli, Pietro; Polverini, Ilaria; Gargiulo, M.

Purpose. Magnetic resonance angiography (MRA) has recently become instrumental in the diagnosis of arterial disease in various body districts and is gaining an increasingly important role in the study of peripheral vascularisation. The aim of our study was to evaluate the reliability of MRA using digital subtraction angiography (DSA) as the reference standard. Materials and methods. Between November 2003 and August 2004, 30 patients with known peripheral arterial disease were studied by MRA and DSA. MRA was performed with a Philips Intera 1.5 T, with acquisitions from the coeliac trunk to the feet. For acquisitions of the feet and ankles we used unenhanced time-of-flight (TOF) sequences with a head coil. The angiographic sequence was acquired in three volumes of 40-45 cm after administration of paramagnetic contrast material. Results. In the patients with peripheral arterial disease, the technique provided a precise evaluation of the stenosis (mild, moderate, severe) or obstruction of the peripheral district as well as the detection of other diseases, such as stenosis of the renal arteries or aneurysms. Conclusions. Total-body three-dimensional (3D) MRA allows a fast, safe, and accurate assessment of the arterial system in patients with arteriosclerosis and can be considered an alternative to DSA in the management of patients with steno-obstructive disease of the peripheral arteries.

2006 - Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience [Articolo su rivista]
Cortesi, L; Turchetti, D; Marchi, I; Fracca, A; Canossi, B; Battista, R; Ruscelli, Silvia; Pecchi, Ar; Torricelli, Pietro; Federico, Massimo

Background: Breast cancer ( BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification. Methods: We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio ( SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided. Results: After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased ( SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk ( SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P =.74). Conclusion: The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC.

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.

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 - 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

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.

2005 - MRI evaluation of myometrial invasion by endometrial carcinoma. Comparison between fast-spin-echo T2W and coronal FMPSPGR Gadolinium-dota-enhanced sequences [Articolo su rivista]
Nasi, F; Fiocchi, F; Pecchi, A; Rivasi, Francesco; Torricelli, Pietro

Purpose. The depth of myometrial invasion by endometrial carcinoma strongly affects the incidence of metastasis to regional nodes and influences the surgical strategies. The aim of this paper is to compare the results of FSE T2-w and Gadolinium-enhanced FMPSGR MR sequences in assessing the depth of myometrial invasion by endometrial cancer. Materials and methods. Forty-five women with histopathologically-proven endometrial carcinoma underwent preoperative MRI. Axial SE T1w, axial, sagittal and para-coronal FSE T2w and para-coronal Gadolinium-enhanced FMPSGR sequences were performed using a high field strength magnet (1.5T). Within one month of MR all patients underwent hysterectomy, and anatomical evaluation of the surgical specimen was done sectioning the uterus along the short axis. Based upon the results of the histological evaluation the results of the FSE T2w and Gadolinium-enhanced sequences were compared and the statistical difference between the results obtained was statistically evaluated. Results. The histological evaluation showed intramucosal neoplasm in 1 patients, myometrial infiltration less than 50% in 31 patients, myometrial infiltration more than 50% in 12 patients and transmural cancer in 1 patient. Statistical evaluation showed that the FSE T2w sequence had a global sensitivity and specificity of 80.6% and 87.6%, respectively, with a mean Negative Predictive Value of 92.6% and a mean Positive Predictive Value of 86%. Gadolinium-enhanced FMPSPGR sequence had a global sensitivity and specificity of 90.6% and 93.3%, respectively, with a mean Negative Predictive Value of 96,3% and a mean Positive Predictive Value of 88%. The staging accuracy (chi(2) test) on FMPSPGR images (95%) was higher than that on FSE T2w images (78%). Conclusions. In our experience Gadolinium-enhanced dynamic sequences increase the accuracy of MR imaging in diagnosing the depth of myometrial invasion. In particular they improve the visualisation of the inner myometrium, the so called subendometrial enhancing zone, whose disruption or changes are essential for diagnosing myometrial invasion. The major diagnostic advantages of the enhanced sequences were found in postmenopausal women, where visualisation of the junctional zone may be difficult in the T2w sequences. We believe that Gadolinium-enhanced dynamic sequences should be used whenever the diagnosis is unclear at FSE T2w sequences.

2005 - Radiologic imaging of the transplanted small bowel [Articolo su rivista]
Pecchi, A; DE SANTIS, M; Torricelli, Pietro; Romagnoli, R; Francesco, Fd; Cautero, Nicola; Pinna, A.

Background: The radiologic evaluation of the transplanted bowel is largely unknown and rather complex because it involves several techniques that depend on indications and times that have not been fully defined. Methods: From December 2000 to November 2002 in the Section of Radiology I of the University of Modena and Reggio Emilia (Modena, Italy), 11 patients with transplanted bowel were studied with different methods: traditional radiologic evaluation with contrast agent (all patients), evaluation of transit time with radiopaque markers (five patients), ultrasonographic (US) evaluation of the intestinal wall and Doppler US of the vascular axes (five patients), computed tomographic (CT) evaluation (all patients), and magnetic resonance (MR) evaluation of the bowel and the vascular axes (five patients). Traditional contrast examination enabled evaluation of the gastroesophageal transit and cardia functionality; anatomy and integrity of the anastomoses (proximal and distal); time of gastric emptying; morphology, tone, and kinesis of the transplanted small bowel loops and time of global transit. The study of transit with radiopaque markers was carried out in five patients to define the time of transit through the entire transplanted bowel, confirm recovery of intestinal motility, and identify possible abnormalities. The US examination was carried out in five patients to evaluate the morphology, thickness, and echo structural features of the intestinal loops. Color Doppler was performed to visualize the superior mesenteric artery and a wall arteriole of the sampled loop. CT examination was performed 2 to 4 weeks after surgery to evaluate the anatomy of the transplanted organs, arterial and venous anastomoses in case of complications identified with other methods or suspected, and periodically in the follow-up of patients who underwent transplantation due to Gardner syndrome. The protocol for MR evaluation of the bowel included coronal single-shot fast spin-echo T2-weighted sequences, axial and/or sagittal single-shot fast spin-echo T2-weighted sequences, coronal fast multiplanar spoiled gradient-echo (FMP- SPGR) sequences, coronal FMPSPGR sequences with and without administration of intravenous paramagnetic contrast agent, and axial or sagittal FMPSPGR fat-saturated sequences performed after dynamic gadolinium administration. Results and conclusion: The study of transit with radiopaque markers was useful in patients with chronic intestinal pseudo-obstruction because it identified recovery and normalization of motility. Traditional contrast examination of the gastrointestinal tract continues to play an important role in transplanted patients because it is a simple examination that allows evaluation of the graft anatomy and recovery of motility of the residual native bowel and the transplanted loops. Moreover, it plays a crucial role in early detection of major postoperative complications such as intestinal obstruction, perforation, fistulas, and anastomotic complications (stenosis and dehiscence). CT examination is crucial for the detection of fluid collections, abscesses, and fistulas because it can serve as a guide of drainage and during follow-up of patients with Gardner syndrome can be used to investigate all possible sites in which desmoids might arise in addition to their relation to the graft. Because patients with transplanted bowel are generally rather a young population of reproductive age and because of technologic advances, MR may represent an effective method that does not use ionizing radiation and can therefore substitute for traditional radiologic evaluation. US represents a quick examination technique that is easily available and well tolerated by patients, and it has a role to play in the follow-up of transplanted patients and in the identification of major postoperative complications. However, its role in monitoring possible rejection remains to be defined with studies on wider and more representative samples.

2004 - Hodgkin's disease - A quantitative evaluation by computed tomography of tumor burden [Articolo su rivista]
Torricelli, Pietro; Grimaldi, Pl; Fiocchi, Federica; Federico, Massimo; Romagnoli, Renato

A direct method for the evaluation by computed tomography (CT) of the neoplastic mass (tumor burden [TB]) has been adopted in 34 patients diagnosed with Hodgkin´s disease in the early stage. Stressed are its prognostic value, and its correlation with the clinical and laboratory parameters usually adopted in the staging of the disease and in its follow-up. It is concluded that the CT-calculated TB is a reliable index showing good correlation with other commonly used prognostic parameters.

2003 - Atypical lipomatous tumour (lipoma-like well-differentiated liposarcoma) arising in a pulmonary hamartoma and clinically presenting with pneumothorax [Articolo su rivista]
Rossi, Giorgio; Cavazza, A; Valli, R; Torricelli, Pietro; Richeldi, Luca; Rivasi, Francesco; Brambilla, E.

We document an uncommon variant of pulmonary hamartoma (PH), discovered in the left upper lobe of a 60-year-old man after an episode of pneumothorax, a unique clinical presentation for such an occurrence. The tumour showed a prominent leaf-like pattern and was mainly composed of mature fat with adipocytes of different size and scattered throughout lipoblasts and floret-like cells. A lobectomy was performed and more than 7 years after surgery the patient's course is still uneventful. This case represents an exceedingly rare example of an histologically malignant change in PH and bears a close clinicopathologic resemblance to atypical lipomatous tumours of soft tissues. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

2003 - Gadolinium-enhanced MRI with dynamic evaluation in diagnosing the local recurrence of rectal cancer [Articolo su rivista]
Torricelli, Pietro; Pecchi, A; Luppi, G; Romagnoli, R.

Background: At early stages, the diagnosis of local recurrence of rectal cancer is often difficult and magnetic resonance imaging (MRI) is currently considered the most accurate method for diagnosing recurrence. We evaluated the role of unhenhanced and gadolinium-enhanced MRI for the diagnosis of local recurrence of rectal cancer. Methods: Thirty-six patients, suspected of having a pelvic recurrence of rectal cancer, were evaluated by a high field strength MRI unit. Unenhanced spin-echo T1- and T2-weighted sequences and gadolinium-enhanced dynamic fast multiplanar spoiled gradient recalled sequences were performed in all patients. The dynamic images were re-elaborated with semiquantitative postprocessing by plotting intensity-time curves and calculating the percentage of signal increase at the end of the first postcontrast dynamic sequence. The pelvic lesions were classified as recurrent or not recurrent by applying the following diagnostic criteria: (a) morphology and signal intensity of the lesion in unenhanced sequences and (b) percentage of enhancement in dynamic enhanced sequences. Diagnosis was confirmed by computed tomography-guided needle biopsy (12 patients), surgery (four patients), clinical and imaging follow-up (20 patients). Results: The diagnosis was local recurrence in 15 patients and noncancerous lesions in 21 patients. Unenhanced MRI had 80% sensitivity and 86% specificity. Analysis of the percentage of enhancement showed 87% sensitivity and 100% specificity. Conclusion: In agreement with the literature, our results showed a high sensitivity and specificity for dynamic MRI. This technique thus can be considered an important adjunct to unenhanced MRI, especially in selected cases in which unenhanced MRI cannot rule out local recurrences. However, these results must be validated by further investigations.

2003 - Leukaemic pulmonary infiltrates in adult acute myeloid leukaemia: a high-resolution computerized tomography study [Articolo su rivista]
Potenza, Leonardo; Luppi, Mario; Morselli, M; Tonelli, S; D'Apollo, N; Facchini, L; Torricelli, Pietro; Tazzioli, Giovanni; Saviola, A; Bresciani, P; Longo, G; Torelli, Giuseppe

Leukaemic infiltration of the lungs may occur in acute myeloid leukaemia (AML). Pulmonary infiltrates are usually microscopic and invariably associated with hyperleucocytosis. Four AML patients with respiratory symptoms and low leucocyte counts underwent standard chest radiography, bronchoscopy with bronchoalveolar lavage and high-resolution computerized tomography (HRCT) of the lungs. HRCT scans showed pulmonary infiltrates with alveolar, interstitial, mixed and peribronchial/perivascular patterns in all patients, including one with negative standard radiographic findings. Infectious agents were excluded. Histology of the lung biopsy/autopsy specimens showed leukaemic infiltrates. Pulmonary leukaemia may be the cause of pulmonary infiltrates, even in non-hyperleucocytosic AML patients with low blast counts.

2003 - Metastasi pancreatica solitaria da carcinoma renale: Descrizione di 1 caso simulante tumore neuroendocrino [Solitary pancreatic metastasis from renal cell carcinoma. A case report] [Articolo su rivista]
Pecchi, A.; Cesinaro, A. M.; Torricelli, Pietro


2003 - Pseudoneoplastic appearance of cytomegalovirus-associated colitis in non-immunocompromised patients: report of two cases. [Articolo su rivista]
Maiorana, Antonino; Torricelli, Pietro; Bellini, Nicola; F., Giusti

Two cases of human cytomegalovirus (HCMV) colitis with pseudoneoplastic appearance are described. Patients presented with abdominal pain, fever, and diarrhea. Colonoscopy revealed a stenosing lesion in one patient and a broad-based, vegetant mass in the other patient, and histopathological examination of colectomy specimens revealed exuberant inflammatory masses with infiltration of mononuclear cells and ulcers with granulation tissue. Typical intranuclear HCMV inclusions were numerous. Peculiar to both patients was the lack of any apparent causes of immunodeficiency, such as human immunodeficiency virus infection or previous organ transplantation.

2003 - Tracheobronchopathia osteochondroplastica: Report of a case diagnosed using multidetector CT [La tracheobroncopatia osteocondroplastica: Descrizione di un caso diagnosticato con TC multistrato] [Articolo su rivista]
Pecchi, A.; Torricelli, Pietro; Marchioni, A.; Pellegrino, M.; Romagnoli, R.


2003 - Tumori non odontogeni. [Capitolo/Saggio]
Torricelli, Pietro; Pecchi, A.; Chiarini, Luigi; Figurelli, S.; Romagnoli, R.

Nell'ambito della diagnostica per immagini nella patologia odontostomatologica e maxillo-facciale, questo capitolo di libro si occupa dei tumori non odontogeni.

2002 - La Risonanza nella valutazione dei disordini funzionali del pavimento pelvico femminile [Magnetic resonance imaging in evaluating functional disorders of female pelvic floor] [Articolo su rivista]
Torricelli, Pietro; Pecchi, A.; Caruso Lombardi, A.; Vetruccio, E.; Vetruccio, S.; Romagnoli, R.

urpose. To evaluate the diagnostic capabilities of MRI in the study of functional diseases of the female pelvic floor. Materials and methods. Ten healthy volunteers and 30 patients with clinically suspected pelvic floor deficiency, with or without pelvic organ prolapse, were evaluated by a high field strength magnet operating at 1.5 T. In each case SSFSE sequences (TR/TE:25720/67) in axial, coronal and sagittal planes, both at rest and during Valsalva's manoeuvre, were performed. Based on the MRI findings using fixed and mobile anatomical landmarks, the functional disease of the pelvic floor was diagnosed and quantified based on the identification and grading of visceral prolapse. The MRI findings were compared with the clinical findings in all cases and with the surgical data in the 7 patients who had undergone surgery. Results. The MR image quality was adequate in all cases. In the group of symptomatic women MRI diagnosed: urethral hypermobility syndrome: 22 cases; isolated abnormalities of the anterior compartment: 8 cases of cystocele (low grade: 2, middle grade: 2, severe: 4); isolated abnormalities of the middle compartment: 6 cases of hysterocele (low grade: 2, middle grade: 4); isolated abnormalities of the posterior compartment: 5 cases of low-grade rectocele; 2 cases of enterocele (1 low grade, 1 middle grade ); multi-compartment abnormalities: 11 cases; joint prolapse of anterior and middle compartment: 5 cases; joint prolapse of posterior and middle compartment: 3 cases; joint prolapse of anterior, middle and posterior compartment: 3 cases. The values of both fixed and mobile landmarks were significantly higher in the symptomatic group compared with the healthy volunteers. MRI confirmed the pelvic examination findings in all cases; in particular MRI findings were in total agreement with the clinical severity of prolapse, as defined by the Baden-Walker classification. In 7 cases MRI detected additional alterations (4 cases of hysterocele and 3 of enterocele) that had been missed at clinical evaluation. Discussion and conclusions. In our experience MRI made an important contribution to the diagnosis and grading of functional disorders of the female pelvic floor and pelvic organ prolapse. The ability to simultaneously demonstrate both muscular and ligamentous structures and pelvic viscera, without using X-rays or contrast agents, is the main reason for the good results achieved by MRI and for its widespread use in this disorder. Furthermore the use of fast, breath-hold sequences can provide high-quality images both at rest and during Valsalva's manoeuvre.

2002 - La RM con bobina endorettale nella stadiazione locale del carcinoma rettale [Endorectal coil MRI in local staging of rectal cancer] [Articolo su rivista]
Torricelli, Pietro; Lo Russo, S.; Pecchi, A.; Luppi, G.; Cesinaro, A. M.; Romagnoli, Renato


2002 - Sclerosing stromal tumor of the ovary: US, CT, and MRI findings [Articolo su rivista]
Torricelli, Pietro; Lombardi, Ac; Boselli, F; Rossi, Giorgio

We present the sonographic, computed tomographic, and magnetic resonance imaging findings in a case of a sclerosing stromal tumor of the ovary with pathologic correlations.

2001 - Cystic paraganglioma of the renal capsule [Articolo su rivista]
Rossi, Giorgio; G., Oleari; C., Botti; Torricelli, Pietro; P., Baccarini; Barbolini, Giuseppe


2001 - La risonanza magnetica con studio dinamico e sottrazione di immagini nella valutazione della risposta dell'osteosarcoma alla chemioterapia [Dynamic contrast enhanced Magnetic Resonance Imaging Subtraction in evaluating osteosarcoma response to chemotherapy] [Articolo su rivista]
Torricelli, Pietro; Montanari, N; Spina, V; Manfrini, M; Bertoni, F; Saguatti, G; Romagnoli, R.

Purpose. To evaluate the results of a new technique of dynamic contrast enhanced Magnetic Resonance (MR) imaging subtraction in the assessment of osteosarcoma response to chemotherapy. Methods. 24 patients with high grade osteosarcoma, treated with preoperative neo-adjuvant chemotherapy, underwent MR at high field strength (1.5 T). Both unenhanced conventional SE T1- and T2-weighted sequences in the coronal and axial plane and dynamic Gd-DTPA-enhanced SE T 1-weighted sequences in the coronal plane were performed. Image postprocessing included subtraction of unenhanced image from enhanced images (arbitrary called "angiographic subtraction") and subtraction of each enhanced image from the last-enhanced image (arbitrary called "pathologic area" subtraction). The early enhancing areas detected in the angiographic subtraction and the pathologic areas detected in the pathologic area subtraction were correlated with histopathological findings on histological macrosections obtained from the resected specimen. The sensitivity, specificity, accuracy, positive and negative predictive value of both the subtraction techniques were calculated. Results. The early enhancing areas of angiographic subtraction were related not only to viable tumor but also to the host reactions such as flogosis and granulation tissue. The pathologic areas detected at the pathologic area subtraction correlated in most cases with viable tumor, while in 3 cases they did not correspond to viable tumor tissue and in 1 case a small area of residual viable tumor was missed. In assessing response to chemotherapy, pathologic areas subtraction had an accuracy of 95% (specificity: 100%, sensitivity: 93%, PPV: 100%, NPV: 88%), whereas angiographic subtraction had an accuracy of 79% (specificity: 37%, sensitivity: 100%, PPV: 76%, NPV: 100%) Conclusions. Pathologic area subtraction may be a useful technique for assessing the response of osteosarcoma to chemotherapy and for detecting residual viable tumor tissue.

2001 - Meningocele intratoracico nella neurofibromatosi di Recklinghausen [Descrizione di un caso] [Articolo su rivista]
C., Dal Molin; P., Ariosi; Torricelli, Pietro


2001 - RM statica e dinamica del pavimento pelvico: Radio-anatomia ed applicazioni nel prolasso genito-urinario [Relazione in Atti di Convegno]
Vetruccio, S; Barbieri, F.; Torricelli, Pietro; Vetruccio, E.; Caruso Lombardi, A.; Jasonni, Valerio


2001 - Spontaneous rupture of the spleen:report of two cases. [Articolo su rivista]
Torricelli, Pietro; Coriani, C; Marchetti, M; Rossi, Aldo; Manenti, Antonio

Spontaneous splenic rupture is rare and in most cases occurs in a spleen affected by hematologic, neoplastic, or infectious disease or as a complication of pancreatitis. We report the imaging findings in two cases of spontaneous splenic rupture due to non-Hodgkin's lymphoma and pancreatic pseudocyst

2000 - Sindrome di Poland. Descrizione di un caso. [Articolo su rivista]
Ariosi, P; Torricelli, Pietro; Stefani, Alessandro; Morandi, Uliano

Gli Autori descrivono un raro caso di Sindrome di Poland in maschio di 16 anni. Non è stata necessaria correzione chirurgica.

2000 - Spontaneous renal hematomas [Ematomi renali spontanei: Descrizione di 4 casi] [Articolo su rivista]
Torricelli, Pietro; Renzi, E.; Tazzioli, Giovanni; LO RUSSO, S

Spontaneus renal and peritoneal hematomas are heavy clinical events and , even if rare, they need an early diagnosis in order to plan therapy. A spontaneus renal hematoma should be suspected in case of acute lumbar pain because in more than 60% of cases it is due to a neoplastic lesion.

1999 - Cellular localization of human herpesvirus 8 in nonneoplastic lymphadenopathies and chronic interstitial pneumonitis by in situ polymerase chain reaction studies [Articolo su rivista]
Trovato, R; Luppi, Mario; Barozzi, Patrizia; Da Prato, L; Maiorana, Antonino; Lico, S; Marasca, Roberto; Torricelli, Pietro; Torelli, Giuseppe; Ceccherini Nelli, L.

Objectives: To study the cellular localization of human herpesvirus 8 (HHV-8) in rare cases of HHV-8 infection from Italy that are associated neither with human immunodeficiency virus (HIV) infection nor Kaposi's sarcoma (KS). Methods: The presence and distribution of HHV-8-infected cells was investigated by direct in situ polymerase chain reaction (PCR) in the lymph node tissues from 2 patients with reactive lymphadenopathies with florid follicular hyperplasia and increased vascularity and in the lung tissue from 1 patient with chronic interstitial pneumonitis. Results: HHV-8 was localized in lymphoid and monocyte-macrophage cells scattered in the interfollicular regions of both lymph nodes but not in endothelial cells. In the lung tissue, HHV-8 was found in the inflammatory cells infiltrating the interalveolar interstitium, in endothelial cells of the pulmonary vasculature, and in rare pneumocytes. Conclusions: HHV-8 can infect nonneoplastic lymph nodes of immunocompetent subjects, and the distribution of infected cells outside of the germinal centers resembles that of Epstein-Barr virus (EBV)-infected cells in the lymph nodes in the course of infectious mononucleosis. Endothelial cells and pneumocytes may be a target of HHV-8 infection out of the KS setting, at least in the presence of a chronic inflammatory process.

1999 - Erratum: Cellular localization of human herpesvirus 8 in nonneoplastic lymphadenopathies and chronic interstitial pneumonitis by in situ polymerase chain reaction studies (Journal of Human Virology (January/February 1999) 2:1 (38-44)) [Articolo su rivista]
Trovato, R.; Luppi, M.; Barozzi, P.; Da Prato, L.; Maiorana, A.; Lico, S.; Marasca, R.; Torricelli, P.; Torelli, G.; Ceccherini-Nelli, L.

1999 - Magnetic resonance with endorectal coil in the local staging of prostatic carcinoma. Comparison with histologic macrosections in 40 cases [Articolo su rivista]
Torricelli, P.; Iadanza, M.; De Santis, M.; Pollastri, C. A.; Cesinaro, A. M.; Trentini, G.; Romagnoli, R.

PURPOSE: Endorectal coil MRI is widely used in the diagnostic workup of prostate cancer, but diagnostic accuracy rates reported in the literature are quite variable. We report our personal experience with endorectal coil MRI in the local staging of prostate carcinoma. MATERIAL AND METHODS: Forty consecutive patients with histologically proved prostate carcinoma were examined with endorectal coil MRI at high field strength (1.5 T). All patients underwent a sagittal T1-weighted SE location sequence (TR 400, TE 20), an axial T1-weighted SE (TR 400, TE 20), two axial T2-weighted FSE sequences (TR 3000, TE 102, ETL 8) with and without fat suppression, and a coronal T2-weighted FSE sequence (TR 3000, TE 102, ETL 8); an axial Fast Multiplanar Spoiled Gradient Recalled (FMSPGR) dynamic sequence after Gd-DTPA injection was also performed in 18 patients. MR staging of local tumor spread was done according to the current literature criteria. All patients were submitted to radical prostatectomy, and histologic macrosections on the same plane as MR images were obtained from surgical specimens. MR and histologic staging were compared to assess MR accuracy in detecting capsular infiltration, seminal vesicles and apex involvement. The diagnostic yield of Gd-DTPA was also investigated. RESULTS: MRI correctly staged 31 of 40 cases (77.5%). MR accuracy was 80% in detecting capsular infiltration (85.7% sensitivity and 73.6% specificity), 90% in seminal vesicle involvement (91.6% sensitivity, 89.2% specificity) and 72.5% in apex involvement (79.1% sensitivity, 62.5% specificity). Dynamic studies with Gd-DTPA did not improve staging accuracy in any case. DISCUSSION AND CONCLUSIONS: In agreement with most of the current literature, MRI showed moderate overall accuracy in the local staging of prostate carcinoma. Particularly, MRI had good accuracy in detecting seminal vesicle involvement but moderate sensitivity and specificity in demonstrating capsular infiltration and apex involvement. Due to its high cost, MRI should not be routinely used in prostate cancer staging but should be reserved to the patients whose clinical and serological data suggest extraprostatic tumor spread, whose preoperative demonstration could avoid noncurative surgery.

Tazzioli, G.; Montanari, N; Pollastri, Ca; Ferretti, A; Torricelli, Pietro

A case of large sized angiomyolipoma with atipical clinical presentation is reported.The retroperitoneal mass, showed by ultrasonography,was mainly made by fat tissue, as showed by CT and NRI, and it was associated with focal, probably metastatic, liver lesions.

1997 - Effects of lipiodol retention on MRI signal intensity from hepatocellular carcinoma and surrounding liver treated by chemoembolization [Articolo su rivista]
Desantis, M; Alborino, S; Tartoni, Pl; Torricelli, Pietro; Casolo, A; Romagnoli, R.

Opinion is divided regarding the influence of iodized oil on MRI signal intensity of hepatic tumours treated with transcatheter arterial chemoembolization (TACE), in which lipiodol deposits. The aim of our study was to ascertain whether or not lipiodol directly influences the MRI signal intensity of hepatocellular carcinoma (HCC) treated by TACE and that of the surrounding liver. Thirteen patients with HCC were studied retrospectively. CT and MRI scans were performed both before and 3 months after TACE. The CT scan was performed to check whether embolized nodules contained lipiodol and how lipiodol was distributed within them. In addition, eight patients were examined prospectively within 7 days after TACE. In these patients a CT scan was performed to see how lipiodol was distributed in the neoplastic nodules and in normal hepatic parenchyma. In the first group of patients the contrast-to-noise (C/N) ratio on T1-weighted (T1W) images and the T2 relaxation time on T2-weighted (T2W) images were calculated for both neoplasm and surrounding liver. In the second group of patients we also measured the signal intensity of non-neoplastic liver that was either permeated or not permeated by lipiodol. The data were analysed with Wilcoxon's test. On T1W images we observed that the retention of lipiodol increased the C/N ratio in all the tumours studied within 1 week after TACE. In the patients studied 3 months after; TACE the C/N ratio was not significantly increased. On T2W images lipiodol retention did not change tumour signal intensity. The iodized oil did not change the signal intensity of the liver surrounding the tumour, in comparison with the liver not permeated by lipiodol, on either T1W or T2W images. The results indicate that lipiodol does not modify the signal intensity in non-neoplastic hepatic parenchyma in which it is deposited; after 3 months it does not significantly affect the signal of the tumours that accumulated it. Lipiodol produces a high signal on T1W im ages over the first few days following TACE in those tumours in which it is deposited.

1997 - Spontaneous pneumomediastinum: A rare presentation of an endobronchial neoplasm. A case report [Articolo su rivista]
Torricelli, P.; Fontana, G.; De Paola, M.

1996 - An interactive atlas of magnetic resonance anatomy on CD-ROM for Macintosh [Articolo su rivista]
Montanari, N.; Bertolani, M.; Romagnoli, R.; Spina, V.; Torricelli, P.

Computer assisted education in radiology has been increasingly used during the past ten years and now complements traditional learning resources. Magnetic Resonance Imaging (MRI) of musculoskeletal anatomy, and particularly of joints, lends itself naturally to learning modules on computer. This paper describes the design, development and use of an interactive computer assisted teaching module of MR joint anatomy on CD-ROM for Macintosh: to date, we have used this atlas for ankle and elbow anatomy. The atlas is divided into three main sections: MR anatomy, traditional anatomy and a quiz. On each MR image, any anatomical detail can be identified clicking on it with the mouse. Buttons allow to visualize cross-reference points and to go directly on the desired image. If the student wants to look at anatomical drawings of the last identified structure, a button retrieves all the cards in the traditional anatomy section containing that structure. Finally, the student can make his own self-assessment, verifying his learning immediately with the exam mode: the software makes a random selection of 10 MR images where an anatomical structure must be indicated; if the answer is wrong, the software gives the right one and shows the misinterpreted structure. Then, the student is given a total score for his performance. The computer assisted teaching modules present some advantages: the images can be viewed in a given sequence (like traditional learning resources) or in any self-paced, customized way; this possibility, together with the friendly interface of Macintosh computers could make learning more active and pleasant.

1996 - Magnetic resonance imaging of the brachial plexus: Anatomy and study technique [Articolo su rivista]
Montanari, N.; Spina, V.; Torricelli, P.; Marongiu, M. C.; Bertolani, M.; De Santis, M.; Romagnoli, R.

Brachial plexopathies are a common diagnostic problem: conventional imaging techniques can be useful in the detection of associated conditions (Pancoast tumors, first rib or clavicle fractures, etc.) but they cannot visualize brachial plexus structures directly. Also Computed Tomography (CT) is limited in the study of the retroclavicular region because of the artifacts due to the presence of the humeral heads in the slice. CT myelography exhibits very high accuracy in posttraumatic brachial plexopathies but fails to reveal the postganglionic plexus. In contrast, Magnetic Resonance Imaging (MRI) allows the direct detection of the brachial plexus, from spine to axilla, thanks to its multiplanarity and high contrast resolution. However, MR images are so rich in anatomical details (particularly on the oblique planes) that sometimes they become very difficult to interpret. To better define the anatomical relationships of the brachial plexus and to assess the best planes to study its different portions, 9 healthy volunteers were examined with MRI and MR images were compared with anatomical drawings and frozen cadaver sections. MRI depicts the brachial plexus from its origin to the axilla, but none of the investigated planes is sufficient, alone, to study the whole plexus adequately. The paraganglionic portion is clearly depicted on oblique sagittal images, while coronal and sagittal images are more useful for primary trunks and spinal nerves; the distal portion is perfectly visualized on sagittal images. Thus, we conclude that different examination protocols are necessary for every specific plexus portion, which means that brachial plexus MRI must be performed to try to solve a specific question by the orthopedic surgeon or the clinician.

Piccinini, Lino; G., Luppi; A., Zoboli; Torricelli, Pietro

Synchronous renal cell cancer (RCC) associated with primary neoplasms of other organs or tissues represents a rare diagnostic report during life. Recently, the widespread use of new diagnostic techniques (echography, computed tomography and magnetic resonance imaging) has permitted diagnosis of clinically silent RCC. We report 6 RCC cases occasionally diagnosed during initial staging of a primary cancer of other organs: 1 rhinopharyngeal carcinoma, 1 gastric cancer, 1 Waldenstrom's disease, 1 non-Hodgkin's lymphoma, 2 breast cancer. RCC was clinically silent in all patients. The diagnostic problems related to a report of a renal mass in patients with neoplastic disease at other sites and the consequent therapeutic implications are discussed.

1995 - Giant gastric leiomyoma. Report of a case [Articolo su rivista]
Torricelli, P.; Cuscianna, G.; Rossi, A.; Ficarra, G.

1995 - Spontaneous adrenal gland haematoma in a patient with antiphospholipid antibodies [Articolo su rivista]
Luppi, Mario; Marasca, Roberto; Torricelli, Pietro; Leonardi, G; Gavioli, Gl; Bocchi, A; Torelli, G.

No abstract available

1994 - Gadolinium-DTPA-enhanced MRI to study renal cancer [Articolo su rivista]
Torricelli, P.; Montanari, N.; De Santis, M.; Pollastri, C.

To investigate the role of Gd-DTPA in the MR study of renal cancers, 30 patients affected with primary (28) or recurrent (2) renal cancers were submitted to high-field MRI (1.5 T). T1- and T2-weighted and Gd-DTPA-enhanced T1-weighted sequences were always acquired. Based on qualitative and quantitative criteria (calculation of the signal-to-noise ratio in the tumor mass and of the signal-difference-to-noise ratio between tumor and renal parenchyma), Gd-DTPA influence was studied on the following variables: signal intensity and tumor demonstration, detectability of morphostructural features of tumor tissue and staging accuracy. As for the latter variable, MR results were compared with the results of anatomical and surgical staging (28 cases). Relative to unenhanced T1- and T2-weighted sequences, on Gd-DTPA-enhanced sequences 80% of the lesions were markedly hypointense relative to renal parenchyma and they were better demonstrated in 93% of cases. The S/N and the SD/N ratios were higher on Gd-DTPA-enhanced than on unenhanced images. After Gd-DTPA administration, the intratumoral necrotic areas, the walls and the septations of the cystic masses and the boundaries between tumors and renal parenchyma were better demonstrated. Staging accuracy was the same (90%) on both Gd-DTPA-enhanced T1-weighted and unenhanced images. Therefore, Gd-DTPA, although failing to increase staging accuracy, improves tumor depiction and demonstrates the morphostructural features of the mass. Since Gd-DTPA caused no side-effects, Gd-DTPA-enhanced T1-weighted sequences can replace T2-weighted sequences, whose acquisition time is definitely longer.

1994 - The epiphyseal involvement of metaphyseal bone sarcomas in patients with fertile growth plates. A magnetic resonance assessment [Articolo su rivista]
Spina, V.; Torricelli, P.; Montanari, N.; Manfrini, M.; Picci, P.; Sangiorgi, L.; Romagnoli, R.

The growth plate is thought to be capable of limiting tumor spread. To assess the presence and extent of epiphyseal involvement in bone tumors, the plain radiographs and the MR images of 41 patients with metaphyseal sarcoma and radiographically apparent growth plate were studied. The results were compared with surgical, microscopic and histologic findings. Histology demonstrated that in 3 patients the tumor did not reach the growth plate, in 25 the epiphysis was involved while in 13 cases the tumor reached the physis but did not spread to the epiphysis. In the latter group of patients, histology demonstrated a microinfiltration of the physis in 5 cases. Radiography and MR sensitivities were 77.2% and 100%, respectively, while specificity was 94% for both methods. Histology showed that the epiphysis was involved in 25/41 cases (61%) and the growth plate in 30/41 (73%). Our results show that the growth plate does not usually act as a barrier against tumor spread and that MRI is the diagnostic tool of choice in the assessment of epiphyseal spread in metaphyseal tumors even though it cannot detect growth plate microinfiltrations.

1993 - MR in the characterization of benign ovarian masses [Articolo su rivista]
Torricelli, P.; De Santis, M.; Montanari, N.; Romagnoli, R.

To investigate the role of MRI in characterizing benign ovarian masses, the MR images of 64 patients affected with benign ovarian masses were retrospectively reviewed. The benign nature of the masses was proven at surgery (42 cases), fine-needle biopsy (10 cases), laparoscopy (6 cases) and follow-up (6 cases). MRI correctly characterized 56 of 64 masses (87.5%). In particular, all the cases of simple serous cyst (9), of hemorrhagic cyst (10), of fibroma (4), of dermoid cyst (18) and of tubo-ovarian abscess (7). MRI misdiagnosed 4 endometrial cysts--2 of them as hemorrhagic cysts and 2 as dermoid cysts-, 1 serous cystoadenoma as cystoadenocarcinoma and 1 suppurative mucinous cystoadenoma as tubo-ovarian abscess. Moreover, 1 angiofibroma and 1 hematosalpynx were misdiagnosed as endometrial cysts. In conclusion, MRI can be considered a second-choice diagnostic tool which can replace CT in the evaluation of the patients in whom US alone fails to yield an unquestionable diagnosis.

Desantis, M; Torricelli, Pietro; Cristani, A; Cioni, G; Montanari, N; Sardini, C; Ventura, E; Romagnoli, R.

Objective: Magnetic resonance imaging of hepatocellular carcinomas (HCCs) was performed before and after transcatheter arterial chemoembolization (TACE). The changes of tumor signal intensity were compared to residual tumor or tumor recurrence in the follow-up period. Materials and Methods: Fifteen cirrhotic patients with HCC were studied. All patients were examined with MRI both before and 3 months after TACE. Requirement for the study was that all lesions were detectable by MR before TACE. Results: Magnetic resonance imaging detected 31 tumors. The changes of tumor signal intensity were compared to residual tumor or tumor recurrence in the follow-up period. On T1-weighted (T1W) images before TACE, 16 tumors were hyperintense, 11 were isointense, and 4 were hypointense; on T2W images, 26 tumors were hyperintense, 5 were isointense, and none were hypointense. On T1W images 3 months after TACE, 8 tumors were hyperintense, 18 were isointense, and 9 were hypointense; on T2W images, 11 were hyperintense, 11 were isointense, and 9 were hypointense. All the tumors that became hypointense on T2W images after TACE did not recur on follow-up. All lesions that were still hyperintense on T2W images after TACE showed residual tumor during the follow-up. Among 11 tumors that were isointense on T2W images after TACE, 7 were hyperintense on T2W images before TACE; 6 of these did not recur. Four tumors were isointense on T2W images before and after TACE; 2 of these showed residual tumor in the follow-up. On T2W images after TACE, 15 of 16 HCCs that decreased in signal intensity did not recur on follow-up. On T1W images no correlation was seen between the changes of the signal intensity of the lesion and tumor recurrence in the follow-up; however, 9 of 17 HCCs that did not recur after TACE showed decreased signal intensity. All the tumors (10 of 10) with decreased signal intensity on both T1W and T2W images after TACE did not show tumor recurrence on follow-up. Conclusion: The results suggest that MRI is useful in the assessment of the therapeutic effect of TACE in HCC.

1993 - Osteosarcoma: Magnetic resonance imaging following preoperative chemotherapy [Articolo su rivista]
Spina, V.; Torricelli, P.; Manfrini, M.; Picci, P.; Romagnoli, R.

1992 - Magnetic resonance in the staging of renal carcinoma. The results compared with computed tomography in 42 cases [Articolo su rivista]
Torricelli, P.; Puviani, M.; De Santis, M.; Nasi, G.; Pollastri, C.

In order to investigate the value of MRI in the staging of renal cell carcinoma and to compare the results of MRI and CT, the authors evaluated by means of MRI and CT 42 patients affected with renal cell carcinoma. All patients underwent surgery, and pathology of the surgical specimens was performed. A comparison was made between the surgical and pathologic data and MRI and CT results. Moreover, a comparative evaluation of MRI and CT findings was also made. From the comparison between pathologic data and CT and MRI results MRI was seen to have correctly staged 36 of 42 cases (85%), versus CT 33 of 42 cases (78%). Moreover, MRI proved to be superior to CT in evaluating venous involvement (stages III A and III C) and extra-fascial tumor spread (stage IVA). On the contrary, no significant differences were found between MRI and CT in the evaluation of perirenal involvement (stages I-II) and lymph node metastases (stage III B). MRI misdiagnosed 6 of 42 cases: 2 false negatives in evaluating extracapsular tumor spread, 1 false positive of mesenteric infiltration, 1 false positive of renal vein thrombosis, 1 false positive and 1 false negative in evaluating lymph node metastases. CT misdiagnoses (9 of 42 cases) were the same as those of MRI in 5 cases, while in the MRI false positive of renal vein thrombosis CT was correct. The extant 4 incorrect CT findings were: 2 false positive of renal vein thrombosis, 1 false negative of infiltration of diaphragm and psoas muscle, 1 false positive infiltration of the right liver lobe. As yet, therefore, MRI cannot be routinely employed to stage all renal cancer patients. On the contrary, MRI should be considered as a second-choice diagnostic tool to employ in selected cases when CT alone cannot solve all the problems relative to staging.

1990 - Computed tomography of the pseudocystic cancer of the liver [Articolo su rivista]
Manenti, A.; Marchetti, M.; Gibertini, G.; Torricelli, P.

Torricelli, Pietro; Martinelli, C; Biagini, R; Ruggieri, P; Decristofaro, R.

Adani, R; Calo, M; Torricelli, Pietro; Squarzina, Pb; Caroli, A.

1989 - Calcified cavernous hemangioma of the stomach. A case report [Articolo su rivista]
Torricelli, P.; Furno, A.; Baldoni, C.; Tomasini, A.

1989 - Capabilities and limitations of CT in the preoperative evaluation of primary malignant tumors of the bone. Observations on 138 cases [Articolo su rivista]
Torricelli, P.; Martinelli, C.; Ruggieri, P.; Biagini, R.; Casadei, R.

1989 - CT in established Volkmann's contracture in forearm muscles. [Articolo su rivista]
Landi, Antonio; DE SANTIS, Giorgio; Torricelli, Pietro; A., Colombo; P., Bedeschi

Differential diagnosis between true and pseudo-Volkmann's contracture should not be based on clinical grounds alone, because clinical data are often insufficient in determining the severity and the extent of muscle damage. CT has been utilised in 11 cases where a flexion contracture of the forearm muscles was present and corresponded closely with the surgical findings. True and pseudo-Volkmann's contracture can thus be distinguished and the severity and extent of the muscle damage determined.

1989 - Echographic examination in the screening of hip dysplasia in newborn infants and infants [Articolo su rivista]
Barbolini, G.; Torricelli, P.; Monetti, G.; Laudizi, L.; Gatti, G.; Sturloni, N.

Sonography was employed to evaluate the accuracy of congenital hip dysplasia in 1014 cases, using Graf's methodology and classification in neonatal and infant age. Sonography appears useful to detect and monitor this disease. In fact all the acetabular development can be better revealed than by radiography.

1988 - Pre-operative examination of atheromatous lesions of supra-aortic vessels by Doppler and digital subtraction angiography [Articolo su rivista]
Martinelli, C.; Aimi, G.; Torricelli, P.; Silingardi, R.; Vecchiati, E.; Coppi, G.

1988 - Radiographic and CT findings in pigmented villonodular synovitis of the hip (2 cases) [Articolo su rivista]
Marchetti, M.; Torricelli, P.; Gallo, E.; Cerofolini, E.

1987 - Clinical, radiological-computerized tomography and scintigraphic findings in a case of chronic renal insufficiency with calcifications of the soft tissues [Articolo su rivista]
Torricelli, P.; Romani, F.; Lucidi, G. N.; Pantusa, M.

1987 - CT appearance of sacrococcygeal chordoma [Articolo su rivista]
Martinelli, C.; Torricelli, P.; Reggiani, G.; Capanna, R.; Ruggieri, P.; Biagini, R.

1987 - CT diagnosis of lumbosacral conjoined nerve roots - Findings in 19 cases [Articolo su rivista]
Torricelli, P.; Spina, V.; Martinelli, C.

The authors report the observations derived from CT evaluation of 19 cases of lumbosacral conjoined nerve roots; 11 of these have been confirmed by lumbar myelography and/or at surgery. They conclude that CT without intrathecal metrizamide allows the recognition in most cases of the presence of conjoined nerve roots and to differentiate them from a herniated disk fragment; this is especially useful to avoid surgical damage of anomalous roots. © 1987 Springer-Verlag.

1987 - Value and limits of computed tomography in the study of benign bone tumors [Articolo su rivista]
Torricelli, P.; Reggiani, G.; Martinelli, C.; Boriani, S.; Folchi Vici, F.

1986 - [Computerized axial tomography in the preoperative study of osteoid osteoma] [Articolo su rivista]
Torricelli, P; Ruggieri, P; Biagini, R; Martinelli, C; Porcellini, G; Boriani, S


1986 - Computerized tomography in spinal osteoblastoma. Observations in 10 cases [Articolo su rivista]
Torricelli, P.; Martinelli, C.; Boriani, S.; Ferraro, A.

In order to stress the role of computed tomography (CT) in the evaluation of benign spinal osteoblastoma, the authors examined by CT 10 patients with surgically and histologically proved osteoblastomas of the spine. Basing on surgical and histopathological findings CT proved to be a very important method for attesting the presence of the tumors (usually showed by radiographic examination), and specially for their staging and follow-up. CT in fact showed the real extent of the tumor into the spinal canal and towards the paraspinal soft tissues, and allowed the early detection of post surgical relapses. The authors conclude that CT is a primary diagnostic modality for preoperative planning and follow-up of benign osteoblastoma.

1986 - Computerized tomography in the assessment of soft-tissue neoplasms. Observations in 124 cases (La tomografia computerizzata nella valutazione delle neoplasie delle parti molli. Osservazioni in 124 casi). [Articolo su rivista]
Torricelli, Pietro; Calò, M; Boriani, S; DE SANTIS, Giorgio

In order to evaluate the role of Computed Tomography (CT) in prediction of nature, staging and follow-up of soft-tissue tumors, the authors examined by CT 124 patients with soft tissue neoplasms who later underwent surgery (116 cases) or fine needle biopsy (8 cases). Comparison between CT and surgical or anatomical results showed that CT was able to correctly predict the benignancy or malignancy of the masses in 76% of cases but it was very seldom able to allow an histological prediction. On the contrary CT was found to be a very useful tool for pre-therapeutic staging and follow-up of the tumors, because it gave many diagnostic information which influenced therapeutic choices and strategies.

1985 - Arteriographic and tomodensitometric pictures in three cases of popliteal artery entrapment [Articolo su rivista]
Calo, M.; Crisi, G.; de Santis, M.; Pompei, G.; Torricelli, P.

CT could be an effective diagnostic modality of "popliteal artery entrapment". The authors present three cases of this pathology, studied with CT and arteriography. © 1985.

1985 - Bone cysts of the calcaneus (study of 14 cases) [Articolo su rivista]
Fantini, A.; Ruggieri, P.; Biagini, R.; Torricelli, P.; Capanna, R.

1985 - Computed tomography and bone scintigraphy in evaluation of osteoid osteoma|TOMOGRAFIA COMPUTERIZZATA E SCINTIGRAFIA NELLA VALUTAZIONE DELL'OSTEOMA OSTEOIDE [Articolo su rivista]
Torricelli, P.; Romani, F.; Pompei, G.; Canossi, G.

1985 - Malignant Schwannoma associated with Von Recklinghausen's disease. Report of a case following radiation therapy [Articolo su rivista]
Torricelli, P.; Guarneri, A. G.; Romani, F.; Lenzi, M.

1985 - The CT appearance of two-level fractures of the posterior vertebral apophysis. A case report [Articolo su rivista]
De Santis, M.; Crisi, G.; Davidovits, P.; Torricelli, P.

1984 - Computer tomography in affections of the soft tissues of the limbs: Observations in 50 cases and comparison with arteriography [Articolo su rivista]
Calo, M.; Torricelli, P.; De Santis, M.

1984 - Computer tomography in diagnosis of synovial cysts of the popliteal region [Articolo su rivista]
Calo, M.; Torricelli, P.; Pompei, G.

1984 - Selective intracoronary thrombolysis in acute myocardial infarction [Articolo su rivista]
Pompei, G.; Romani, F.; Torricelli, P.

1983 - Eritropoiesi extramidollare intratoracica. Considerazioni clinico radiologiche su due casi di talassemia minor [Articolo su rivista]
Romani, F.; Emilia, Giovanni; Pompei, G.; Federico, Massimo; Torricelli, Pietro

Vengono analizzati due casi di eritropoiesi extramidollare intratoracica, riscontrati in pazienti talassemici, con particolare riguardo ai reperti radiologici: essi, accanto ai dati anamnestici, clinici e di laboratorio, consentono una precisa interpretazione diagnostica.

1983 - Post nephectomy arteriovenous fistula: A reversible cause of hypertension and cardiac failure. Report of a case [Articolo su rivista]
Pompei, G.; Romani, F.; Torricelli, P.; Villa, E.

1982 - Double contrast radiological examination of the stomach. Technique and results. Comparison of the radiological and endoscopic picture in 214 cases [Articolo su rivista]
Miceli, F.; Canossi, G. C.; Torricelli, P.; Rigo, G. P.; Perini, M.; Gandolfo, M.; Leoni, A.; Romagnoli, R.