Hematopoietic and lymphoid tumors are a heterogeneous group of diseases including lymphomas, mult... more Hematopoietic and lymphoid tumors are a heterogeneous group of diseases including lymphomas, multiple myeloma (MM), and leukemias. These diseases are associated with systemic involvement and various clinical presentations including acute neurological deficits. Adult patients with hematologic malignancies (HM) are at risk for developing a wide array of acute conditions involving the nervous system. HM in adults may present as tumoral masses responsible for mass effect, possibly resulting in acute neurological signs and symptoms caused by tumor growth with compression of central nervous system (CNS) structures. Moreover, as result of the hematologic disease itself or due to systemic treatments, hematologic patients are at risk for vascular pathologies, such as ischemic, thrombotic, and hemorrhagic disorders due to the abnormal coagulation status. The onset of these disorders is often with acute neurologic signs or symptoms. Lastly, it is well known that patients with HM can have impaired function of the immune system. Thus, CNS involvement due to immune-related diseases such as mycotic, parasitic, bacterial, and viral infections linked to immunodeficiency, together with immune reconstitution inflammatory syndrome, are frequently seen in hematologic patients. Knowledge of the etiology and expected CNS imaging findings in patients with HM is of great importance to reach a fast and correct diagnosis and guide treatment choices. In this manuscript we review the computed tomography (CT) and magnetic resonance findings of these conditions which can be related to the disease itself and/or to their treatments
European review for medical and pharmacological sciences, 2016
The aim of our study was to compare the apparent diffusion coefficient (ADC) values of pathologic... more The aim of our study was to compare the apparent diffusion coefficient (ADC) values of pathological bowel loops wall (pADC) with the ADC values of normal appearing ones (naADC) and to determine a discriminating threshold. 60 patients were studied at our Institution through a MR-enterography that included free-breathing axial Diffusion Weighted Imaging (DWI) with two b (0 and 800 s/mm2) after histological diagnosis of active Crohn's disease (CD). The one (when unique) or the best analyzable (when multiple) pathological bowel loop was identified in each patient, on the basis of the MRI features: wall thickness, presence of mural oedema and wall contrast enhancement after contrast medium administration. A normal appearing bowel loop was used for comparison. ADC values were measured in consensus by two radiologists, and they were compared with t-test. The ADC threshold value for the differentiation between pathological and normal appearing bowel loops was determined. The pADC values...
BACKGROUND AND PURPOSE: Spontaneous transdural spinal cord herniation is no longer a rare cause o... more BACKGROUND AND PURPOSE: Spontaneous transdural spinal cord herniation is no longer a rare cause of myelopathy. The high frequency of diagnoses has led to an increase in the number of surgical procedures. The purpose of this study was to describe the spectrum of postoperative MR imaging findings concerning spontaneous transdural spinal cord herniation and to provide a practical imaging approach for differentiating expected changes and complications after an operation. MATERIALS AND METHODS: We retrospectively reviewed MR images from 12 patients surgically treated for spontaneous transdural spinal cord herniation. Surgery comprised either dural defect enlargement or duraplasty procedures. Postoperative follow-ups included at least 3 (early, intermediate, late) MR imaging studies. MR images were analyzed with respect to 3 spinal compartments: intradural intramedullary, intradural extramedullary, and extradural. The meaning and reliability of changes detected on MR images were related to their radiologic and clinical evolution with time. RESULTS: Spinal cord realignment has been stable since the early study, whereas spinal cord signal and thickness evolved during the following scans. Most extramedullary and extradural changes gradually reduced in later MR images. Three patients treated with dural defect enlargements experienced the onset of new neurologic symptoms. In those patients, late MR images showed extradural fluid collection and the development of pial siderosis. CONCLUSIONS: Our findings demonstrate the spectrum of postoperative imaging findings in spontaneous transdural spinal cord herniation. Spinal cord thickness and signal intensity continued to evolve with time; most extramedullary postsurgical changes became stable. Changes observed in later images may be suggestive of complications. ABBREVIATIONS: DDE ϭ dural defect enlargement; E-MRI ϭ early MR imaging; I-MRI ϭ intermediate MR imaging; JOA ϭ Japanese Orthopedic Association; L-MRI ϭ late MR imaging; STSCH ϭ spontaneous transdural spinal cord herniation
In the present prospective study, we assessed the role of various Magnetic Resonance Imaging biom... more In the present prospective study, we assessed the role of various Magnetic Resonance Imaging biomarkers combined with self-assessed xerostomia questionnaires and patientand treatment-related factors, in predicting xerostomia at 12 months after chemoradiotherapy for oropharyngeal squamous cell carcinoma. We hypothesized that the integration of pre-treatment imaging biomarkers, which addresses the tissue heterogeneity and individual variations among patients, could improve the accuracy of conventional prediction models that are based only on dose information, ultimately providing a better understanding of the pathophysiological mechanisms underlying radiation induced salivary dysfunction. The implementation of multifactorial models, driven by machine learning algorithms, may improve prediction accuracy of radiation-induced toxicity and tailor individual treatment options for patients.
Poster presentations (153.6±6.9 c.u. vs 108.3±3.9 c.u.). The ration between B1-and B2-cells SDH a... more Poster presentations (153.6±6.9 c.u. vs 108.3±3.9 c.u.). The ration between B1-and B2-cells SDH activities characterized with 3 times B1-cells activity domination compared with control group (80% vs 20%). B-cells SDH activity and their number gradually decreased with increasing duration of the disease, mainly by virtue of the B2-cells parameters change. After the year of infliximab therapy it was observed significant B1-cells number augmentation in patients with nonsustained efficacy of the therapy (16% before 1 infusion vs 26.6% after 1 year). Moreover the period of infliximab tolerance development corresponded to B1-cells SDH activity augmentation. Patients with sustained infliximab therapy efficacy had higher B2-cells SDH activity compared with patients with nonsustained effect (113.0±3.2 c.u. vs 94.1±2.7 c.u.). Conclusions: Children with IBD were characterized with increase SDH activity of circulating B1-lymphocytes. Patients with nonsustained effect of infliximab therapy demonstrated gradually circulating B1-cells number increase along with B2-cells mitochondrial activity depression. The period of infliximab tolerance development corresponded to B1-cells SDH activity augmentation.
Poster: "ECR 2016 / C-0596 / Intracranial hypotension (IH): step by step from pathophysiolog... more Poster: "ECR 2016 / C-0596 / Intracranial hypotension (IH): step by step from pathophysiology to the detection of the causes of CSF leakage" by: "E. Ruberto1, E. Gangemi2, A. Botto1, A. M. Costantini2, M. Sciandra2, R. russo1, S. Gaudino1, C. Colosimo1; 1Rome/IT, 2Roma/IT"
Poster: "ECR 2016 / B-0823 / Acute/subacute small ischaemic lesions on DWI in patients with ... more Poster: "ECR 2016 / B-0823 / Acute/subacute small ischaemic lesions on DWI in patients with cerebral amyloid angiopathy and cortical superficial siderosis" by: "E. Gangemi1, A. Charidimou2, D. Werring2, H. R. Jager2; 1Rome/IT, 2London/UK"
Poster: "ECR 2013 / C-1146 / Pictorial Essay of MRI Findings of Creutzfeldt-Jacob Disease (C... more Poster: "ECR 2013 / C-1146 / Pictorial Essay of MRI Findings of Creutzfeldt-Jacob Disease (CJD)" by: "E. Gangemi1, S. Gaudino2, R. Colantonio2, M. G. Vita2, C. Masullo2, T. Tartaglione2, C. Colosimo2; 1Roma/IT, 2Rome/IT"
Poster: "ECR 2015 / B-0579 / DWI and T2-W MRI for the evaluation of residual lymph nodes in ... more Poster: "ECR 2015 / B-0579 / DWI and T2-W MRI for the evaluation of residual lymph nodes in patients affected by squamous cell carcinoma of the head and neck, treated with chemo-radiotherapy" by: "E. Gangemi, F. Piludu, V. Manciocco, A. Guerrisi, R. Covello, S. Marzi, A. Vidiri; Rome/IT"
The aim of this paper is to define the pre-treatment radiological characteristics of oropharyngea... more The aim of this paper is to define the pre-treatment radiological characteristics of oropharyngeal squamous cell carcinoma (OPSCC) using morphological and non-morphological magnetic resonance imaging (MRI), based on HPV status, in a single-institution cohort. In total, 100 patients affected by OPSCC were prospectively enrolled in the present study. All patients underwent 1.5T MR with standard sequences, including diffusion-weighted imaging with and intravoxel incoherent motion (IVIM-DWI) technique and a dynamic contrast-enhanced (DCE) MRI. For all patients, human papillomavirus (HPV) status was available. No statistically significant differences in the volume of primary tumors (PTs) and lymph nodes (LNs) were observed based on HPV status. When comparing the two patient groups, no significant differences were found for the PT radiologic characteristics (presence of well-defined borders, exophytic growth, ulceration, and necrosis) and LN morphology (solid/cystic/necrotic). Tumor subsi...
Introduction: Chronic sclerosing sialadenitis (Küttner tumor) is a relatively uncommon and often ... more Introduction: Chronic sclerosing sialadenitis (Küttner tumor) is a relatively uncommon and often under-recognized cause of salivary gland enlargement, characterised by sclerosing IgG4-related inflammation, producing a hard swelling of the gland that mimics malignancy. The name tumor is tricky and misleading, in fact the disease has no histological features of malignancy, but still it cannot easily be distinguished from cancer because of its hard consistency to touch. Case Reports: We aim to report three cases of Küttner tumor and to review morphological MRI features (homogeneous T1- and T2-hypointensity, homogeneous contrast enhancement) and diffusion weighted imaging findings (low ADC values) which can help radiologists to reach the correct diagnosis. Conclusion: Definite diagnosis of Küttner tumor is histopathological. However imaging features are straightforward and can address radiologists toward the correct diagnosis.
In human epidermal growth factor receptor 2 (HER2+) expressing breast cancer subtype, the inciden... more In human epidermal growth factor receptor 2 (HER2+) expressing breast cancer subtype, the incidence of brain metastases is common and patients often die due to uncontrolled cranial disease. This is a case report of a HER2+ breast cancer woman with diffuse brain metastases that experienced long survival and clinical benefit from multiple radiotherapy treatments and combined systemic therapy, without increased toxicity.
Objectives To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magne... more Objectives To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI) parameters and positron emission tomography with 18 F-fluorodeoxyglucose (18 F-FDG-PET) values in oropharyngeal squamous cell carcinoma (OPSCC), both in primary tumors (PTs) and in metastatic lymph nodes (LNs). Methods 52 patients with a new pathologically-confirmed OPSCC were included in the present retrospective cohort study. Imaging including DCE-MRI and 18 F-FDG PET/CT scans were acquired in all patients. Both PTs and the largest LN, if present, were volumetrically contoured. Quantitative parameters, including the transfer constants, K trans and K ep , and the volume of extravascular extracellular space, v e , were calculated from DCE-MRI. The percentiles (P), P10, P25, P50, P75, P90, and skewness, kurtosis and entropy were obtained from the histogram-based analysis of each perfusion parameter. Standardized uptake values (SUV), SUV max , SUV peak , SUV mean , metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated applying a SUV threshold of 40%. The correlations between all variables were investigated with the Spearman-rank correlation test. To exclude false positive results under multiple testing, the Benjamini-Hockberg procedure was applied.
Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of ... more Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of invasion evaluation in the staging of oral cavity squamous cell carcinoma, since it is a predictor of nodal metastasis and an independent prognostic factor. Although the histopathological definition of depth of invasion is clear, an accurate method for its radiological assessment has not yet been validated. Purpose To investigate the role of MRI-derived depth of invasion evaluation in staging oral tongue squamous cell carcinoma and to assess the inter-reader agreement and the radiological–pathological correlation. Material and Methods We retrospectively reviewed 43 patients with oral tongue squamous cell carcinoma who underwent preoperative MRI. The MRI-derived depth of invasion was measured by two radiologists, each with a different degree of experience in head and neck imaging. The pathological depth of invasion was recorded from histopathological reports. The inter-reader and the radi...
PURPOSE/AIM • To summarize MRI imaging characteristics of Pilocytic Astrocitoma (PA) • To highlig... more PURPOSE/AIM • To summarize MRI imaging characteristics of Pilocytic Astrocitoma (PA) • To highlight the unusual MRI features of PA • To underline the role of advanced techniques (DWI, PWI, MRS) in the diagnosis of PA • To interpret MRI changes after therapy CONTENT ORGANIZATION • Introduction to PA: epidemiology, classification, pathology, natural history, treatment. • Usual and unusual MRI features of PA (case-based approach). • Potential and limits of advances techniques . • Do’s and don'ts during the follow-up. SUMMARY Major teaching points: • Know the characteristic as well as the less common appearance on conventional and advanced MRI techniques of PA • Be aware of the utility and limits of advanced techniques, and recognize the most reliable parameters for the diagnosis of PA • Understand how to interpret CE fluctuations of PA during follow-up
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADAS... more Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a common cause of inherited stroke in young adults. CADASIL causes extensive white matter T2 hyperintensities at brain MRI, in particular involving anterior-temporal lobes and external capsules; usually, there is no spinal cord involvement. Since CADASIL clinical spectrum is heterogeneous and MRI findings are sometimes not specific, Multiple Sclerosis (MS) represents a frequent CADASIL misdiagnosis. Herein, we describe the case of a 48-year-old man affected by CADASIL and referred to our clinic with an initial diagnosis of secondary progressive MS because of diffuse leukoencephalopathy and spinal cord lesions at MRI.
Hematopoietic and lymphoid tumors are a heterogeneous group of diseases including lymphomas, mult... more Hematopoietic and lymphoid tumors are a heterogeneous group of diseases including lymphomas, multiple myeloma (MM), and leukemias. These diseases are associated with systemic involvement and various clinical presentations including acute neurological deficits. Adult patients with hematologic malignancies (HM) are at risk for developing a wide array of acute conditions involving the nervous system. HM in adults may present as tumoral masses responsible for mass effect, possibly resulting in acute neurological signs and symptoms caused by tumor growth with compression of central nervous system (CNS) structures. Moreover, as result of the hematologic disease itself or due to systemic treatments, hematologic patients are at risk for vascular pathologies, such as ischemic, thrombotic, and hemorrhagic disorders due to the abnormal coagulation status. The onset of these disorders is often with acute neurologic signs or symptoms. Lastly, it is well known that patients with HM can have impaired function of the immune system. Thus, CNS involvement due to immune-related diseases such as mycotic, parasitic, bacterial, and viral infections linked to immunodeficiency, together with immune reconstitution inflammatory syndrome, are frequently seen in hematologic patients. Knowledge of the etiology and expected CNS imaging findings in patients with HM is of great importance to reach a fast and correct diagnosis and guide treatment choices. In this manuscript we review the computed tomography (CT) and magnetic resonance findings of these conditions which can be related to the disease itself and/or to their treatments
European review for medical and pharmacological sciences, 2016
The aim of our study was to compare the apparent diffusion coefficient (ADC) values of pathologic... more The aim of our study was to compare the apparent diffusion coefficient (ADC) values of pathological bowel loops wall (pADC) with the ADC values of normal appearing ones (naADC) and to determine a discriminating threshold. 60 patients were studied at our Institution through a MR-enterography that included free-breathing axial Diffusion Weighted Imaging (DWI) with two b (0 and 800 s/mm2) after histological diagnosis of active Crohn's disease (CD). The one (when unique) or the best analyzable (when multiple) pathological bowel loop was identified in each patient, on the basis of the MRI features: wall thickness, presence of mural oedema and wall contrast enhancement after contrast medium administration. A normal appearing bowel loop was used for comparison. ADC values were measured in consensus by two radiologists, and they were compared with t-test. The ADC threshold value for the differentiation between pathological and normal appearing bowel loops was determined. The pADC values...
BACKGROUND AND PURPOSE: Spontaneous transdural spinal cord herniation is no longer a rare cause o... more BACKGROUND AND PURPOSE: Spontaneous transdural spinal cord herniation is no longer a rare cause of myelopathy. The high frequency of diagnoses has led to an increase in the number of surgical procedures. The purpose of this study was to describe the spectrum of postoperative MR imaging findings concerning spontaneous transdural spinal cord herniation and to provide a practical imaging approach for differentiating expected changes and complications after an operation. MATERIALS AND METHODS: We retrospectively reviewed MR images from 12 patients surgically treated for spontaneous transdural spinal cord herniation. Surgery comprised either dural defect enlargement or duraplasty procedures. Postoperative follow-ups included at least 3 (early, intermediate, late) MR imaging studies. MR images were analyzed with respect to 3 spinal compartments: intradural intramedullary, intradural extramedullary, and extradural. The meaning and reliability of changes detected on MR images were related to their radiologic and clinical evolution with time. RESULTS: Spinal cord realignment has been stable since the early study, whereas spinal cord signal and thickness evolved during the following scans. Most extramedullary and extradural changes gradually reduced in later MR images. Three patients treated with dural defect enlargements experienced the onset of new neurologic symptoms. In those patients, late MR images showed extradural fluid collection and the development of pial siderosis. CONCLUSIONS: Our findings demonstrate the spectrum of postoperative imaging findings in spontaneous transdural spinal cord herniation. Spinal cord thickness and signal intensity continued to evolve with time; most extramedullary postsurgical changes became stable. Changes observed in later images may be suggestive of complications. ABBREVIATIONS: DDE ϭ dural defect enlargement; E-MRI ϭ early MR imaging; I-MRI ϭ intermediate MR imaging; JOA ϭ Japanese Orthopedic Association; L-MRI ϭ late MR imaging; STSCH ϭ spontaneous transdural spinal cord herniation
In the present prospective study, we assessed the role of various Magnetic Resonance Imaging biom... more In the present prospective study, we assessed the role of various Magnetic Resonance Imaging biomarkers combined with self-assessed xerostomia questionnaires and patientand treatment-related factors, in predicting xerostomia at 12 months after chemoradiotherapy for oropharyngeal squamous cell carcinoma. We hypothesized that the integration of pre-treatment imaging biomarkers, which addresses the tissue heterogeneity and individual variations among patients, could improve the accuracy of conventional prediction models that are based only on dose information, ultimately providing a better understanding of the pathophysiological mechanisms underlying radiation induced salivary dysfunction. The implementation of multifactorial models, driven by machine learning algorithms, may improve prediction accuracy of radiation-induced toxicity and tailor individual treatment options for patients.
Poster presentations (153.6±6.9 c.u. vs 108.3±3.9 c.u.). The ration between B1-and B2-cells SDH a... more Poster presentations (153.6±6.9 c.u. vs 108.3±3.9 c.u.). The ration between B1-and B2-cells SDH activities characterized with 3 times B1-cells activity domination compared with control group (80% vs 20%). B-cells SDH activity and their number gradually decreased with increasing duration of the disease, mainly by virtue of the B2-cells parameters change. After the year of infliximab therapy it was observed significant B1-cells number augmentation in patients with nonsustained efficacy of the therapy (16% before 1 infusion vs 26.6% after 1 year). Moreover the period of infliximab tolerance development corresponded to B1-cells SDH activity augmentation. Patients with sustained infliximab therapy efficacy had higher B2-cells SDH activity compared with patients with nonsustained effect (113.0±3.2 c.u. vs 94.1±2.7 c.u.). Conclusions: Children with IBD were characterized with increase SDH activity of circulating B1-lymphocytes. Patients with nonsustained effect of infliximab therapy demonstrated gradually circulating B1-cells number increase along with B2-cells mitochondrial activity depression. The period of infliximab tolerance development corresponded to B1-cells SDH activity augmentation.
Poster: "ECR 2016 / C-0596 / Intracranial hypotension (IH): step by step from pathophysiolog... more Poster: "ECR 2016 / C-0596 / Intracranial hypotension (IH): step by step from pathophysiology to the detection of the causes of CSF leakage" by: "E. Ruberto1, E. Gangemi2, A. Botto1, A. M. Costantini2, M. Sciandra2, R. russo1, S. Gaudino1, C. Colosimo1; 1Rome/IT, 2Roma/IT"
Poster: "ECR 2016 / B-0823 / Acute/subacute small ischaemic lesions on DWI in patients with ... more Poster: "ECR 2016 / B-0823 / Acute/subacute small ischaemic lesions on DWI in patients with cerebral amyloid angiopathy and cortical superficial siderosis" by: "E. Gangemi1, A. Charidimou2, D. Werring2, H. R. Jager2; 1Rome/IT, 2London/UK"
Poster: "ECR 2013 / C-1146 / Pictorial Essay of MRI Findings of Creutzfeldt-Jacob Disease (C... more Poster: "ECR 2013 / C-1146 / Pictorial Essay of MRI Findings of Creutzfeldt-Jacob Disease (CJD)" by: "E. Gangemi1, S. Gaudino2, R. Colantonio2, M. G. Vita2, C. Masullo2, T. Tartaglione2, C. Colosimo2; 1Roma/IT, 2Rome/IT"
Poster: "ECR 2015 / B-0579 / DWI and T2-W MRI for the evaluation of residual lymph nodes in ... more Poster: "ECR 2015 / B-0579 / DWI and T2-W MRI for the evaluation of residual lymph nodes in patients affected by squamous cell carcinoma of the head and neck, treated with chemo-radiotherapy" by: "E. Gangemi, F. Piludu, V. Manciocco, A. Guerrisi, R. Covello, S. Marzi, A. Vidiri; Rome/IT"
The aim of this paper is to define the pre-treatment radiological characteristics of oropharyngea... more The aim of this paper is to define the pre-treatment radiological characteristics of oropharyngeal squamous cell carcinoma (OPSCC) using morphological and non-morphological magnetic resonance imaging (MRI), based on HPV status, in a single-institution cohort. In total, 100 patients affected by OPSCC were prospectively enrolled in the present study. All patients underwent 1.5T MR with standard sequences, including diffusion-weighted imaging with and intravoxel incoherent motion (IVIM-DWI) technique and a dynamic contrast-enhanced (DCE) MRI. For all patients, human papillomavirus (HPV) status was available. No statistically significant differences in the volume of primary tumors (PTs) and lymph nodes (LNs) were observed based on HPV status. When comparing the two patient groups, no significant differences were found for the PT radiologic characteristics (presence of well-defined borders, exophytic growth, ulceration, and necrosis) and LN morphology (solid/cystic/necrotic). Tumor subsi...
Introduction: Chronic sclerosing sialadenitis (Küttner tumor) is a relatively uncommon and often ... more Introduction: Chronic sclerosing sialadenitis (Küttner tumor) is a relatively uncommon and often under-recognized cause of salivary gland enlargement, characterised by sclerosing IgG4-related inflammation, producing a hard swelling of the gland that mimics malignancy. The name tumor is tricky and misleading, in fact the disease has no histological features of malignancy, but still it cannot easily be distinguished from cancer because of its hard consistency to touch. Case Reports: We aim to report three cases of Küttner tumor and to review morphological MRI features (homogeneous T1- and T2-hypointensity, homogeneous contrast enhancement) and diffusion weighted imaging findings (low ADC values) which can help radiologists to reach the correct diagnosis. Conclusion: Definite diagnosis of Küttner tumor is histopathological. However imaging features are straightforward and can address radiologists toward the correct diagnosis.
In human epidermal growth factor receptor 2 (HER2+) expressing breast cancer subtype, the inciden... more In human epidermal growth factor receptor 2 (HER2+) expressing breast cancer subtype, the incidence of brain metastases is common and patients often die due to uncontrolled cranial disease. This is a case report of a HER2+ breast cancer woman with diffuse brain metastases that experienced long survival and clinical benefit from multiple radiotherapy treatments and combined systemic therapy, without increased toxicity.
Objectives To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magne... more Objectives To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI) parameters and positron emission tomography with 18 F-fluorodeoxyglucose (18 F-FDG-PET) values in oropharyngeal squamous cell carcinoma (OPSCC), both in primary tumors (PTs) and in metastatic lymph nodes (LNs). Methods 52 patients with a new pathologically-confirmed OPSCC were included in the present retrospective cohort study. Imaging including DCE-MRI and 18 F-FDG PET/CT scans were acquired in all patients. Both PTs and the largest LN, if present, were volumetrically contoured. Quantitative parameters, including the transfer constants, K trans and K ep , and the volume of extravascular extracellular space, v e , were calculated from DCE-MRI. The percentiles (P), P10, P25, P50, P75, P90, and skewness, kurtosis and entropy were obtained from the histogram-based analysis of each perfusion parameter. Standardized uptake values (SUV), SUV max , SUV peak , SUV mean , metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated applying a SUV threshold of 40%. The correlations between all variables were investigated with the Spearman-rank correlation test. To exclude false positive results under multiple testing, the Benjamini-Hockberg procedure was applied.
Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of ... more Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of invasion evaluation in the staging of oral cavity squamous cell carcinoma, since it is a predictor of nodal metastasis and an independent prognostic factor. Although the histopathological definition of depth of invasion is clear, an accurate method for its radiological assessment has not yet been validated. Purpose To investigate the role of MRI-derived depth of invasion evaluation in staging oral tongue squamous cell carcinoma and to assess the inter-reader agreement and the radiological–pathological correlation. Material and Methods We retrospectively reviewed 43 patients with oral tongue squamous cell carcinoma who underwent preoperative MRI. The MRI-derived depth of invasion was measured by two radiologists, each with a different degree of experience in head and neck imaging. The pathological depth of invasion was recorded from histopathological reports. The inter-reader and the radi...
PURPOSE/AIM • To summarize MRI imaging characteristics of Pilocytic Astrocitoma (PA) • To highlig... more PURPOSE/AIM • To summarize MRI imaging characteristics of Pilocytic Astrocitoma (PA) • To highlight the unusual MRI features of PA • To underline the role of advanced techniques (DWI, PWI, MRS) in the diagnosis of PA • To interpret MRI changes after therapy CONTENT ORGANIZATION • Introduction to PA: epidemiology, classification, pathology, natural history, treatment. • Usual and unusual MRI features of PA (case-based approach). • Potential and limits of advances techniques . • Do’s and don'ts during the follow-up. SUMMARY Major teaching points: • Know the characteristic as well as the less common appearance on conventional and advanced MRI techniques of PA • Be aware of the utility and limits of advanced techniques, and recognize the most reliable parameters for the diagnosis of PA • Understand how to interpret CE fluctuations of PA during follow-up
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADAS... more Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a common cause of inherited stroke in young adults. CADASIL causes extensive white matter T2 hyperintensities at brain MRI, in particular involving anterior-temporal lobes and external capsules; usually, there is no spinal cord involvement. Since CADASIL clinical spectrum is heterogeneous and MRI findings are sometimes not specific, Multiple Sclerosis (MS) represents a frequent CADASIL misdiagnosis. Herein, we describe the case of a 48-year-old man affected by CADASIL and referred to our clinic with an initial diagnosis of secondary progressive MS because of diffuse leukoencephalopathy and spinal cord lesions at MRI.
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Papers by Emma Gangemi