Papers by Michele Di Martino
Digestive and Liver Disease
Introduction/Aim: Muscle alterations, portosystemic shunts (SPSS) and minimal hepatic encephalopa... more Introduction/Aim: Muscle alterations, portosystemic shunts (SPSS) and minimal hepatic encephalopathy (MHE) are related to hepatic encephalopathy (HE), however no studies have investigated the relative role of all these risk factors detected in the same patients. The aim of the study was to assess the prognostic impact of muscle alterations, MHE and SPSS on hepatic encephalopathy and transplant free survival. Patients/Methods: 114 cirrhotics were submitted to Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT) to detect MHE. CT scan was used to analyze the skeletal muscle index (SMI), muscle attenuation and SPSS. The incidence of the first episode of HE and survival were estimated. Results: Previous HE was present in 47 patients (41%). The variables independently associated to previous HE were: sarcopenia, MHE and SPSS. 44 patients (39%) developed overt HE during 14 ±11 months; MHE and SPSS were the only variables significantly asociated to overt HE. During the same follow-up, 42 patients died (37%); MELD and sarcopenia were the only variables significantly asociated to transplant free survival. Conclusions: MHE, sarcopenia and SPSS are clinically relevant and should be sought for in cirrhotics. In particular, MHE and SPSS are the only risk factors significantly associated to the development of HE while MELD and sarcopenia are independently associated to overall mortality.
Scientific Reports, 2021
This study aimed to ascertain, for the first time, whether serum magnesium (Mg) concentration is ... more This study aimed to ascertain, for the first time, whether serum magnesium (Mg) concentration is affected by the presence of hepatocellular carcinoma (HCC). We retrospectively enrolled consecutive cirrhotic patients with a diagnosis of HCC (n = 130) or without subsequent evidence of HCC during surveillance (n = 161). Serum levels of Mg were significantly (P < 0.001) lower in patients with HCC than in those without (median [interquartile range]: 1.80 [1.62–1.90] mg/dl vs. 1.90 [1.72–2.08] mg/dl). On multivariate logistic regression, low serum Mg was associated with the presence of HCC (OR 0.047, 95% CI 0.015–0.164; P < 0.0001), independently from factors that can influence magnesaemia and HCC development. In a subset of 94 patients with HCC, a linear mixed effects model adjusted for confounders showed that serum Mg at diagnosis of HCC was lower than before diagnosis of the tumor (β = 0.117, 95% CI 0.039–0.194, P = 0.0035) and compared to after locoregional treatment of HCC (β =...
Liver International, 2021
Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher drop... more Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher dropouts and graft losses after transplant. The study aims to create an ‘urgency’ model combining sarcopenia and Model for End‐stage Liver Disease Sodium (MELDNa) to predict the risk of dropout and identify an appropriate threshold of post‐LT futility.
European Journal of Radiology, 2019
Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over p... more Intra-procedural dual phase cone beam computed tomography has a better diagnostic accuracy over pre-procedural MRI and MDCT in detection and characterization of HCC in cirrhotic patients undergoing TACE procedure
World journal of gastroenterology, Jan 21, 2018
Locoregional treatments (LRT) represent a broad strategy used for reducing the risk of drop-off a... more Locoregional treatments (LRT) represent a broad strategy used for reducing the risk of drop-off and contextually improving the survivals in patients with hepatocellular cancer receiving a liver transplantation (LT). However, it is not sufficiently clear if LRT are only a surrogate of tumor aggressiveness or if they consent a real benefit in terms of tumor stabilization. A recent study by Pommergaard et al reported the results from the European Liver Transplant Registry. Patients receiving LRT before LT had better 5-year survival rates respect to no-LRT cases (69.7% 65.8%; < 0.001). When the number of LRT was tested, one-to-two treatments were connected with improved survivals respect to no treatment [hazard ratio (HR) = 0.85 and 0.71, respectively]. The efficacy of LRT was also reported in the presence of larger tumors (HR = 0.78) and micro-macrovascular invasion (HR = 0.71). The results observed in the present study are partially in discordance with other analyses showing a detr...
Insights into Imaging, 2017
Background This article aims to comprehensively describe indications, contraindications, technica... more Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications. Teaching points • Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens. • CT has the highest accuracy for diagnosis as an imaging guide. • Compared to FNAB, CNB has a higher accuracy for diagnosis. • Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications. • Several clinical and technical variables can affect diagnostic accuracy and patient safety.
Journal of the Endocrine Society, 2017
Wnt1-inducible signaling pathway protein 1 (WISP1) is a novel adipokine participating in adipose ... more Wnt1-inducible signaling pathway protein 1 (WISP1) is a novel adipokine participating in adipose tissue (AT) dysfunction; so far, no data on WISP1 in diabetes are available. Objectives: To evaluate plasma WISP1 in subjects with type 2 diabetes (T2D) and its correlates linked to AT inflammation. Design and Participants: For this cross-sectional study, 97 consecutive dysmetabolic patients were recruited at the diabetes outpatient clinics of Sapienza University in Rome; 71 of them had T2D, with (n = 35) or without (n = 36) obesity, and 26 were obese patients without diabetes. Twenty-one normalweight nondiabetic individuals were enrolled as a control group. Study participants underwent clinical workup and blood sampling for metabolic/inflammatory characterization; magnetic resonance imaging (MRI) data on subcutaneous AT and visceral AT (VAT) area, hepatic fat content, and VAT homogeneity were available for most diabetic patients. Results: Plasma WISP1 significantly increased throughout classes of obesity and correlated with greater VAT area, interleukin-8 (IL-8), and lower adiponectin levels, without differing between diabetic and nondiabetic participants. Higher IL-8 was the main determinant of increased WISP1. MRI-assessed VAT inhomogeneity was associated with higher WISP1, IL-8 and C-reactive protein levels, independent of obesity; high WISP1 strongly predicted VAT inhomogeneity (P , 0.001). Conclusions: WISP1 levels are increased in obese persons and are directly related to adiposity, independent of glycemic status or insulin resistance; moreover, they are strongly associated with increased plasma IL-8 and signal abnormalities of VAT. The overall data add insights to the mechanisms underlying metabolic alterations and may open a scenario for innovative therapeutic approaches for diabetes prevention and care.
Clinical science (London, England : 1979), Oct 25, 2016
Adipose tissue (AT) inflammation leads to increased free fatty acids efflux and ectopic fat depos... more Adipose tissue (AT) inflammation leads to increased free fatty acids efflux and ectopic fat deposition, but whether AT dysfunction drives to selective fat accumulation in specific sites remains unknown. Aim of this study was to investigate the correlation between AT dysfunction, hepatic/pancreatic fat fraction (HFF, PFF) and the associated metabolic phenotype in patients with type 2 diabetes (T2D). Sixty-five consecutive T2D patients were recruited at the Diabetes Centre of Sapienza University, Rome, Italy. Study population underwent clinical examination and blood sampling for routine biochemistry and calculation of insulin secretion (HOMA-β%) and insulin-resistance (HOMA-IR, ADIPO-IR) indexes. Subcutaneous (SAT) and visceral (VAT) AT area, HFF and PFF were determined by magnetic resonance. 55.4% of T2D patients had NAFLD; they were significantly younger and more insulin-resistant than non-NAFLD subjects. ADIPO-IR was the main determinant of HFF independent of age, sex, HOMA-IR, VAT...
PURPOSE/AIM In patients with hepatic cirrhosis the development of portosystemic venous anastomose... more PURPOSE/AIM In patients with hepatic cirrhosis the development of portosystemic venous anastomoses is quite common. An important site of portosystemic venous anastomoses is around the umbilicus, clinically named the Cruveilheir-Baumgarten syndrome. The purpose of this exhibit is 1) To understand the physiopatology of the portosystemic venous anastomoses. 2) To review the current indications for performing CT Angiography 3) To learn the CT technical parameters to be used 4) To show which post-processing techniques can be used and their indications. CONTENT ORGANIZATION 1) Physiopathology of the portosystemic venous anastomoses. 2) Comparison of different imaging modalities :Sonography, CT and MR. 3) Current indications for performing hepatic CT Angiography underlining radiation exposure, cost and diagnostic efficacy. 4) CT technical parameters to be used, as well as the correct delay time, concentration and volume of contrast material. 5) Post-processing techniques and their indicati...
PURPOSE To evaluate the usefullness of diffusion-weighted MR imaging (DWI) using a breath-hold si... more PURPOSE To evaluate the usefullness of diffusion-weighted MR imaging (DWI) using a breath-hold single-shot echo-planar imaging (SSEPI) sequence in the differentation between benign and malignant focal liver lesions. METHOD AND MATERIALS 50 patients with focal liver lesions (12 hemangiomas, 10 cysts, 13 shunts, 7 regenerative nodules, 30 HCCs, 10 metastases) underwent MR imaging at 1,5T (Avanto, Siemens) using a body-phased array coil. DWI was perfomed by a breath-hold SSEPI sequence (TR = 2028, TE = 76, matrix = 192x125, slice thickness 5,00 mm, GRAPPA, b-values 0, 50, 500, 800 sec/ mm2). ADC values were obtained. Imaging result were correlated with histopathologic findings and imaging follow-up. Mann-Whitney test and a receiver operating characteristic (ROC) curve were used for statistical analysis. RESULTS The mean ADC values (x10exp-3 mm2/sec) ± standard deviation were 1,45 ± 0,61 for hemangiomas, 0,96 ± 0,21 for HCCs, 1,276 ± 0,299 for shunts, 1,6 ± 0,278 for regenerative nodule...
PURPOSE To intraindividually compare Gadoxetic Acid (Gd-EOB-DTPA) enhanced MRI and 64-slice CT fo... more PURPOSE To intraindividually compare Gadoxetic Acid (Gd-EOB-DTPA) enhanced MRI and 64-slice CT for detection of HCC in cirrhotic patients METHOD AND MATERIALS Informed consent and ethical approval were obtained. Fifty-six consecutive patients with 84 HCC nodules underwent MRI at 1.5T (Avanto, Siemens) and 64-slice CT (Sensation 64, Siemens) at a mean interval of 14 days. MR acquisitions comprised unenhanced breath-hold T2W images and volumetric 3D Gd-EOB-DTPA-enhanced (0.02 mmol/kg; Primovist®) T1W GRE images acquired at 25s, 60s, 180s (dynamic phase) and 20 min (hepatobiliary phase). 64-slice CT was performed with 0.6 x 64 mm collimation, 3-mm section thickness, 250 mAs, 120 kVp. A triple-phase protocol was started 18s, 60s and 180s after reaching a trigger threshold of 150 HU above baseline CT number of the aorta. Image analysis was independently performed by three observers in two sessions separated by 4 weeks. Diagnostic accuracy was evaluated using the alternative-free response...
World journal of gastroenterology : WJG, Jan 21, 2015
To analyze the associations of pancreatic fat with other fat depots and β-cell function in pediat... more To analyze the associations of pancreatic fat with other fat depots and β-cell function in pediatric nonalcoholic fatty liver disease (NAFLD). We examined 158 overweight/obese children and adolescents, 80 with NAFLD [hepatic fat fraction (HFF) ≥ 5%] and 78 without fatty liver. Visceral adipose tissue (VAT), pancreatic fat fraction (PFF) and HFF were determined by magnetic resonance imaging. Estimates of insulin sensitivity were calculated using the homeostasis model assessment of insulin resistance (HOMA-IR), defined by fasting insulin and fasting glucose and whole-body insulin sensitivity index (WBISI), based on mean values of insulin and glucose obtained from oral glucose tolerance test and the corresponding fasting values. Patients were considered to have prediabetes if they had either: (1) impaired fasting glucose, defined as a fasting glucose level ≥ 100 mg/dL to < 126 mg/dL; (2) impaired glucose tolerance, defined as a 2 h glucose concentration between ≥ 140 mg/dL and < ...
European Journal of Gastroenterology & Hepatology, 2015
The aim of this study was to evaluate and compare the diagnostic confidence of multiphase compute... more The aim of this study was to evaluate and compare the diagnostic confidence of multiphase computed tomography (CT) and magnetic resonance (MR) after administration of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the diagnosis of malignant-benign neoplasm of the liver in operators with different levels of experience. Forty patients underwent multiphase CT and MR after administration of Gd-EOB-DTPA. All exams were evaluated by two experienced observers independently; they rated their diagnostic confidence on a five-degree scale: 1 (certainly benign), 2 (probably benign), 3 (uncertain), 4 (probably malignant) and 5 (certainly malignant). Receiver operating characteristic curve analysis and area under the curve (AUC) were carried out for each observer and their difference was tested according to the different methodologies used. In our population, there were 15 malignant neoplasms and 25 benign neoplasms. For the CT analysis, AUC was 0.792 [SE=0.088; 95% confidence interval (CI) 0.634-0.903] and 0.701 (SE=0.099; 95% CI 0.535-0.835) for observers 1 and 2, respectively, whereas for the MR analysis, AUC was 0.923 (SE=0.058; 95% CI 0.793-0.983) and 0.934 (SE=0.054; 95% CI 0.808-0.987). For both observers, a statistically significant difference was found in diagnostic confidence between the AUC of CT and MR (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Our results indicate that, for expert and intermediate experience observers, the diagnostic confidence using MR with Gd-EOB-DTPA is statistically significantly superior to CT with a multiphase technique.
Journal of Hepatology, 2018
Background: Recently, several studies have identified a possible relationship between the therapy... more Background: Recently, several studies have identified a possible relationship between the therapy with oxaliplatin and the development of non-cirrhotic portal hypertension. However, the incidence and the way of presentation of the disease in series of patients treated with oxaliplatin have not been yet described. The aim of the study is to search for the development of radiological signs of portal hypertension (PH) in a series of patients submitted to therapy with oxaliplatin. Methods: From a total of 570 neoplastic patients consecutively observed, based on stringent selection criteria aimed at the elimination of all patients with active or potential portal hypertension, 143 patients undergoing oxaliplatin therapy and with a computed tomography (CT) performed prior to treatment were finally included in the study. Changes in portal vein and spleen diameters, the appearance of oesophago-gastric varices and of other collaterals at the CT performed after at least 3 months from the therapy have been evaluated by an experienced radiologist. Portal hypertension was defined by the contemporaneous presence of portal vein diameter>15 mm and longitudinal spleen diameter>12 cm or by the presence of esophagogastric varices and/or portosistemical shunts. Results: 118 patients were affected by colorectal cancer, 25 were affected by a other gastrointestinal neoplasia for which they underwent to neoadiuvant (18) or adiuvant (125) chemotherapy. The most used therapeutic regimens were XELOX and FOLFOX. Before the chemotherapy no one of the 143 patients had portal hypertension. After 7.5±3.1 months from the therapy, 7 patients (4.9%) developed radiological signs of portal hypertension. In particular, all of the 7 patients showed portal vein diameter >15mm and splenomegaly, one patient of them developed oesophageal varices (0.7%) and another one developed oesophago-gastric varices (0.7%) and ascites. Conclusion: Liver vascular damage causing the development of portal hypertension is common in the patients undergoing oxaliplatin-based chemotherapy regimens. Thus, this side effect should be always considered by submitting this kind of patients to specific controls to early recognize its onset.
CONSORT 2010 checklist. (DOC 216 kb)
World Journal of Gastroenterology, 2016
All study participants, or their legal guardian, provided informed written consent prior to study... more All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
PURPOSE To evaluate the diagnostic impact of different section thicknesses using 64-slice CT to d... more PURPOSE To evaluate the diagnostic impact of different section thicknesses using 64-slice CT to detect hepatic colorectal metastases. METHOD AND MATERIALS 43 hepatic resection candidates with known colorectal metastases were prospectively examined. All patients underwent multiphasic CT performed with a 64-slice scanner (Sensation 64, Siemens). CT imaging parameters were: collimation 0.6 x 64 mm, pitch, 1.4; effective mAs, 160, and kVp, 120. All patients received nonionic contrast medium (400 mgI/mL; Iomeron 400, Bracco) at a rate of 5 mL/sec. A triple-phase CT protocol was performed with acquisition of hepatic arterial (delay time determined with bolus tracking technique), portal-venous (60 sec), and delayed (180 sec) phases. CT datasets were reconstructed with four different section thicknesses: 0.6 mm; 1 mm; 3 mm; and 5 mm. Each dataset was interpreted separately by three observers using a commercially available software (Vitrea 2, Vital Images). Four reading sessions were achieve...
PURPOSE To intraindividually compare Gadoxetic Acid (Gd-EOB-DTPA) enhanced MRI and 64-slice CT fo... more PURPOSE To intraindividually compare Gadoxetic Acid (Gd-EOB-DTPA) enhanced MRI and 64-slice CT for detection of HCC in patients with cirrhosis METHOD AND MATERIALS Informed consent and ethical approval were obtained. Thirty-five consecutive patients with 89 HCC nodules underwent MRI at 1.5T (Avanto, Siemens) and 64-slice CT (Sensation 64, Siemens) at a mean interval of 14 days (range, 10–20 days). MR acquisitions comprised unenhanced breath-hold T2W images and volumetric 3D Gd-EOB-DTPA-enhanced (0.1 mmol/kg; Primovist®) T1W GRE images acquired at 25s, 60s, 180s (dynamic phase) and 20 min (hepatobiliary phase). 64-slice CT was performed with 0.6 x 64 mm collimation, 3-mm section thickness, 250 mAs, 120 kVp. A triple-phase protocol was started 18s, 60s and 180s after reaching a trigger threshold of 150 HU above baseline CT number of the aorta. Image analysis was independently performed by three observers in two sessions separated by 4 weeks. Diagnostic accuracy was evaluated using the...
Uploads
Papers by Michele Di Martino