Papers by Francesco Somma
Insights into Imaging, 2014
The 'ESGAR-THE EUROPEAN SOCIETY OF GASTRO-INTESTINAL AND ABDOMINAL RADIOLOGY' (or) 'ESGAR 2014-25... more The 'ESGAR-THE EUROPEAN SOCIETY OF GASTRO-INTESTINAL AND ABDOMINAL RADIOLOGY' (or) 'ESGAR 2014-25th ESGAR Annual Meeting' is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS), www.uems.net. The 'ESGAR 2014-25th ESGAR Annual Meeting' is designated for a maximum of (or 'for up to') 24 hours of European external CME credits. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.
La radiologia medica, 2011
Purpose. Acute mesenteric ischaemia (AMI) is a lifethreatening vascular emergency with a high mor... more Purpose. Acute mesenteric ischaemia (AMI) is a lifethreatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution. Methods. Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the fi rst group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI. Results. Macroscopically, a refl ex spastic ileus followed by refl ex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fl uid levels, free intraperitoneal fl uid and bowelwall oedema. Histological analysis confi rmed ischaemia and earlier damage involving the central portion of the ileum. Conclusions. This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.
Journal of medical case reports, 2014
Peutz-Jeghers syndrome is an autosomal dominant disease with incomplete penetrance and variable e... more Peutz-Jeghers syndrome is an autosomal dominant disease with incomplete penetrance and variable expression caused by germline mutation of serine threonine kinase 11/liver kinase B1; it is characterized by hamartomatous polyps in the gastrointestinal tract, mucocutaneous melanin pigmentation, and increased predisposition to neoplasms. In Peutz-Jeghers syndrome, bilateral Sertoli cell testicular tumors cause endocrine manifestations including gynecomastia and feminization. This study aimed to assess the role of breast ultrasound in the evaluation of the effectiveness of an innovative surgical approach. This report presents a pair of European 9-year-old identical male twins with Peutz-Jeghers syndrome, bilateral prepubertal gynecomastia, and testicular multifocal calcifications. Both twins were treated with anastrozole for 2 years. After finishing treatment, both underwent subcutaneous mastectomy performed by the "modified" Webster technique. Breast examination and ultrasound...
Journal of biological regulators and homeostatic agents
Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduct... more Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduction of quality of life. It represents a very common clinical problem that afflicts women three to seven time more often than men. The purpose of this study was to assess the diagnostic tools available to define the imaging strategy in patients with pelvic floor dynamic dysfunctions and to investigate their abilities in the diagnosis of enterocele, elytrocele and edrocele. From January 2008 to May 2011, 614 patients with symptoms related to pelvic floor dynamic dysfunctions were enrolled in our retrospective study. After anamnesis and clinical examination, entero-colpo-defecography (ECD) and supine entero-magnetic resonance (SE-MR) exams were performed in all patients. This study showed that the diagnostic efficacy of ECD is higher than that of SE-MR in the detection of enterocele and edrocele. Furthermore, elytrocele can be visualized only with ECD considering the position of patient dur...
Seminars in Ultrasound, CT and MRI, 2015
Maxillofacial region is an anatomically complex area, representing a crossroads of different syst... more Maxillofacial region is an anatomically complex area, representing a crossroads of different systems and apparatus. It is defined as the anatomical region lying on the facial skeleton from the inferior outline of maxilla up to an ideal plane passing through the skull base and the inion point, posteriorly. In this area, the digestive and respiratory systems connect to themselves and open in the mouth and sino-nasal cavities. Even the orbits with the ocular globes and their surrounding tissues lie in the same area. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body due to the "pivotal role" of the face in human relations. Moreover, the external openings of respiratory and digestive systems and the orbital cavities represent an easy way in for foreign bodies (FBs). Based on the access paths, it is possible to distinguish ingested, inhaled, penetrating, and iatrogenic (owing to surgery) FBs. FB may stop in oral and ocular cavities, or proceed deeply, reaching the surrounding soft tissues, the facial bones, or other cavities such as sino-nasal region, mouth, orbits, and further spaces of the head and neck region, like infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FBs accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection. Semin Ultrasound CT MRI 36:2-7 C 2014 Published by Elsevier Inc.
Synovial sarcoma has been defined by the World Health Organization (WHO) in 2002 as a type of mes... more Synovial sarcoma has been defined by the World Health Organization (WHO) in 2002 as a type of mesenchymal tissue cell tumor that exhibits epithelial differentiation and represents the third most common soft-tissue sarcoma in adults, accounting for approximately 10% of soft-tissue sarcomas. To date, only few reports have focused on mediastinal synovial sarcoma imaging findings. Herein, we report a case of a 13 cm primary mediastinal giant synovial sarcoma, diagnosed in a 56-year-old patient admitted in our Department of Radiology with a six-month history of dyspnea and back pain.
Synovial sarcoma has been defined by the World Health Organization (WHO) in 2002 as a type of mes... more Synovial sarcoma has been defined by the World Health Organization (WHO) in 2002 as a type of mesenchymal tissue cell tumor that exhibits epithelial differentiation and represents the third most common soft-tissue sarcoma in adults, accounting for approximately 10% of soft-tissue sarcomas. To date, only few reports have focused on mediastinal synovial sarcoma imaging findings. Herein, we report a case of a 13 cm primary mediastinal giant synovial sarcoma, diagnosed in a 56-year-old patient admitted in our Department of Radiology with a six-month history of dyspnea and back pain.
PURPOSE Our purpose is to assess and compare the survival of patients with portal vein thrombosis... more PURPOSE Our purpose is to assess and compare the survival of patients with portal vein thrombosis (PVT) and patients without PVT after a TARE using Y-90 microspheres of unresectable HCC, not responsive to other loco-regional treatments. METHOD AND MATERIALS Between November 2005 and February 2013, 81 TARE were performed in 74 patients (43% male; 57% female; range of age 28-84years) with unresectable HCC (size of lesions 1.1 to 5.5cm) and bilirubine values up to 2.6 mg/dl, 21 with PVT. Every patient was studied with Multislice Computed Tomography (MSCT) scans and angiography while just 12 of them underwent the embolization of the Gastro-duodenal artery, using micro-coils. In these cases, a previous study was performed with the injection of TC-99MAA through a 3F microcatheter. Proton-Pump Inhibitors (PPI) were administered to prevent gastritis and ulcers. RESULTS The average dose administered was 1.7GBq. After the treatment, fever and abdominal pain were found in 29 and 19 patients, r...
Japanese Journal of Radiology, 2014
Estimation of skeletal muscle metastases (SMMs) at the time of diagnosis and/or initial staging o... more Estimation of skeletal muscle metastases (SMMs) at the time of diagnosis and/or initial staging of lung cancer. Retrospective evaluation of clinical charts and imaging data suggestive of SMMs of patients with histology-proved lung cancer over a 5-year period. SMMs were identified in 46 out of 1,754 patients. Single and multiple (62.9% of cases) SMMs were detected by total body multi-detector computed tomography (MDCT). They were associated with poorly differentiated (43%) and advanced adenocarcinomas (52%) without clinically relevant symptoms and/or signs. Psoas and buttock muscles were most frequently involved (33.3%). MDCT findings consisted of well-defined homogeneously hyperdense oval masses (31%), lesions with ring-like enhancement and central hypoattenuation (68%), or large abscess-like necrotic lesions (24%). Sonography revealed well-defined hypoechoic masses (41.6%), ill-defined hypoechoic lesions (33.3%), or anechoic areas with a necrotic centre (25%). Positron emission tomography revealed that all SMMs were metabolically active. SMMs are uncommon but not negligible in lung cancer, with an estimated prevalence of 2.62% in our series. Although histology remains the recommended method, use of high-performance imaging techniques and increased clinical suspicion may improve their early detection. Efforts addressing their effect on the natural history of lung cancer are needed.
Seminars in Ultrasound, CT and MRI, 2015
Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences... more Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach. Semin Ultrasound CT MRI 36:48-56 C 2014 Elsevier Inc. All rights reserved.
La radiologia medica, 2014
for directing the patient towards the most appropriate treatment, avoiding surgery when not neces... more for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary.
World Journal of Gastroenterology, 2012
To define the evolution of ischemic lesions with 7T magnetic resonance imaging (7T-MRI) in an ani... more To define the evolution of ischemic lesions with 7T magnetic resonance imaging (7T-MRI) in an animal model of acute colonic ischemia.
Seminars in Ultrasound, CT and MRI, 2012
Radiologists receive little formal training regarding the structure of the radiology report and i... more Radiologists receive little formal training regarding the structure of the radiology report and its importance as a medicolegal document; failure to communicate, in fact, represents one of the main problems facing the modern radiologists' activity. Duty to the patient does not end anymore with the written report; the paradox is that we are so advanced in imaging technology, but not in communicating imaging findings. Communication must be timely, appropriate, and fully documented. There is an increasing trend to communicate results directly to the patients; radiologists have the greatest problem when communicating unexpected findings. To improve patient care and reduce the risk of being sued, radiologists should follow shared report guidelines and be more familiar with their professional responsibilities. Semin Ultrasound A lthough imaging technologies have undergone dramatic evolution over the past century, radiology reporting has remained largely static, in both content and structure. Existing free-text reports have been often criticized for a number of inherent deficiencies, including inconsistencies in content, structure, organization, and nomenclature. 1 A radiology report should be accurate and expressed with appropriate confidence with respect to current best practice and knowledge; it has to measure up the central role of the radiologist in the patient's care and management. By providing high-quality service, in fact, the radiologist will continue to be quoted, by other physicians, as a congenial professional colleague who offers valuable advice. Quality has become a critical issue for radiologists. Measuring and improving quality is essential not only to ensure optimum effectiveness of care and comply with increasing regulatory requirements, but also to combat current trends leading to commoditization of radiology services. Unfortunately, radiologists receive little formal training regarding the structure of the radiology report and its importance as a medicolegal document. 3 Good reporting has to include the description of the images, providing the classic radiologic findings, the diagnostic conclusion, and, eventually, the suggestion of further diagnostic imaging tests. Moreover, to reduce medicolegal consequences, a good radiology reading should be complete and correct, with appropriate construction; provide speedy diagnostic information, particularly in the emergency setting; reveal the ability to carry out and optimize the examination, including the imaging technique and the used contrast agent (justification); disclose all the information regarding the administered radiation dose, confirming that the residual risk has been as low as reasonable (optimization); and be clinically focused and attempt to answer the specific question for which the imaging study was performed.
Magnetic Resonance Imaging, 2013
Objectives: The aim of this study is to analyze the chronological development of macroscopic, mic... more Objectives: The aim of this study is to analyze the chronological development of macroscopic, microscopic and magnetic resonance imaging (MRI) findings in a rat model of Superior Mesenteric Venous (SMV) ligation, and to evaluate the role of MRI in the diagnosis of mesenteric venous thrombosis. Methods: Thirty adult Sprague-Dawley rats were used and divided in two different groups that underwent a different surgical model and a different monitoring of ischemic damage. Group I underwent macroscopical and histological observation; Group II underwent 7 T μMRI evaluation and histological analysis. Results: The first alterations occurred 30 min after SMV ligation and progressively worsened until the eighth hour. The morphological and MRI findings showed the same course. Conclusions: This study provides a systematic evaluation of early anatomopathological and MRI findings following the SMV ligation. MRI allows to identify the early pathological findings of venous mesenteric ischemia and allows to correlate those to the histopathological features. Our data suggest a relevant role of MRI in the diagnostic management of mesenteric venous thrombosis, allowing to non-invasively identify and characterize the histopathologic findings. So, thanks to these skills, its future application in early diagnosis of human mesenteric venous ischemia is supposable.
PLOS ONE, 2015
To evaluate safety and efficacy of Trans-Arterial Ethanol-Lipiodol Embolization (TAELE) compared ... more To evaluate safety and efficacy of Trans-Arterial Ethanol-Lipiodol Embolization (TAELE) compared with conventional Trans-Arterial Chemo-Embolization (cTACE) in the treatment of small intermediate-HCC (BCLC-Stage B). A random sample of 87 patients (37.93% male; 62.07% female; age range, 36-86 years) with documented small intermediate-HCC and treated with TAELE (mixture 1:1 of Ethanol and Lipiodol) or cTACE (mixture of 50mg-Epirubicin and 5cc-Lipiodol) were retrospectively studied in an institutional review board approved protocol. The two procedures were compared with χ2-test, χ2-test with Yates correction, McNemar's exact test, ANOVA test and log-rank test. TAELE and cTACE therapies were performed in 45 and 42 patients, respectively. Thirty days after the procedure, a Multi-Detector Computed Tomography (MDCT) showed no significant difference in the number of patients with partial and complete response between the two groups (p-value = 0.958), according to mRECIST. Contrary, significant differences were found in tumor-devascularization, lesion-reduction and post-embolization syndrome occurrence (p-value = 0.0004, p-value = 0.0003 and p-value = 0.009, respectively). Similar survival was observed during 36-month follow-up (p-value = 0.884). Compared to cTACE, TAELE showed a better toxicity profile with similar 36-month survival and similar one-month anti-tumor effects, which makes it better tolerated by patients, especially in case of more than one treatment.
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Papers by Francesco Somma