Objective The objective of this work was to evaluate the potential of diagnostic imaging in the i... more Objective The objective of this work was to evaluate the potential of diagnostic imaging in the identification, localiza-tion, and characterization of soft-tissue inflammatory myofi-broblastic tumors (IMTs) of limbs with correlation to differential diagnosis and therapy. Materials and methods From a retrospective analysis of 324 histologically verified soft-tissue lesions of limbs and extremities diagnosed in our institute from January 2002 to July 2010, we selected seven cases of histologically proven IMT. These included six males and one female, aged between 28 and 81 years (mean age, 57 years). Lesions were localized in three cases to the thigh, in two cases to the popliteal space, and in the remaining two cases, to the shoulder girdle. All patients were evaluated on the basis of US, CT, and MRI. Results Ultrasound detected the presence of a non-homogeneous solid formation in all cases and calcifications in three cases. CT showed the presence and type of calcification/ossification and bone reaction. On MRI, all cases had low signal intensity on SE T1-weighted sequences and an intermediate–low signal intensity on SE and FSE T2-weighted sequences in six of them; only one case had an intermediate–high signal intensity on SE and FSE T2-weighted sequences. Both contrast-enhanced CT and MRI showed precocious enhancement in association with multiple peripheral hypertrophic blood vessels. Conclusions On the basis of integrated imaging data obtained by US, CT, and MRI, it is possible to evaluate the lesion extension to provide a loco-regional staging, to characterize IMTs, and to allow an optimal therapeutical planning.
Goldenhar syndrome (GS) is a poly-malformation syndrome, also defined as oculo-auricolo-vertebral... more Goldenhar syndrome (GS) is a poly-malformation syndrome, also defined as oculo-auricolo-vertebral dysplasia with hemifacial microsomia. It is a rare congenital defect involving first and second branchial arches. The aetiology is not known. The most supported hypothesis is based on the abnormal embryonic vascular supply after mesodermal migration. Autosomal dominant, autosomal recessive and multifactorial modes of inheritance have been reported. We report the case of a female neonate affected by hemifacial microsomia and presence of pre-auricular tragi. Patients were subjected to computed tomography scan and MRI that revealed a mandibular unilateral hypoplasia without association of skeleton, brain and ocular alteration. The purpose of our study was to define the important role of the CT and MRI in the diagnosis of this poly-marformation syndrome.
This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct ident... more This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct identification of complex tears of the biceps pulley and their possible correlation with anterosuperior impingement (ASI) development. MR arthrography examinations of 23 athletes with clinical suspicion of ASI were reviewed. All examinations were obtained with a 1.5-T unit (Signa Horizon, GE Healthcare). The shoulders were studied with a dedicated surface coil with the patient's arm in the neutral position and in internal and external rotation. In five patients, images in abduction-external rotation (ABER) were obtained. Within 2 month after MR arthrography, the athletes underwent arthroscopic surgery. MR arthrography images showed a spectrum of tears that, according to the Habermeyer classification, were subdivided into four groups: type 1 in three patients; type 2 in five; type 3 in seven; type 4 in eight. At arthroscopic evaluation, one patient presented type 1 lesion, five type 2, fiv...
Our study aimed to assess the role of magnetic resonance imaging (MRI) in the characterisation of... more Our study aimed to assess the role of magnetic resonance imaging (MRI) in the characterisation of musculoskeletal tumours and to identify specific perfusion patterns for the different tumours. Between January 2003 and September 2005, we evaluated the conventional and perfusion MRIs of 39 patients with musculoskeletal tumours. Dynamic MRI was performed with a 1.5-T and 1.0-T MRI unit before and after the intravenous administration of contrast material, using dedicated phased-array coils appropriate for the region to be studied and fast and ultrafast consecutive sequences. Postprocessing was done on an independent workstation (Advantage Windows, GE Medical System), with Functool (GE) software, which allowed a quantitative evaluation of enhancement as a function of time. The results were compared with the histopathological diagnoses obtained by biopsy or surgery. The lesions identified in the 39 patients included 23 soft tissue tumours (12 benign, 11 malignant) and 16 bone tumours (ten benign, six malignant). Comparing the time-intensity diagrams of lesions of the same histological type, we found typical enhancement patterns for some bone tumours only, especially for bone, cartilaginous, fibrohistiocytic and pseudoinflammatory lesions. No typical enhancement pattern could be detected for any of the histological types of soft tissue tumour. Analysis of the slope of the time-intensity curves has a sensitivity and specificity of 64%-58% for soft tissue tumours and 86%-67% for bone tumours in determining the biological aggressiveness of the lesions. Perfusion MRI had moderate sensitivity and specificity in the differential diagnosis between lesions with high or low biological activity. Only in a few cases was it possible to find some correlation between perfusion patterns and lesion histology. The slope values should therefore be used in combination with conventional spin-echo images and other imaging and clinical data in order to narrow the field of the possible differential diagnoses and reliably predict the nature of the lesion.
To evaluate retrospectively the role and the effectiveness of self-expandable Wallstents and ball... more To evaluate retrospectively the role and the effectiveness of self-expandable Wallstents and balloon-expandable Strecker stents in patients with inoperable malignant obstruction of the biliary tree. Fifty patients with malignant biliary obstruction were treated from August 1991 to August 1992 by percutaneous placement of 55 metallic endoprostheses (39 Wallstents, 16 Strecker stents). All patients were followed by clinical evaluation, laboratory data, and ultrasonographic examination until death. Wallstent placement was successful in 36 patients without procedure-related complications. One partial occlusion after 1 year was resolved by percutaneous balloon dilatation. Fourteen patients were treated with 16 Strecker stents. Stenting was unsuccessful in four cases; four occlusions (after 6 h, 48 h, 2 and 6 months) were encountered. Wallstent endoprostheses have good results and long-term patency. There were some problems with Strecker stents during the placement and there was a higher occlusion rate.
To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy... more To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy. Twenty-three patients affected by symptomatic uterine adenomyosis (11 focal and 7 diffuse forms), diagnosed using MRI, were included in this study. Eighteen out of 23 were submitted to MRgFUS. All junctional zone more than 12 mm in width were considered to be adenomyosis. Study evaluates the pre-treatment target volume measured prior to the treatment on the CE T1-weighted sequence and the MRgFUS-treated volume (MRgFUS-TV), represented by the volume of the lesion ablated, measured directly by means of the MRgFUS. The treated volume on the CE T1-weighted sequence (CE MRI-TV) was measured immediately after treatment. After 1 year, the junctional zone thickness was measured in order to compare pre- and post-treatment values. The therapeutic plan consisted of a high-energy-grid sonication. Symptomatology was assessed through the UFS-QOL. The pre-treatment target volume mean value was of 59....
We aimed to evaluate interobserver agreement in the definition of spine instability among spine n... more We aimed to evaluate interobserver agreement in the definition of spine instability among spine neuroradiologists with or without experience in dynamic magnetic resonance imaging (MRI). Two expert neuroradiologists and two residents retrospectively evaluated the pre-operative dynamic MRI examinations of patients with vertebral instability. Segmental motion, defined as excessive (more than 3 mm) translational motion from supine to upright, was investigated in 103 subjects (309 segments) using kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration, facet joint osteoarthritis, and ligament flavum hypertrophy. These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. The agreement among the neuroradiologists was calculated using the kappa coefficient. All patients had neurosurgical intervention to stabilize the spine. Agree...
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a totally noninvasive ablation t... more Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a totally noninvasive ablation technique that in the last years had an important development in a large number of applications: in particular gynaecological disorders, bone lesions, prostate, breast, brain and other organs. This review of MRgFUS is focused on the technical aspects and the current clinical application in musculoskeletal interventions. More precisely, this paper aims to review the relatively scarce literature on this topic also in comparison with our 3-year experience in the use of this technique in the field of musculoskeletal interventions.
Objective The objective of this work was to evaluate the potential of diagnostic imaging in the i... more Objective The objective of this work was to evaluate the potential of diagnostic imaging in the identification, localiza-tion, and characterization of soft-tissue inflammatory myofi-broblastic tumors (IMTs) of limbs with correlation to differential diagnosis and therapy. Materials and methods From a retrospective analysis of 324 histologically verified soft-tissue lesions of limbs and extremities diagnosed in our institute from January 2002 to July 2010, we selected seven cases of histologically proven IMT. These included six males and one female, aged between 28 and 81 years (mean age, 57 years). Lesions were localized in three cases to the thigh, in two cases to the popliteal space, and in the remaining two cases, to the shoulder girdle. All patients were evaluated on the basis of US, CT, and MRI. Results Ultrasound detected the presence of a non-homogeneous solid formation in all cases and calcifications in three cases. CT showed the presence and type of calcification/ossification and bone reaction. On MRI, all cases had low signal intensity on SE T1-weighted sequences and an intermediate–low signal intensity on SE and FSE T2-weighted sequences in six of them; only one case had an intermediate–high signal intensity on SE and FSE T2-weighted sequences. Both contrast-enhanced CT and MRI showed precocious enhancement in association with multiple peripheral hypertrophic blood vessels. Conclusions On the basis of integrated imaging data obtained by US, CT, and MRI, it is possible to evaluate the lesion extension to provide a loco-regional staging, to characterize IMTs, and to allow an optimal therapeutical planning.
Goldenhar syndrome (GS) is a poly-malformation syndrome, also defined as oculo-auricolo-vertebral... more Goldenhar syndrome (GS) is a poly-malformation syndrome, also defined as oculo-auricolo-vertebral dysplasia with hemifacial microsomia. It is a rare congenital defect involving first and second branchial arches. The aetiology is not known. The most supported hypothesis is based on the abnormal embryonic vascular supply after mesodermal migration. Autosomal dominant, autosomal recessive and multifactorial modes of inheritance have been reported. We report the case of a female neonate affected by hemifacial microsomia and presence of pre-auricular tragi. Patients were subjected to computed tomography scan and MRI that revealed a mandibular unilateral hypoplasia without association of skeleton, brain and ocular alteration. The purpose of our study was to define the important role of the CT and MRI in the diagnosis of this poly-marformation syndrome.
This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct ident... more This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct identification of complex tears of the biceps pulley and their possible correlation with anterosuperior impingement (ASI) development. MR arthrography examinations of 23 athletes with clinical suspicion of ASI were reviewed. All examinations were obtained with a 1.5-T unit (Signa Horizon, GE Healthcare). The shoulders were studied with a dedicated surface coil with the patient's arm in the neutral position and in internal and external rotation. In five patients, images in abduction-external rotation (ABER) were obtained. Within 2 month after MR arthrography, the athletes underwent arthroscopic surgery. MR arthrography images showed a spectrum of tears that, according to the Habermeyer classification, were subdivided into four groups: type 1 in three patients; type 2 in five; type 3 in seven; type 4 in eight. At arthroscopic evaluation, one patient presented type 1 lesion, five type 2, fiv...
Our study aimed to assess the role of magnetic resonance imaging (MRI) in the characterisation of... more Our study aimed to assess the role of magnetic resonance imaging (MRI) in the characterisation of musculoskeletal tumours and to identify specific perfusion patterns for the different tumours. Between January 2003 and September 2005, we evaluated the conventional and perfusion MRIs of 39 patients with musculoskeletal tumours. Dynamic MRI was performed with a 1.5-T and 1.0-T MRI unit before and after the intravenous administration of contrast material, using dedicated phased-array coils appropriate for the region to be studied and fast and ultrafast consecutive sequences. Postprocessing was done on an independent workstation (Advantage Windows, GE Medical System), with Functool (GE) software, which allowed a quantitative evaluation of enhancement as a function of time. The results were compared with the histopathological diagnoses obtained by biopsy or surgery. The lesions identified in the 39 patients included 23 soft tissue tumours (12 benign, 11 malignant) and 16 bone tumours (ten benign, six malignant). Comparing the time-intensity diagrams of lesions of the same histological type, we found typical enhancement patterns for some bone tumours only, especially for bone, cartilaginous, fibrohistiocytic and pseudoinflammatory lesions. No typical enhancement pattern could be detected for any of the histological types of soft tissue tumour. Analysis of the slope of the time-intensity curves has a sensitivity and specificity of 64%-58% for soft tissue tumours and 86%-67% for bone tumours in determining the biological aggressiveness of the lesions. Perfusion MRI had moderate sensitivity and specificity in the differential diagnosis between lesions with high or low biological activity. Only in a few cases was it possible to find some correlation between perfusion patterns and lesion histology. The slope values should therefore be used in combination with conventional spin-echo images and other imaging and clinical data in order to narrow the field of the possible differential diagnoses and reliably predict the nature of the lesion.
To evaluate retrospectively the role and the effectiveness of self-expandable Wallstents and ball... more To evaluate retrospectively the role and the effectiveness of self-expandable Wallstents and balloon-expandable Strecker stents in patients with inoperable malignant obstruction of the biliary tree. Fifty patients with malignant biliary obstruction were treated from August 1991 to August 1992 by percutaneous placement of 55 metallic endoprostheses (39 Wallstents, 16 Strecker stents). All patients were followed by clinical evaluation, laboratory data, and ultrasonographic examination until death. Wallstent placement was successful in 36 patients without procedure-related complications. One partial occlusion after 1 year was resolved by percutaneous balloon dilatation. Fourteen patients were treated with 16 Strecker stents. Stenting was unsuccessful in four cases; four occlusions (after 6 h, 48 h, 2 and 6 months) were encountered. Wallstent endoprostheses have good results and long-term patency. There were some problems with Strecker stents during the placement and there was a higher occlusion rate.
To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy... more To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy. Twenty-three patients affected by symptomatic uterine adenomyosis (11 focal and 7 diffuse forms), diagnosed using MRI, were included in this study. Eighteen out of 23 were submitted to MRgFUS. All junctional zone more than 12 mm in width were considered to be adenomyosis. Study evaluates the pre-treatment target volume measured prior to the treatment on the CE T1-weighted sequence and the MRgFUS-treated volume (MRgFUS-TV), represented by the volume of the lesion ablated, measured directly by means of the MRgFUS. The treated volume on the CE T1-weighted sequence (CE MRI-TV) was measured immediately after treatment. After 1 year, the junctional zone thickness was measured in order to compare pre- and post-treatment values. The therapeutic plan consisted of a high-energy-grid sonication. Symptomatology was assessed through the UFS-QOL. The pre-treatment target volume mean value was of 59....
We aimed to evaluate interobserver agreement in the definition of spine instability among spine n... more We aimed to evaluate interobserver agreement in the definition of spine instability among spine neuroradiologists with or without experience in dynamic magnetic resonance imaging (MRI). Two expert neuroradiologists and two residents retrospectively evaluated the pre-operative dynamic MRI examinations of patients with vertebral instability. Segmental motion, defined as excessive (more than 3 mm) translational motion from supine to upright, was investigated in 103 subjects (309 segments) using kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration, facet joint osteoarthritis, and ligament flavum hypertrophy. These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. The agreement among the neuroradiologists was calculated using the kappa coefficient. All patients had neurosurgical intervention to stabilize the spine. Agree...
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a totally noninvasive ablation t... more Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a totally noninvasive ablation technique that in the last years had an important development in a large number of applications: in particular gynaecological disorders, bone lesions, prostate, breast, brain and other organs. This review of MRgFUS is focused on the technical aspects and the current clinical application in musculoskeletal interventions. More precisely, this paper aims to review the relatively scarce literature on this topic also in comparison with our 3-year experience in the use of this technique in the field of musculoskeletal interventions.
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