Emilia Vergara - Academia.edu (original) (raw)
Papers by Emilia Vergara
![Research paper thumbnail of Hyperfunctioning parathyroid gland and skeletal involvement on [18F]fluorocholine PET/CT: one look with two views](https://attachments.academia-assets.com/108079788/thumbnails/1.jpg)
](European Journal of Hybrid Imaging, Dec 12, 2022
Hyperparathyroidism is an endocrine disorder (Evangelista et al. 2020). Primary hyperparathyroidi... more Hyperparathyroidism is an endocrine disorder (Evangelista et al. 2020). Primary hyperparathyroidism is related to autonomous overproduction of parathyroid hormone (PTH) by parathyroid glands. In most cases, the disease is caused by a single parathyroid adenoma (89%) and less commonly by parathyroid hyperplasia (6%), double parathyroid adenoma (4%), or parathyroid carcinoma (< 1%) (Younes et al. 2005). The secondary form of hyperparathyroidism is caused by a chronic stimulus on the parathyroid glands due to low circulating calcium levels, while in tertiary hyperparathyroidism, the parathyroid glands take on their own functional autonomy due to a continuous stimulus from secondary hyperparathyroidism. The classic symptoms of hyperparathyroidism are characterized by painful bones, kidney stones, fatigue overtones, hypercalcemia, abdominal cramps and in some cases mental disorders (Younes et al. 2005). Non-invasive imaging techniques play a key role in the management of hyperparathyroidism. Both [ 99m Tc] Tc-sestamibi single-photon emission tomography (SPECT) and [ 18 F]fluorocholine positron emission tomography (PET)/computed tomography (CT) boast high sensitivity in the identification of hyperfunctioning parathyroid lesions (Petranović Ovčariček et al. 2021; Zhang et al. 2020; Broos et al. 2019). [ 99m Tc]Tc-sestamibi is endowed with
Applied Sciences
Coronary artery calcification and sarcopenia may have a relevant prognostic impact in oncological... more Coronary artery calcification and sarcopenia may have a relevant prognostic impact in oncological and non-oncological patients. The use of freeware software is promising for quantitative evaluation of these parameters after whole-body positron emission tomography (PET)/computed tomography (CT) and might be useful for one-stop shop risk stratification without additional radiation ionizing burden and further charges to health care costs. In this study, we compared two semiautomatic freeware software tools (Horos Medical Image software and LIFEx) for the assessment of coronary artery calcium (CAC) score and muscle mass in 40 patients undergoing whole-body PET/CT. The muscle areas obtained by the two software programs were comparable, showing high correlation with Lin’s concordance coefficient (0.9997; 95% confidence intervals: 0.9995–0.9999) and very good agreement with Bland–Altman analysis (mean difference = 0.41 cm2, lower limit = −1.06 cm2, upper limit = 1.89) was also found. For C...
Journal of Child Neurology, 2016
We evaluated whether perfusion brain abnormalities by single-photon emission computed tomography ... more We evaluated whether perfusion brain abnormalities by single-photon emission computed tomography (SPECT) imaging improves diagnostic and prognostic assessment in Sydenham chorea. Twenty-three children with acute autoimmune chorea underwent technetium-99m hexamethylpropyleneamine oxime brain SPECT imaging. In 16 children, SPECT was repeated during the follow-up. A pattern of basal ganglia hyperperfusion was observed in 20 (87%) patients. In 4 of 10 patients with generalized chorea, perfusion was comparable in right and left striatum and right and left thalamus. In 13 patients with hemi-chorea and in 3 with generalized chorea, unilateral hyperperfusion was detected. Three patients with generalized chorea had normal perfusion. Tracer uptake of basal ganglia of the patients at the acute phase was higher than at the follow-up ( P < .001). SPECT seems a useful noninvasive tool in pediatric patients with Sydenham chorea to support the clinicians during the acute phase of disease and to ...
La Radiologia medica, 1995
P280, a synthetic peptide composed of 26 aminoacids, has high affinity (Kd = 100 nM) and specific... more P280, a synthetic peptide composed of 26 aminoacids, has high affinity (Kd = 100 nM) and specificity for the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor expressed on activated platelets. In this study we investigated the potential usefulness of imaging deep vein thrombosis (DVT) and pulmonary embolism (PE) in humans with 99mTc-P280. In 15 patients (9 men and 6 women; mean age +/- s.d.: 49.2 +/- 14.1) with known DVT and/or PE, serial images were acquired within 24 hours of the injection of approximately 200 micrograms of P280 radiolabelled with 10-23 mCi of 99mTc. P280 was labelled with the ligand exchange method using 99mTc-glucoheptonate. Rapid blood clearance (< or = 5% ID was still circulating in 1 hour) enabled identification of thrombi as early as 60 minutes after the injection, with significant thrombi-to-background ratios (range: 2-4) in 11/15 patients (73%), in 7/9 with DVT, in 2/3 with PE and in 2/3 patients with both DVT and PE. Radiotracer uptake was clearly detectable...
The quarterly journal of nuclear medicine : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), 1995
In 10 patients with histologically proven neuroendocrine tumors (4 carcinoids, 4 pheochromocytoma... more In 10 patients with histologically proven neuroendocrine tumors (4 carcinoids, 4 pheochromocytomas, 1 medullary thyroid cancer and 1 Merkel tumor) the results of radiolabeled metaiodobenzylguanidine (MIBG) and somatostatin analogs were compared. A total of 24 tumor lesions was detected on standard imaging studies. MIBG scintigraphy correctly localized 12 (50%) of these lesions which were observed in 5 patients (4 with pheochromocytoma and 1 with carcinoid tumor). Scintigraphy using labeled somatostatin analogs correctly localized 21 (87%) lesions which occurred in 8 patients (4 with carcinoid, 2 with pheochromocytoma, 1 with medullary thyroid cancer and 1 with Merkel tumor). Concordant scintigraphic results were obtained in 1 patient with carcinoid and 2 with pheochromocytoma. In conclusion, although this series was limited, our results suggest that MIBG is more accurate than somatostatin analogs in imaging pheochromocytoma. Conversely, somatostatin analogs are more accurate than MI...
Biomedicine & Pharmacotherapy, 1992
We describe in detail the current trend using monoclonal antibodies to diagnose ovarian cancer ei... more We describe in detail the current trend using monoclonal antibodies to diagnose ovarian cancer either in vitro or in vivo. The approach with such powerful reagents allows to differentiate in virro tumor histotypes and to detect in peritonea1 washings the presence of a few neoplastic cells which characterize the minimal disease. The detection of elevated sera levels of ovarian cancer-associated antigens, such as CA-125 and TAG-72, allows the monito~ng, follow-up of these patients and the response to therapy with great accuracy. We focused our attention on the role in vivo of iabeffed monoclonaf antibodies, mainly for diagnostic purposes. Radioimmunoscintigraphy has been found to be more reliable than CT and US to detect foci of disease mainly in patients already treated by surgery, overcoming all the problems usually encountered with these two procedures, radioimmunoscintigraphy I monoclonal antibodks I ovarian tumor Rhmt?-Utilisation des aoticotps monuclonaux dans le cancer de I'owire. Nous dkcrivons en ditaif la mgthode cozzrante qui utilise les ~z~corps mo~oc~o~~ pour le diagnostic in vitro ou in vivo du cancer de l'ovaire. L'upproche avec de tels agents puissants pernzet de diffkrencier in vitro des histotypzs tunzoraux et de localiser dans ie lavage du peritoine fa presence de petites quantitb de celizdes neoplasiques qui caract&risent la nzaludie mininzak rrisiduelle. La d&e&on de niveaux PIeves d'antig&zes associ&s au cancer de i'ovaire tel que CA 125 et TAG 72 permet la surveillance de la maladie et la re'ponse d la th&apie avec une tris botzne pr&ision. &j&z. nous concentrons notre attention sur ie rcite in vivo des anticorps nzonoclona~ nzarqzks principuLenzent d des fins diagnosziques. La radio-imm~oscientigraph~, en eflet. s'est rev&&e plus s&e que fe scanner et I'&bogruphie, principalement dans in iocuiisation des foyers de maiadte chew les patients deja trait& par la chirurgie, surmontant ainsi IOUS les problemes fr6quemment rencontrks avec ces deux merhodes.
Gastroenterology, 1995
ABSTRACT We evaluated the role of per-rectal portal scintigraphy with 99m-technetium pertechnetat... more ABSTRACT We evaluated the role of per-rectal portal scintigraphy with 99m-technetium pertechnetate (99m-Tc test) for early diagnosis of cirrhosis. Forty patients with biochemical evidence of chronic liver disease were studied. Laparobiopsy documented chronic active hepatitis (CAH) without cirrhosis in 2.2 of the patients and CAH with cirrhosis (CAHc) in 18 patients. Clinical or laboratory findings could not differentiate between CAH and CAHc. Twelve healthy volunteers served as controls. The results, expressed as shunt index (SI), i.e., the ratio between heart radioactivity and the sum of heart and liver radioactivity in the first 30 s of observation, were: controls 5.66 ± 1.66, CAH 15.27 ± 2.83 and CAHc 24.88 ± 3.95. A significant difference between the mean SI values in the three groups studied (F = 142.71, p < 0.0001) was observed. At values less than 17, our test showed a predictivity of 100% for cirrhosis exclusion, while at values higher than 19 the predictive positive value for a diagnosis of cirrhosis was 100%. Invasive diagnostic procedures should be performed only in patients with SI values between 17–19.
Neurology and Therapy, 2019
Introduction: Subjects with Rett syndrome (RS) develop invariably severe motor deterioration resu... more Introduction: Subjects with Rett syndrome (RS) develop invariably severe motor deterioration resulting in swallowing difficulties that may produce excessive drooling. Hypersalivation can cause discomfort due to hygienic problems and may complicate with oral and respiratory dysfunctions. The aim of this study is to evaluate the response to treatment with botulinum toxin (BTX) for hypersalivation and to identify possible benefits of saliva reduction on oral motor and respiratory disorders of patients with RS. Methods: Five consecutive patients with RS and hypersalivation were treated with incobotulinumtoxin A injected in salivary glands with ultrasound guidance. Severity of excessive drooling was assessed with the Thomas-Stonell and Greenberg Scale (TGSC) and the clinical impact of the treatment was evaluated using three selected items of RS Assessment Rating Scale (R.A.R.S.): eating habits, dyspnoea and bruxism. Scale rating was performed before BTX injection (T0), 4 (T1) and 12 (T2) weeks after. Results: Scores of TGSC and R.A.R.S. (for eating and bruxism) were reduced significantly after therapy at T1. Conclusions: BTX treatment for sialorrhea in RS is effective in reducing saliva production and may also improve oral motor functions.
Journal of Ultrasound
Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. He... more Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. Here we are describing for the first time a case of bilateral testicular metastasis in a patient with a known ileocecal valve NET using an in-depth ultra-sound studying including microvascular flow imaging (MV-flow), ultra-sound new technique, able to detect small vessel slow-signal.
Journal for Vascular Ultrasound, 2022
Microvascular flow imaging is a new ultrasound technique with better ability than color Doppler i... more Microvascular flow imaging is a new ultrasound technique with better ability than color Doppler imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, color Doppler, and finally also with microvascular flow imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.
Journal for Vascular Ultrasound, 2021
Portal vein thrombosis (PVT) is a common complication of liver cirrhosis and is often the first s... more Portal vein thrombosis (PVT) is a common complication of liver cirrhosis and is often the first sign of undetected hepatocellular carcinoma. It is crucial to differentiate malignant from benign thrombosis in determining prognosis and treatment. We describe a case of malignant PVT, detected for the first time by a new ultrasound technology, microvascular flow imaging, which can depict low flow in small vessels.
Background. Chronic liver diseases (CHDs) are an important public health issue. The presence of s... more Background. Chronic liver diseases (CHDs) are an important public health issue. The presence of significant fibrosis is a hallmark for liver disease staging and prognosis. Aims. To develop a non-invasive score that can discriminate between patients with or without fibrosis in the aim to avoid liver biopsy.Methods. Forty patients with CHDs who received liver biopsy to stage fibrosis and 12 normal subjects performed also share wave elastography (SWE) and ELF-test. We chose two different outcome for histological fibrosis (F0-F1 vs F2-F4) and (F0-F2 vs F3-F4). ELF-test and SWE were independent predictors, categorized using ROC analysis. Two scores called SCORE1 and SCORE2 were devised.Results. The discriminatory values for SCORE1 were SWE>5.62 kPa and ELF-test >9.33 and for SCORE2 were SWE>7.04 kPa and ELF-test 9.33. SCORE1 specificity was 91.7% (CI 77.5-98.2%), significatively greater than obtained using SWE 63.9% (CI 46.2-79.2%; p=0.0013) or ELF-test 83.3% (CI 67.2-93.6%; p=0...
The International Journal of Biological Markers, 1992
Localization of gastrointestinal tumors by means of labeled monoclonal antibodies is a new, sensi... more Localization of gastrointestinal tumors by means of labeled monoclonal antibodies is a new, sensitive and suitable technique currently used in several centers. Encouraging results have been documented with several monoclonal antibodies by different authors. This article reviews our experience with radioimmunoscintigraphy in 59 patients with colorectal cancer in follow-up, using 131I and 111In labeled B72.3, and in 16 patients with primary gastrointestinal tumors using 99mTc anti-CEA monoclonal antibody (type F023C5). The sensitivity of both B72.3 and anti-CEA was greater than 70% either for primary tumors and abdominal recurrences or distant metastases except hepatic ones. A significant gradient in antibody uptake was measured on surgical biopsies between tumors and normal tissues allowing a good in vivo contrast for gamma detection. We have defined the impact of some factors affecting in vivo tumor targeting. In fact, pharmacodynamics of MAbs, percentage of injected dose bound to t...
Frontiers in Medicine, 2019
Background: We evaluated the incremental value of [ 99m Tc]sestamibi single photon-emission compu... more Background: We evaluated the incremental value of [ 99m Tc]sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism. Methods: Forty-six patients with biochemical evidence of hyperparathyroidism and inconclusive ultrasound underwent sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Decision tree analysis was performed to evaluate the value of SPECT/CT over planar scintigraphy for classifying patients with or without hyperfunctioning parathyroid tissue. The added value of SPECT/CT was also evaluated by decision curve analysis. Results: Planar scintigraphy was positive for presence of hyperfunctioning parathyroid in 52% of patients, with sensitivity of 63% and specificity of 100%. SPECT/CT was positive in 80% of patients with sensitivity of 97% and specificity of 100%. At decision tree analysis, after an initial split on planar imaging results, no further split was performed in patients with positive results, while those with negative results were further stratified by SPECT/CT. At decision curve analysis, the model including SPECT/CT was associated with the highest net benefit compared to the model including only planar technique and to a strategy considering that all patients should be treated. Conclusion: Sestamibi SPECT/CT provides incremental value over dual-phase scintigraphy in preoperative localization of hyperfunctioning parathyroid tissue in subjects with inconclusive ultrasound. Hybrid technique allows a better identification of pathological lesion to perform minimally invasive surgery and showed the highest net benefit, improving selection of surgical approach.
Frontiers in Endocrinology, 2018
Background: The management of indeterminate thyroid lesions is controversial. The American Thyroi... more Background: The management of indeterminate thyroid lesions is controversial. The American Thyroid Association (ATA) guidelines suggest a conservative approach for low risk indeterminate thyroid lesions (TIR3A). Case Report: We report a clinical case of a young girl who had TIR3A in a thyroid nodule located in the isthmus. After considering clinical and ultrasound (US) risk factors, we assessed literature data and guidelines to plan the extension of surgery. We found several studies supporting that the isthmus malignant lesions were associated with a higher rate of multifocality, capsular invasion, extrathyroidal extension, and central lymph node (LN) metastases. These data could predict a more aggressive behavior and a poor prognosis of the isthmus thyroid cancer compared to differentiated thyroid cancer, originating in the thyroid lobes. On the basis of these literature data and considering the familial risk for thyroid cancer of our patient, we decided to perform a total thyroidectomy. The histological examination revealed a follicular variant of papillary carcinoma located in the isthmus with capsular invasion. Conclusion: The isthmus location could be an additional risk factor to consider for a correct surgical approach in indeterminate thyroid lesions and thyroid cancer at fine-needle aspiration (FNA). We suggest that a careful ultrasonography should be carried out in patients with isthmus nodules. Total thyroidectomy should be performed in aggressive nodular disease. Prospective studies are needed to establish the best treatment for these lesions.
PloS one, 2017
The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The... more The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14-16.7 kPa and were 4.49 kPa and 2.92-7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with...
The Journal of nuclear medicine and allied sciences
Ten patients with intracranial malignancies were studied by radioimmunoscintigraphy with I-131 BC... more Ten patients with intracranial malignancies were studied by radioimmunoscintigraphy with I-131 BC-2 MoAb. Sensitivity and specificity of radioimmunoimaging were determined and compared with the results obtained with computed X-ray tomography and magnetic resonance imaging. BC-2 MoAb is a murine IgG1 anti-tenascin, which is not expressed by adult normal brain and has been found in large amount in gliomas and/or cerebral metastases, as well as other human tumors. Gamma-camera images obtained at 1 to 4 days exhibited increasing uptake of BC-2 in eight tumors, with varying degrees of contrast with the surrounding normal brain. Two lesions resulted negative to RIS: a meningioma and an oligodendroglioma. Specific tumor uptake of I-131 BC-2 was determined, by external gamma imaging, and ranged from 0.002 up to 0.007 percent of injected dose. Nonspecific uptake in the tumor was determined injecting 99m-Tc-FO23C5 (an isotype-matched control IgG1) in four patients and it was lower than 0.0001...
European Journal of Hybrid Imaging, Dec 12, 2022
Hyperparathyroidism is an endocrine disorder (Evangelista et al. 2020). Primary hyperparathyroidi... more Hyperparathyroidism is an endocrine disorder (Evangelista et al. 2020). Primary hyperparathyroidism is related to autonomous overproduction of parathyroid hormone (PTH) by parathyroid glands. In most cases, the disease is caused by a single parathyroid adenoma (89%) and less commonly by parathyroid hyperplasia (6%), double parathyroid adenoma (4%), or parathyroid carcinoma (< 1%) (Younes et al. 2005). The secondary form of hyperparathyroidism is caused by a chronic stimulus on the parathyroid glands due to low circulating calcium levels, while in tertiary hyperparathyroidism, the parathyroid glands take on their own functional autonomy due to a continuous stimulus from secondary hyperparathyroidism. The classic symptoms of hyperparathyroidism are characterized by painful bones, kidney stones, fatigue overtones, hypercalcemia, abdominal cramps and in some cases mental disorders (Younes et al. 2005). Non-invasive imaging techniques play a key role in the management of hyperparathyroidism. Both [ 99m Tc] Tc-sestamibi single-photon emission tomography (SPECT) and [ 18 F]fluorocholine positron emission tomography (PET)/computed tomography (CT) boast high sensitivity in the identification of hyperfunctioning parathyroid lesions (Petranović Ovčariček et al. 2021; Zhang et al. 2020; Broos et al. 2019). [ 99m Tc]Tc-sestamibi is endowed with
Applied Sciences
Coronary artery calcification and sarcopenia may have a relevant prognostic impact in oncological... more Coronary artery calcification and sarcopenia may have a relevant prognostic impact in oncological and non-oncological patients. The use of freeware software is promising for quantitative evaluation of these parameters after whole-body positron emission tomography (PET)/computed tomography (CT) and might be useful for one-stop shop risk stratification without additional radiation ionizing burden and further charges to health care costs. In this study, we compared two semiautomatic freeware software tools (Horos Medical Image software and LIFEx) for the assessment of coronary artery calcium (CAC) score and muscle mass in 40 patients undergoing whole-body PET/CT. The muscle areas obtained by the two software programs were comparable, showing high correlation with Lin’s concordance coefficient (0.9997; 95% confidence intervals: 0.9995–0.9999) and very good agreement with Bland–Altman analysis (mean difference = 0.41 cm2, lower limit = −1.06 cm2, upper limit = 1.89) was also found. For C...
Journal of Child Neurology, 2016
We evaluated whether perfusion brain abnormalities by single-photon emission computed tomography ... more We evaluated whether perfusion brain abnormalities by single-photon emission computed tomography (SPECT) imaging improves diagnostic and prognostic assessment in Sydenham chorea. Twenty-three children with acute autoimmune chorea underwent technetium-99m hexamethylpropyleneamine oxime brain SPECT imaging. In 16 children, SPECT was repeated during the follow-up. A pattern of basal ganglia hyperperfusion was observed in 20 (87%) patients. In 4 of 10 patients with generalized chorea, perfusion was comparable in right and left striatum and right and left thalamus. In 13 patients with hemi-chorea and in 3 with generalized chorea, unilateral hyperperfusion was detected. Three patients with generalized chorea had normal perfusion. Tracer uptake of basal ganglia of the patients at the acute phase was higher than at the follow-up ( P < .001). SPECT seems a useful noninvasive tool in pediatric patients with Sydenham chorea to support the clinicians during the acute phase of disease and to ...
La Radiologia medica, 1995
P280, a synthetic peptide composed of 26 aminoacids, has high affinity (Kd = 100 nM) and specific... more P280, a synthetic peptide composed of 26 aminoacids, has high affinity (Kd = 100 nM) and specificity for the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor expressed on activated platelets. In this study we investigated the potential usefulness of imaging deep vein thrombosis (DVT) and pulmonary embolism (PE) in humans with 99mTc-P280. In 15 patients (9 men and 6 women; mean age +/- s.d.: 49.2 +/- 14.1) with known DVT and/or PE, serial images were acquired within 24 hours of the injection of approximately 200 micrograms of P280 radiolabelled with 10-23 mCi of 99mTc. P280 was labelled with the ligand exchange method using 99mTc-glucoheptonate. Rapid blood clearance (< or = 5% ID was still circulating in 1 hour) enabled identification of thrombi as early as 60 minutes after the injection, with significant thrombi-to-background ratios (range: 2-4) in 11/15 patients (73%), in 7/9 with DVT, in 2/3 with PE and in 2/3 patients with both DVT and PE. Radiotracer uptake was clearly detectable...
The quarterly journal of nuclear medicine : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), 1995
In 10 patients with histologically proven neuroendocrine tumors (4 carcinoids, 4 pheochromocytoma... more In 10 patients with histologically proven neuroendocrine tumors (4 carcinoids, 4 pheochromocytomas, 1 medullary thyroid cancer and 1 Merkel tumor) the results of radiolabeled metaiodobenzylguanidine (MIBG) and somatostatin analogs were compared. A total of 24 tumor lesions was detected on standard imaging studies. MIBG scintigraphy correctly localized 12 (50%) of these lesions which were observed in 5 patients (4 with pheochromocytoma and 1 with carcinoid tumor). Scintigraphy using labeled somatostatin analogs correctly localized 21 (87%) lesions which occurred in 8 patients (4 with carcinoid, 2 with pheochromocytoma, 1 with medullary thyroid cancer and 1 with Merkel tumor). Concordant scintigraphic results were obtained in 1 patient with carcinoid and 2 with pheochromocytoma. In conclusion, although this series was limited, our results suggest that MIBG is more accurate than somatostatin analogs in imaging pheochromocytoma. Conversely, somatostatin analogs are more accurate than MI...
Biomedicine & Pharmacotherapy, 1992
We describe in detail the current trend using monoclonal antibodies to diagnose ovarian cancer ei... more We describe in detail the current trend using monoclonal antibodies to diagnose ovarian cancer either in vitro or in vivo. The approach with such powerful reagents allows to differentiate in virro tumor histotypes and to detect in peritonea1 washings the presence of a few neoplastic cells which characterize the minimal disease. The detection of elevated sera levels of ovarian cancer-associated antigens, such as CA-125 and TAG-72, allows the monito~ng, follow-up of these patients and the response to therapy with great accuracy. We focused our attention on the role in vivo of iabeffed monoclonaf antibodies, mainly for diagnostic purposes. Radioimmunoscintigraphy has been found to be more reliable than CT and US to detect foci of disease mainly in patients already treated by surgery, overcoming all the problems usually encountered with these two procedures, radioimmunoscintigraphy I monoclonal antibodks I ovarian tumor Rhmt?-Utilisation des aoticotps monuclonaux dans le cancer de I'owire. Nous dkcrivons en ditaif la mgthode cozzrante qui utilise les ~z~corps mo~oc~o~~ pour le diagnostic in vitro ou in vivo du cancer de l'ovaire. L'upproche avec de tels agents puissants pernzet de diffkrencier in vitro des histotypzs tunzoraux et de localiser dans ie lavage du peritoine fa presence de petites quantitb de celizdes neoplasiques qui caract&risent la nzaludie mininzak rrisiduelle. La d&e&on de niveaux PIeves d'antig&zes associ&s au cancer de i'ovaire tel que CA 125 et TAG 72 permet la surveillance de la maladie et la re'ponse d la th&apie avec une tris botzne pr&ision. &j&z. nous concentrons notre attention sur ie rcite in vivo des anticorps nzonoclona~ nzarqzks principuLenzent d des fins diagnosziques. La radio-imm~oscientigraph~, en eflet. s'est rev&&e plus s&e que fe scanner et I'&bogruphie, principalement dans in iocuiisation des foyers de maiadte chew les patients deja trait& par la chirurgie, surmontant ainsi IOUS les problemes fr6quemment rencontrks avec ces deux merhodes.
Gastroenterology, 1995
ABSTRACT We evaluated the role of per-rectal portal scintigraphy with 99m-technetium pertechnetat... more ABSTRACT We evaluated the role of per-rectal portal scintigraphy with 99m-technetium pertechnetate (99m-Tc test) for early diagnosis of cirrhosis. Forty patients with biochemical evidence of chronic liver disease were studied. Laparobiopsy documented chronic active hepatitis (CAH) without cirrhosis in 2.2 of the patients and CAH with cirrhosis (CAHc) in 18 patients. Clinical or laboratory findings could not differentiate between CAH and CAHc. Twelve healthy volunteers served as controls. The results, expressed as shunt index (SI), i.e., the ratio between heart radioactivity and the sum of heart and liver radioactivity in the first 30 s of observation, were: controls 5.66 ± 1.66, CAH 15.27 ± 2.83 and CAHc 24.88 ± 3.95. A significant difference between the mean SI values in the three groups studied (F = 142.71, p < 0.0001) was observed. At values less than 17, our test showed a predictivity of 100% for cirrhosis exclusion, while at values higher than 19 the predictive positive value for a diagnosis of cirrhosis was 100%. Invasive diagnostic procedures should be performed only in patients with SI values between 17–19.
Neurology and Therapy, 2019
Introduction: Subjects with Rett syndrome (RS) develop invariably severe motor deterioration resu... more Introduction: Subjects with Rett syndrome (RS) develop invariably severe motor deterioration resulting in swallowing difficulties that may produce excessive drooling. Hypersalivation can cause discomfort due to hygienic problems and may complicate with oral and respiratory dysfunctions. The aim of this study is to evaluate the response to treatment with botulinum toxin (BTX) for hypersalivation and to identify possible benefits of saliva reduction on oral motor and respiratory disorders of patients with RS. Methods: Five consecutive patients with RS and hypersalivation were treated with incobotulinumtoxin A injected in salivary glands with ultrasound guidance. Severity of excessive drooling was assessed with the Thomas-Stonell and Greenberg Scale (TGSC) and the clinical impact of the treatment was evaluated using three selected items of RS Assessment Rating Scale (R.A.R.S.): eating habits, dyspnoea and bruxism. Scale rating was performed before BTX injection (T0), 4 (T1) and 12 (T2) weeks after. Results: Scores of TGSC and R.A.R.S. (for eating and bruxism) were reduced significantly after therapy at T1. Conclusions: BTX treatment for sialorrhea in RS is effective in reducing saliva production and may also improve oral motor functions.
Journal of Ultrasound
Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. He... more Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. Here we are describing for the first time a case of bilateral testicular metastasis in a patient with a known ileocecal valve NET using an in-depth ultra-sound studying including microvascular flow imaging (MV-flow), ultra-sound new technique, able to detect small vessel slow-signal.
Journal for Vascular Ultrasound, 2022
Microvascular flow imaging is a new ultrasound technique with better ability than color Doppler i... more Microvascular flow imaging is a new ultrasound technique with better ability than color Doppler imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, color Doppler, and finally also with microvascular flow imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.
Journal for Vascular Ultrasound, 2021
Portal vein thrombosis (PVT) is a common complication of liver cirrhosis and is often the first s... more Portal vein thrombosis (PVT) is a common complication of liver cirrhosis and is often the first sign of undetected hepatocellular carcinoma. It is crucial to differentiate malignant from benign thrombosis in determining prognosis and treatment. We describe a case of malignant PVT, detected for the first time by a new ultrasound technology, microvascular flow imaging, which can depict low flow in small vessels.
Background. Chronic liver diseases (CHDs) are an important public health issue. The presence of s... more Background. Chronic liver diseases (CHDs) are an important public health issue. The presence of significant fibrosis is a hallmark for liver disease staging and prognosis. Aims. To develop a non-invasive score that can discriminate between patients with or without fibrosis in the aim to avoid liver biopsy.Methods. Forty patients with CHDs who received liver biopsy to stage fibrosis and 12 normal subjects performed also share wave elastography (SWE) and ELF-test. We chose two different outcome for histological fibrosis (F0-F1 vs F2-F4) and (F0-F2 vs F3-F4). ELF-test and SWE were independent predictors, categorized using ROC analysis. Two scores called SCORE1 and SCORE2 were devised.Results. The discriminatory values for SCORE1 were SWE>5.62 kPa and ELF-test >9.33 and for SCORE2 were SWE>7.04 kPa and ELF-test 9.33. SCORE1 specificity was 91.7% (CI 77.5-98.2%), significatively greater than obtained using SWE 63.9% (CI 46.2-79.2%; p=0.0013) or ELF-test 83.3% (CI 67.2-93.6%; p=0...
The International Journal of Biological Markers, 1992
Localization of gastrointestinal tumors by means of labeled monoclonal antibodies is a new, sensi... more Localization of gastrointestinal tumors by means of labeled monoclonal antibodies is a new, sensitive and suitable technique currently used in several centers. Encouraging results have been documented with several monoclonal antibodies by different authors. This article reviews our experience with radioimmunoscintigraphy in 59 patients with colorectal cancer in follow-up, using 131I and 111In labeled B72.3, and in 16 patients with primary gastrointestinal tumors using 99mTc anti-CEA monoclonal antibody (type F023C5). The sensitivity of both B72.3 and anti-CEA was greater than 70% either for primary tumors and abdominal recurrences or distant metastases except hepatic ones. A significant gradient in antibody uptake was measured on surgical biopsies between tumors and normal tissues allowing a good in vivo contrast for gamma detection. We have defined the impact of some factors affecting in vivo tumor targeting. In fact, pharmacodynamics of MAbs, percentage of injected dose bound to t...
Frontiers in Medicine, 2019
Background: We evaluated the incremental value of [ 99m Tc]sestamibi single photon-emission compu... more Background: We evaluated the incremental value of [ 99m Tc]sestamibi single photon-emission computed tomography (SPECT)/computed tomography (CT) over planar imaging for localization of abnormal parathyroid tissue in patients with primary hyperparathyroidism. Methods: Forty-six patients with biochemical evidence of hyperparathyroidism and inconclusive ultrasound underwent sestamibi dual-phase planar scintigraphy and SPECT/CT for preoperative localization of parathyroid adenoma. Imaging findings were compared with histopathological data. Decision tree analysis was performed to evaluate the value of SPECT/CT over planar scintigraphy for classifying patients with or without hyperfunctioning parathyroid tissue. The added value of SPECT/CT was also evaluated by decision curve analysis. Results: Planar scintigraphy was positive for presence of hyperfunctioning parathyroid in 52% of patients, with sensitivity of 63% and specificity of 100%. SPECT/CT was positive in 80% of patients with sensitivity of 97% and specificity of 100%. At decision tree analysis, after an initial split on planar imaging results, no further split was performed in patients with positive results, while those with negative results were further stratified by SPECT/CT. At decision curve analysis, the model including SPECT/CT was associated with the highest net benefit compared to the model including only planar technique and to a strategy considering that all patients should be treated. Conclusion: Sestamibi SPECT/CT provides incremental value over dual-phase scintigraphy in preoperative localization of hyperfunctioning parathyroid tissue in subjects with inconclusive ultrasound. Hybrid technique allows a better identification of pathological lesion to perform minimally invasive surgery and showed the highest net benefit, improving selection of surgical approach.
Frontiers in Endocrinology, 2018
Background: The management of indeterminate thyroid lesions is controversial. The American Thyroi... more Background: The management of indeterminate thyroid lesions is controversial. The American Thyroid Association (ATA) guidelines suggest a conservative approach for low risk indeterminate thyroid lesions (TIR3A). Case Report: We report a clinical case of a young girl who had TIR3A in a thyroid nodule located in the isthmus. After considering clinical and ultrasound (US) risk factors, we assessed literature data and guidelines to plan the extension of surgery. We found several studies supporting that the isthmus malignant lesions were associated with a higher rate of multifocality, capsular invasion, extrathyroidal extension, and central lymph node (LN) metastases. These data could predict a more aggressive behavior and a poor prognosis of the isthmus thyroid cancer compared to differentiated thyroid cancer, originating in the thyroid lobes. On the basis of these literature data and considering the familial risk for thyroid cancer of our patient, we decided to perform a total thyroidectomy. The histological examination revealed a follicular variant of papillary carcinoma located in the isthmus with capsular invasion. Conclusion: The isthmus location could be an additional risk factor to consider for a correct surgical approach in indeterminate thyroid lesions and thyroid cancer at fine-needle aspiration (FNA). We suggest that a careful ultrasonography should be carried out in patients with isthmus nodules. Total thyroidectomy should be performed in aggressive nodular disease. Prospective studies are needed to establish the best treatment for these lesions.
PloS one, 2017
The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The... more The presence of significant fibrosis is an indicator for liver disease staging and prognosis. The aim of the study was to determine reproducibility of real-time shear wave elastography using a hepatic biopsy as the reference standard to identify patients with chronic liver disease. Forty patients with chronic liver disease and 12 normal subjects received shear wave elastography performed by skilled operators. Interoperator reproducibility was studied in 29 patients. Fibrosis was evaluated using the Metavir score. The median and range shear wave elastography values in chronic liver disease subjects were 6.15 kPa and 3.14-16.7 kPa and were 4.49 kPa and 2.92-7.32 kPa in normal subjects, respectively. With respect to fibrosis detected by liver biopsy, shear wave elastography did not change significantly between F0 and F1 (p = 0.334), F1 and F2 (p = 0.611), or F3 and F4 (0.327); a significant difference was observed between the F0-F2 and F3-F4 groups (p = 0.002). SWE also correlated with...
The Journal of nuclear medicine and allied sciences
Ten patients with intracranial malignancies were studied by radioimmunoscintigraphy with I-131 BC... more Ten patients with intracranial malignancies were studied by radioimmunoscintigraphy with I-131 BC-2 MoAb. Sensitivity and specificity of radioimmunoimaging were determined and compared with the results obtained with computed X-ray tomography and magnetic resonance imaging. BC-2 MoAb is a murine IgG1 anti-tenascin, which is not expressed by adult normal brain and has been found in large amount in gliomas and/or cerebral metastases, as well as other human tumors. Gamma-camera images obtained at 1 to 4 days exhibited increasing uptake of BC-2 in eight tumors, with varying degrees of contrast with the surrounding normal brain. Two lesions resulted negative to RIS: a meningioma and an oligodendroglioma. Specific tumor uptake of I-131 BC-2 was determined, by external gamma imaging, and ranged from 0.002 up to 0.007 percent of injected dose. Nonspecific uptake in the tumor was determined injecting 99m-Tc-FO23C5 (an isotype-matched control IgG1) in four patients and it was lower than 0.0001...