Lorenzo Mannelli | Memorial Sloan-Kettering Cancer Center (original) (raw)
Papers by Lorenzo Mannelli
Radiology and Oncology, Jul 13, 2019
Journal of Gastroenterology and Hepatology, Apr 16, 2018
A 48-year old man with no history of liver disease or alcohol addiction developed jaundice, itchi... more A 48-year old man with no history of liver disease or alcohol addiction developed jaundice, itching and dark urine without any symptom of abdominal pain. A CT examination revealed the presence of a liver mass extending between segments 4, 5 and 8 that was found to be an acinar cell carcinoma at biopsy. The primary hepatic origin was confirmed mainly excluding a primary pancreatic tumor by diagnostic work-up. Since the lesion was considered unresectable at the time of the diagnosis, the patient underwent to Xeloda and oxaliplatin neoadjuvant chemotherapy, with progressive reduction in size of the mass as a sign of good response to therapy.
European Journal of Radiology, May 1, 2018
Critical Reviews in Oncology Hematology, Oct 1, 2020
In recent years the concept of precision medicine has become a popular topic particularly in medi... more In recent years the concept of precision medicine has become a popular topic particularly in medical oncology. Besides the identification of new molecular prognostic and predictive biomarkers and the development of new targeted and immunotherapeutic drugs, imaging has started to play a central role in this new era. Terms such as "radiomics", "radiogenomics" or "radi…-omics" are becoming increasingly common in the literature and soon they will represent an integral part of clinical practice. The use of artificial intelligence, imaging and "-omics" data can be used to develop models able to predict, for example, the features of the tumor immune microenvironment through imaging, and to monitor the therapeutic response beyond the standard radiological criteria. The aims of this narrative review are to provide a simplified guide for clinicians to these concepts, and to summarize the existing evidence on radiomics and "radi…-omics" in cancer immunotherapy.
Abdominal Imaging, Aug 1, 2017
Diagnostics, Mar 10, 2022
We map single energy CT (SECT) scans to synthetic dual-energy CT (synth-DECT) material density io... more We map single energy CT (SECT) scans to synthetic dual-energy CT (synth-DECT) material density iodine (MDI) scans using deep learning (DL) and demonstrate their value for liver segmentation. A 2D pix2pix (P2P) network was trained on 100 abdominal DECT scans to infer synth-DECT MDI scans from SECT scans. The source and target domain were paired with DECT monochromatic 70 keV and MDI scans. The trained P2P algorithm then transformed 140 public SECT scans to synth-DECT scans. We split 131 scans into 60% train, 20% tune, and 20% held-out test to train four existing liver segmentation frameworks. The remaining nine low-dose SECT scans tested system generalization. Segmentation accuracy was measured with the dice coefficient (DSC). The DSC per slice was computed to identify sources of error. With synth-DECT (and SECT) scans, an average DSC score of 0.93 ± 0.06 (0.89 ± 0.01) and 0.89 ± 0.01 (0.81 ± 0.02) was achieved on the held-out and generalization test sets. Synth-DECT-trained systems required less data to perform as well as SECT-trained systems. Low DSC scores were primarily observed around the scan margin or due to non-liver tissue or distortions within ground-truth annotations. In general, training with synth-DECT scans resulted in improved segmentation performance with less data.
![Research paper thumbnail of [18F]Fluorocholine PET/CT-guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer](https://attachments.academia-assets.com/120408964/thumbnails/1.jpg)
](European Journal of Nuclear Medicine and Molecular Imaging, Oct 16, 2019
Background In the last years, functional imaging has given a significant contribution to the clin... more Background In the last years, functional imaging has given a significant contribution to the clinical decision-making of biochemically relapsed prostate cancer (PCa). Hereby, we present a prospective study aiming to validate the role of [ 18 F]Fluoro-Methyl Choline ([ 18 F]FMCH) PET/CT in the selection of PCa patients suitable for stereotactic body radiotherapy (SBRT). Methods Patients with biochemical recurrence limited up to three lesions revealed by [ 18 F]FMCH PET/CT were enrolled in the present study and treated with SBRT on all active lesions. Systemic therapy-free survival since the [ 18 F]FMCH PET/CT was considered as the primary endpoint. Results Forty-six patients were evaluated, and a total of 67 lesions were treated. After a median follow-up of 28.9 months, systemic therapy was started in 30 patients (65.2%) and median systemic therapy-free survival was 39.1 months (95% CI 6.5-68.6); 6, 12, and 24-month ratios were 93.5%, 73.9%, and 63.1%, respectively. At univariate Cox regression analysis, Delta PSA demonstrated an impact on systemic therapy-free survival (p < 0.001). Conclusions Based on our findings, [ 18 F]FMCH PET/CT can identify oligometastatic prostate cancer patients suitable for SBRT, resulting in a systemic therapy-free survival of 39.1 months.
Clinical Nuclear Medicine, 2016
Journal of Computer Assisted Tomography, 2018
Objective-To evaluate the accuracy of single-source dual-energy CT (ssDECT) in iodine quantificat... more Objective-To evaluate the accuracy of single-source dual-energy CT (ssDECT) in iodine quantification using various segmentation methods in an ex-vivo model. Methods-Ten sausages, injected with variable quantities of iodinated contrast, were inserted into two livers and scanned with ssDECT. Material density iodine (MDI) images were reconstructed. Three radiologists segmented each sausage. Iodine concentration, volume and absolute quantity were measured. Agreement between the measured and injected iodine was assessed with the concordance correlation coefficient (CCC). Intra-reader agreement was assessed using the intraclass correlation coefficient (ICC). Results-Air bubbles were observed in sausage (IX). Sausage (X) was within the same view as hyper-attenuating markers used for localization. With IX and X excluded, CCC and ICC were > 0.98 and > 0.88. When included, CCC and ICC were > 0.94 and > 0.79. Conclusions-Iodine quantification was reproducible and precise. However, accuracy reduced in sausages consisting of air filled cavities and within the same view as hyper-attenuating markers.
Nuclear Medicine Communications, Apr 1, 2017
Objective-Determine if second opinion reviews of PET/CT examinations by subspecialists alters rep... more Objective-Determine if second opinion reviews of PET/CT examinations by subspecialists alters reporting of malignant findings. Methods-This IRB-approved study compared 240 FDG PET/CT consecutively dictated reports by two nuclear medicine subspecialists against the original outside institution reports. Subspecialist reviews documented if malignant findings on the outside report were malignant, and noted additional malignant findings not described on the outside report. Final diagnosis of malignancy or benignity was determined by pathology when available, otherwise by imaging follow-up. Results-22 findings (in 20 reports) called suspicious/malignant on the outside reports were deemed benign by subspecialist review. A final diagnosis was available for 20 of 22 findings by pathology (3) or follow-up imaging (17). The subspecialist review was accurate in 20 of 20 (100%) cases where a final diagnosis was available. The subspecialist review called 11 findings (in 11 reports) suspicious/malignant that were not described or deemed benign on the outside reports. Definitive diagnosis was available for 10 of 11 findings by pathology (7) or follow-up imaging (3). The second opinion report was accurate in 7 of 10 (70%) cases where a final diagnosis was available. Conclusions-In 31 of 240 (13%) FDG PET/CT examinations performed at an outside institution, subspecialist review resulted in at least one discordant opinion of malignancy. For 28 discrepant cases where a final diagnosis was available, the subspecialist review defined malignancy or benignity correctly in 25 of 28 (89%) cases. This provides evidence for cost and effort invested in performing second opinion reviews of PET/CT studies.
Clinical Nuclear Medicine, Nov 1, 2017
A previously healthy 4 year-old-female, presented with petechial rash and low platelet count. No ... more A previously healthy 4 year-old-female, presented with petechial rash and low platelet count. No other symptoms. On abdominal ultrasound a 4.7 cm heterogeneous mass was demonstrated anterior to the left kidney. An abdominal MRI subsequently performed demonstrated a heterogeneously enhancing mass at the same location extending to the pancreas and spleen. A surgical biopsy of the mass was obtained. Pathology reported a malignant epithelioid neoplasm consistent with pancreatoblastoma. The mass demonstrated intense FDG uptake on PET and an FDG avid retrocaval lymph node.
Diagnostic and interventional imaging, Dec 1, 2016
Cystic pancreatic lesions vary from benign to malignant entities and are increasingly detected on... more Cystic pancreatic lesions vary from benign to malignant entities and are increasingly detected on cross-sectional imaging. Knowledge of the imaging appearances of cystic pancreatic lesions may help radiologists in their diagnostic reporting and management. In this review, we discuss the morphologic classification of these lesions based on a diagnostic algorithm as well as the management of these lesions. Cyst; Pancreas; MRI; IPMN Recently, multiple technological advances in imaging have significantly increased the detection and characterization of pancreatic cystic lesions . With this increased sensitivity, comes the challenge of managing incidentally discovered pancreatic cystic lesions. While solid pancreatic tumors are almost invariably treated surgically, cystic lesions are currently most problematic. Indeed, the differential diagnosis of these cystic lesions ranges from benign (pseudocysts, serous cystadenomas) to potentially or frankly malignant lesions (intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, cystic neuroendocrine tumors) . To help patient's treatment and follow-up stratification, several professional societies have proposed guidelines for the management of cystic pancreatic lesion . In this review, we discuss the morphologic classification of cystic pancreatic lesions based on a diagnostic algorithm as well as the management of these lesions.
Frontiers in Digital Health
Artificial intelligence (AI) has been successful at solving numerous problems in machine percepti... more Artificial intelligence (AI) has been successful at solving numerous problems in machine perception. In radiology, AI systems are rapidly evolving and show progress in guiding treatment decisions, diagnosing, localizing disease on medical images, and improving radiologists' efficiency. A critical component to deploying AI in radiology is to gain confidence in a developed system's efficacy and safety. The current gold standard approach is to conduct an analytical validation of performance on a generalization dataset from one or more institutions, followed by a clinical validation study of the system's efficacy during deployment. Clinical validation studies are time-consuming, and best practices dictate limited re-use of analytical validation data, so it is ideal to know ahead of time if a system is likely to fail analytical or clinical validation. In this paper, we describe a series of sanity tests to identify when a system performs well on development data for the wrong ...
Insights into Imaging, 2022
As of September 18th, 2021, global casualties due to COVID-19 infections approach 200 million, se... more As of September 18th, 2021, global casualties due to COVID-19 infections approach 200 million, several COVID-19 vaccines have been authorized to prevent COVID-19 infection and help mitigate the spread of the virus. Despite the vast majority having safely received vaccination against SARS-COV-2, the rare complications following COVID-19 vaccination have often been life-threatening or fatal. The mechanisms underlying (multi) organ complications are associated with COVID-19, either through direct viral damage or from host immune response (i.e., cytokine storm). The purpose of this manuscript is to review the role of imaging in identifying and elucidating multiorgan complications following SARS-COV-2 vaccination—making clear that, in any case, they represent a minute fraction of those in the general population who have been vaccinated. The authors are both staunch supporters of COVID-19 vaccination and vaccinated themselves as well.
Clinical Reviews in Allergy & Immunology, 2022
The cardiovascular system is frequently affected by coronavirus disease-19 , particularly in hosp... more The cardiovascular system is frequently affected by coronavirus disease-19 , particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
Dose-Response, 2021
Introduction. Intracranial epidermoid cysts are the most frequent congenital intracranial lesion.... more Introduction. Intracranial epidermoid cysts are the most frequent congenital intracranial lesion. They rare and benign tumors that can present in different clinical situations depending on location and extension of the disease. Diagnosis is obtained with radiological imaging with RM and non-enhanced TC as elective investigating methods. Elective treatment is surgery, based on total/subtotal excision sparring healthy neurovascular structures, considering the benign nature of this lesion. Case Report. In this study we present the case of a 79-year-old woman affected by recidivist epidermal cyst of the posterior fossa. Clinical presentation was characterized by positional subjective vertigo, intense headache localized in the right part of the head increased by Valsalva maneuver and retroarticular subcutaneous swelling. Radiological investigation found a giant epidemoid cyst of the posterior fossa (8,4 x 4,8 x 5,8 cm), treated with surgery. In the postoperative, the patient was fine and...
Neuroradiology, 2021
Purpose The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognit... more Purpose The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognition and resting-state functional magnetic resonance imaging (rs-fMRI) using the Amplitude of Low Frequency Fluctuations (ALFF) technique. Methods In this observational study, patients eligible for CEA were prospectively included. On the same day, within 1 week of the CEA procedure performed and 12 months after the CEA procedure, all patients underwent (i) an MRI examination for rs-fMRI analysis and (ii) a cognitive evaluation using the Italian version of the Mini-Mental State Examination (MMSE) corrected for age and schooling. Pre-CEA and post-CEA MMSE scores were evaluated using paired sample t-tests, adopting a p-value
Dose-Response, 2020
Purpose: The progression of the otitic infectious process toward diseases of particular severity ... more Purpose: The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the possible severe complications. Methods: We conducted a retrospective study of 13 cases of basal cranial osteomyelitis (SBO) due to malignant external otitis, by the ENT Department of the University of Catania. Through a standardized approach and following the latest guidelines, we have evaluated all patients performing a standardized and personalized radiological protocol according to the stage of the patient’s pathology and modulating the treatment consequently. Results: Clinical signs have been observed such as otorrhea (100%), otalgia in 13/13 patients (100%), granulations in external auditory canal (100%), preauricular cellulitis in 9/13...
Radiology and Oncology, Jul 13, 2019
Journal of Gastroenterology and Hepatology, Apr 16, 2018
A 48-year old man with no history of liver disease or alcohol addiction developed jaundice, itchi... more A 48-year old man with no history of liver disease or alcohol addiction developed jaundice, itching and dark urine without any symptom of abdominal pain. A CT examination revealed the presence of a liver mass extending between segments 4, 5 and 8 that was found to be an acinar cell carcinoma at biopsy. The primary hepatic origin was confirmed mainly excluding a primary pancreatic tumor by diagnostic work-up. Since the lesion was considered unresectable at the time of the diagnosis, the patient underwent to Xeloda and oxaliplatin neoadjuvant chemotherapy, with progressive reduction in size of the mass as a sign of good response to therapy.
European Journal of Radiology, May 1, 2018
Critical Reviews in Oncology Hematology, Oct 1, 2020
In recent years the concept of precision medicine has become a popular topic particularly in medi... more In recent years the concept of precision medicine has become a popular topic particularly in medical oncology. Besides the identification of new molecular prognostic and predictive biomarkers and the development of new targeted and immunotherapeutic drugs, imaging has started to play a central role in this new era. Terms such as "radiomics", "radiogenomics" or "radi…-omics" are becoming increasingly common in the literature and soon they will represent an integral part of clinical practice. The use of artificial intelligence, imaging and "-omics" data can be used to develop models able to predict, for example, the features of the tumor immune microenvironment through imaging, and to monitor the therapeutic response beyond the standard radiological criteria. The aims of this narrative review are to provide a simplified guide for clinicians to these concepts, and to summarize the existing evidence on radiomics and "radi…-omics" in cancer immunotherapy.
Abdominal Imaging, Aug 1, 2017
Diagnostics, Mar 10, 2022
We map single energy CT (SECT) scans to synthetic dual-energy CT (synth-DECT) material density io... more We map single energy CT (SECT) scans to synthetic dual-energy CT (synth-DECT) material density iodine (MDI) scans using deep learning (DL) and demonstrate their value for liver segmentation. A 2D pix2pix (P2P) network was trained on 100 abdominal DECT scans to infer synth-DECT MDI scans from SECT scans. The source and target domain were paired with DECT monochromatic 70 keV and MDI scans. The trained P2P algorithm then transformed 140 public SECT scans to synth-DECT scans. We split 131 scans into 60% train, 20% tune, and 20% held-out test to train four existing liver segmentation frameworks. The remaining nine low-dose SECT scans tested system generalization. Segmentation accuracy was measured with the dice coefficient (DSC). The DSC per slice was computed to identify sources of error. With synth-DECT (and SECT) scans, an average DSC score of 0.93 ± 0.06 (0.89 ± 0.01) and 0.89 ± 0.01 (0.81 ± 0.02) was achieved on the held-out and generalization test sets. Synth-DECT-trained systems required less data to perform as well as SECT-trained systems. Low DSC scores were primarily observed around the scan margin or due to non-liver tissue or distortions within ground-truth annotations. In general, training with synth-DECT scans resulted in improved segmentation performance with less data.
European Journal of Nuclear Medicine and Molecular Imaging, Oct 16, 2019
Background In the last years, functional imaging has given a significant contribution to the clin... more Background In the last years, functional imaging has given a significant contribution to the clinical decision-making of biochemically relapsed prostate cancer (PCa). Hereby, we present a prospective study aiming to validate the role of [ 18 F]Fluoro-Methyl Choline ([ 18 F]FMCH) PET/CT in the selection of PCa patients suitable for stereotactic body radiotherapy (SBRT). Methods Patients with biochemical recurrence limited up to three lesions revealed by [ 18 F]FMCH PET/CT were enrolled in the present study and treated with SBRT on all active lesions. Systemic therapy-free survival since the [ 18 F]FMCH PET/CT was considered as the primary endpoint. Results Forty-six patients were evaluated, and a total of 67 lesions were treated. After a median follow-up of 28.9 months, systemic therapy was started in 30 patients (65.2%) and median systemic therapy-free survival was 39.1 months (95% CI 6.5-68.6); 6, 12, and 24-month ratios were 93.5%, 73.9%, and 63.1%, respectively. At univariate Cox regression analysis, Delta PSA demonstrated an impact on systemic therapy-free survival (p < 0.001). Conclusions Based on our findings, [ 18 F]FMCH PET/CT can identify oligometastatic prostate cancer patients suitable for SBRT, resulting in a systemic therapy-free survival of 39.1 months.
Clinical Nuclear Medicine, 2016
Journal of Computer Assisted Tomography, 2018
Objective-To evaluate the accuracy of single-source dual-energy CT (ssDECT) in iodine quantificat... more Objective-To evaluate the accuracy of single-source dual-energy CT (ssDECT) in iodine quantification using various segmentation methods in an ex-vivo model. Methods-Ten sausages, injected with variable quantities of iodinated contrast, were inserted into two livers and scanned with ssDECT. Material density iodine (MDI) images were reconstructed. Three radiologists segmented each sausage. Iodine concentration, volume and absolute quantity were measured. Agreement between the measured and injected iodine was assessed with the concordance correlation coefficient (CCC). Intra-reader agreement was assessed using the intraclass correlation coefficient (ICC). Results-Air bubbles were observed in sausage (IX). Sausage (X) was within the same view as hyper-attenuating markers used for localization. With IX and X excluded, CCC and ICC were > 0.98 and > 0.88. When included, CCC and ICC were > 0.94 and > 0.79. Conclusions-Iodine quantification was reproducible and precise. However, accuracy reduced in sausages consisting of air filled cavities and within the same view as hyper-attenuating markers.
Nuclear Medicine Communications, Apr 1, 2017
Objective-Determine if second opinion reviews of PET/CT examinations by subspecialists alters rep... more Objective-Determine if second opinion reviews of PET/CT examinations by subspecialists alters reporting of malignant findings. Methods-This IRB-approved study compared 240 FDG PET/CT consecutively dictated reports by two nuclear medicine subspecialists against the original outside institution reports. Subspecialist reviews documented if malignant findings on the outside report were malignant, and noted additional malignant findings not described on the outside report. Final diagnosis of malignancy or benignity was determined by pathology when available, otherwise by imaging follow-up. Results-22 findings (in 20 reports) called suspicious/malignant on the outside reports were deemed benign by subspecialist review. A final diagnosis was available for 20 of 22 findings by pathology (3) or follow-up imaging (17). The subspecialist review was accurate in 20 of 20 (100%) cases where a final diagnosis was available. The subspecialist review called 11 findings (in 11 reports) suspicious/malignant that were not described or deemed benign on the outside reports. Definitive diagnosis was available for 10 of 11 findings by pathology (7) or follow-up imaging (3). The second opinion report was accurate in 7 of 10 (70%) cases where a final diagnosis was available. Conclusions-In 31 of 240 (13%) FDG PET/CT examinations performed at an outside institution, subspecialist review resulted in at least one discordant opinion of malignancy. For 28 discrepant cases where a final diagnosis was available, the subspecialist review defined malignancy or benignity correctly in 25 of 28 (89%) cases. This provides evidence for cost and effort invested in performing second opinion reviews of PET/CT studies.
Clinical Nuclear Medicine, Nov 1, 2017
A previously healthy 4 year-old-female, presented with petechial rash and low platelet count. No ... more A previously healthy 4 year-old-female, presented with petechial rash and low platelet count. No other symptoms. On abdominal ultrasound a 4.7 cm heterogeneous mass was demonstrated anterior to the left kidney. An abdominal MRI subsequently performed demonstrated a heterogeneously enhancing mass at the same location extending to the pancreas and spleen. A surgical biopsy of the mass was obtained. Pathology reported a malignant epithelioid neoplasm consistent with pancreatoblastoma. The mass demonstrated intense FDG uptake on PET and an FDG avid retrocaval lymph node.
Diagnostic and interventional imaging, Dec 1, 2016
Cystic pancreatic lesions vary from benign to malignant entities and are increasingly detected on... more Cystic pancreatic lesions vary from benign to malignant entities and are increasingly detected on cross-sectional imaging. Knowledge of the imaging appearances of cystic pancreatic lesions may help radiologists in their diagnostic reporting and management. In this review, we discuss the morphologic classification of these lesions based on a diagnostic algorithm as well as the management of these lesions. Cyst; Pancreas; MRI; IPMN Recently, multiple technological advances in imaging have significantly increased the detection and characterization of pancreatic cystic lesions . With this increased sensitivity, comes the challenge of managing incidentally discovered pancreatic cystic lesions. While solid pancreatic tumors are almost invariably treated surgically, cystic lesions are currently most problematic. Indeed, the differential diagnosis of these cystic lesions ranges from benign (pseudocysts, serous cystadenomas) to potentially or frankly malignant lesions (intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, cystic neuroendocrine tumors) . To help patient's treatment and follow-up stratification, several professional societies have proposed guidelines for the management of cystic pancreatic lesion . In this review, we discuss the morphologic classification of cystic pancreatic lesions based on a diagnostic algorithm as well as the management of these lesions.
Frontiers in Digital Health
Artificial intelligence (AI) has been successful at solving numerous problems in machine percepti... more Artificial intelligence (AI) has been successful at solving numerous problems in machine perception. In radiology, AI systems are rapidly evolving and show progress in guiding treatment decisions, diagnosing, localizing disease on medical images, and improving radiologists' efficiency. A critical component to deploying AI in radiology is to gain confidence in a developed system's efficacy and safety. The current gold standard approach is to conduct an analytical validation of performance on a generalization dataset from one or more institutions, followed by a clinical validation study of the system's efficacy during deployment. Clinical validation studies are time-consuming, and best practices dictate limited re-use of analytical validation data, so it is ideal to know ahead of time if a system is likely to fail analytical or clinical validation. In this paper, we describe a series of sanity tests to identify when a system performs well on development data for the wrong ...
Insights into Imaging, 2022
As of September 18th, 2021, global casualties due to COVID-19 infections approach 200 million, se... more As of September 18th, 2021, global casualties due to COVID-19 infections approach 200 million, several COVID-19 vaccines have been authorized to prevent COVID-19 infection and help mitigate the spread of the virus. Despite the vast majority having safely received vaccination against SARS-COV-2, the rare complications following COVID-19 vaccination have often been life-threatening or fatal. The mechanisms underlying (multi) organ complications are associated with COVID-19, either through direct viral damage or from host immune response (i.e., cytokine storm). The purpose of this manuscript is to review the role of imaging in identifying and elucidating multiorgan complications following SARS-COV-2 vaccination—making clear that, in any case, they represent a minute fraction of those in the general population who have been vaccinated. The authors are both staunch supporters of COVID-19 vaccination and vaccinated themselves as well.
Clinical Reviews in Allergy & Immunology, 2022
The cardiovascular system is frequently affected by coronavirus disease-19 , particularly in hosp... more The cardiovascular system is frequently affected by coronavirus disease-19 , particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
Dose-Response, 2021
Introduction. Intracranial epidermoid cysts are the most frequent congenital intracranial lesion.... more Introduction. Intracranial epidermoid cysts are the most frequent congenital intracranial lesion. They rare and benign tumors that can present in different clinical situations depending on location and extension of the disease. Diagnosis is obtained with radiological imaging with RM and non-enhanced TC as elective investigating methods. Elective treatment is surgery, based on total/subtotal excision sparring healthy neurovascular structures, considering the benign nature of this lesion. Case Report. In this study we present the case of a 79-year-old woman affected by recidivist epidermal cyst of the posterior fossa. Clinical presentation was characterized by positional subjective vertigo, intense headache localized in the right part of the head increased by Valsalva maneuver and retroarticular subcutaneous swelling. Radiological investigation found a giant epidemoid cyst of the posterior fossa (8,4 x 4,8 x 5,8 cm), treated with surgery. In the postoperative, the patient was fine and...
Neuroradiology, 2021
Purpose The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognit... more Purpose The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognition and resting-state functional magnetic resonance imaging (rs-fMRI) using the Amplitude of Low Frequency Fluctuations (ALFF) technique. Methods In this observational study, patients eligible for CEA were prospectively included. On the same day, within 1 week of the CEA procedure performed and 12 months after the CEA procedure, all patients underwent (i) an MRI examination for rs-fMRI analysis and (ii) a cognitive evaluation using the Italian version of the Mini-Mental State Examination (MMSE) corrected for age and schooling. Pre-CEA and post-CEA MMSE scores were evaluated using paired sample t-tests, adopting a p-value
Dose-Response, 2020
Purpose: The progression of the otitic infectious process toward diseases of particular severity ... more Purpose: The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the possible severe complications. Methods: We conducted a retrospective study of 13 cases of basal cranial osteomyelitis (SBO) due to malignant external otitis, by the ENT Department of the University of Catania. Through a standardized approach and following the latest guidelines, we have evaluated all patients performing a standardized and personalized radiological protocol according to the stage of the patient’s pathology and modulating the treatment consequently. Results: Clinical signs have been observed such as otorrhea (100%), otalgia in 13/13 patients (100%), granulations in external auditory canal (100%), preauricular cellulitis in 9/13...