Emanuele Nicolai - Academia.edu (original) (raw)

Papers by Emanuele Nicolai

Circulation, 1981

Acromegaly is associated with increased cardiac morbidity and mortality, but it is not clear whet... more Acromegaly is associated with increased cardiac morbidity and mortality, but it is not clear whether this is the result of a specific disease of heart muscle or of increased incidence of hyperten sion. Methods: Twenty-six patients with acromegaly (11 male and 15 female, mean age 45 Â±13 yr) and 15 and 12 age-and sex-matched normal controls underwent high temporal resolu tion radionuclide angiography and two-dimensional echocardiography at rest. Results: Normal controls and patients with acromegaly did not differ with respect to heart rate, ejection fraction, time to end systole, peak ejection rate (PER) and time to PER. In contrast, peak filling rate (PFR), normalized to end diastolic volume (EDV), or stroke volume (SV), or expressed as the ratio of PFR-to-PER was reduced (p < 0.01), time to PFR (TPFR) was prolonged (p < 0.01), and echocardiographic left ventricular mass index was higher (p < 0.001) in patients with acromegaly compared to normals. Patients with acromegaly were divided in normotensives (group 1, n = 17) and hyperten sives (group 2, n = 9). Although left ventricular mass index was significantly (p < 0.01) higher in group 2 compared to group 1, PFR and time to PFR were not different between the two groups of acromegalie patients. In the entire group of patients with acromegaly significant relationships between left ventricular mass index and EDV/s (r = -0.56, p < 0.01), SV/s (r = -0.73, p < 0.001), and PFR/PER (r = -0.61, p < 0.001) were ob served. Conclusion: Patients with acromegaly have impaired left ventricular diastolic filling at rest related to greater left ven tricular mass index even in the absence of systemic hyperten sion.

The Journal of Rheumatology

To characterize the clinical pattern of early psoriatic arthritis (PsA). We studied 47 consecutiv... more To characterize the clinical pattern of early psoriatic arthritis (PsA). We studied 47 consecutive patients: 29 had definite PsA and 18 had the "sine psoriasis" subset. Inclusion criteria were articular and/or entheseal involvement of < or =12 weeks' duration and the exclusive use, before enrollment, of nonsteroidal antiinflammatory drugs to control articular symptoms. All patients underwent clinical examination, blood tests, total-body bone scintigraphy, articular ultrasonography, and radiography of clinically involved joints and/or entheses. On the basis of clinical examination, early PsA was an oligo-enthesoarthritis in over 75% of patients studied. In contrast, the number of joints and/or entheses showing increased tracer uptake on bone scintigraphy was 3 times greater, compared to the clinical evidence (p < 0.001). Articular ultrasonography confirmed the inflammatory involvement of synovium and/or entheses in all articular sites active at time of bone scinti...

NeuroImage, 2015

Recently introduced hybrid PET/MR scanners provide the opportunity to measure simultaneously, and... more Recently introduced hybrid PET/MR scanners provide the opportunity to measure simultaneously, and in direct spatial correspondence, both metabolic demand and functional activity of the brain, hence capturing complementary information on the brain's physiological state. Here we exploited PET/MR simultaneous imaging to explore the relationship between the metabolic information provided by resting-state fluorodeoxyglucose-PET (FDG-PET) and fMRI (rs-fMRI) in neurologically healthy subjects. Regional Homogeneity (ReHo), Fractional Amplitude of Low Frequency Fluctuations (fALFF), and Degree of Centrality (DC) maps were generated from the rs-fMRI data in 23 subjects, and voxel-wise comparison to glucose uptake distribution provided by simultaneously acquired FDG-PET was performed. The mutual relationships among each couple of these four metrics were explored in terms of similarity, both of spatial distribution across the brain and the whole group, and voxel-wise across subjects, taking into account partial volume effects by adjusting for gray matter (GM) volume. Although a significant correlation between the spatial distribution of glucose uptake and rs-fMRI derived metrics was present, only a limited percentage of GM voxels correlated with PET across subjects. Moreover, the correlation between the spatial distributions of PET and RS-fMRI-derived metrics is spatially heterogeneous across both anatomic regions and functional networks, with lowest correlation strength in the limbic network (Spearman rho around -0.11 for DC), and strongest correlation for the default-mode network (up to 0.89 for ReHo and 0.86 for fALFF). Overall, ReHo and fALFF provided significantly higher correlation coefficients with PET (p=10 -8 and 10 -7 , respectively) as compared to DC, while no significant differences were present between ReHo and fALFF. Local GM volume variations introduced a limited overestimation of the rs-fMRI to FDG correlation between the modalities under investigation through partial volume effects. These novel results provide the basis for future studies of alterations of the coupling between brain metabolism and functional connectivity in pathologic conditions.

We studied 19 patients with angiographically proven coronary artery disease and left ventricular ... more We studied 19 patients with angiographically proven coronary artery disease and left ventricular dysfunction (ejection fraction 33% + 8%) by resting technetium-99m methoxyisobutylisonitrile (99rrrFc-MIBI) and rest-redistribution thallium-201 cardiac imaging. Thallium and 99rrTc-MIBI studies were visually analysed. Of 285 segments, 203 (71%) had normal thallium uptake, 48 (17%) showed reversible thallium defects and 34 (12%) showed irreversible thallium defects. Of these 34 irreversible thallium defects, 19 (56%) were moderate and 15 (44%) were severe. Of the corresponding 285 segments, 200 (70%) had normal 99mTc-MIBI uptake, while 37 (13%) showed moderate and 48 (17%) showed severe reduction of 99mTc-MIBI uptake. Myocardial segmental agreement for regional uptake score between initial thallium and resting 99~-Fc-MIBI images was 90% (~:=0.78). Segmental agreement between delayed thallium and resting 99~I?c-MIBI images was 77% 0c=0.44). In particular, in 26 (9%) segments 99rrrl?c-MIBI uptake was severely reduced while delayed thallium uptake was normal or only moderately reduced. These data suggest that although rest-redistribution thallium and resting 99nTc-MIBI cardiac imaging provide concordant results in the majority of myocardial segments, some segments with severely reduced resting 99n'Tc-MIBI uptake may contain viable but hypoperfused myocardium. Thus, conclusions on myocardial viability based on 99mTc-MIBI uptake should be made with caution in chronic coronary artery disease.

Exercise and dipyridamole 99mTc-labeled methoxy isobutyl isonitrile (MIBI) myocardial scintigraph... more Exercise and dipyridamole 99mTc-labeled methoxy isobutyl isonitrile (MIBI) myocardial scintigraphy have been widely used for the diagnosis of coronary artery disease (CAD). However, only limited data on adenosine 99mTc-labeled MIBI cardiac imaging are currently available. This study was designed to assess the accuracy of quantitative adenosine-rest 99mTc-labeled MIBI tomography in the diagnosis and localization of CAD. Fifty-seven consecutive patients with suspected CAD who underwent coronary angiography and 22 normal volunteers were studied. All patients underwent 99mTc-labeled MIBI tomography after administration of adenosine (140 micrograms/kg intravenously for 6 minutes) and at rest. A total of 171 vascular coronary territories were analyzed quantitatively. All patients with CAD (&amp;gt; or = 50% luminal stenosis) (n = 55) had abnormal 99mTc-labeled MIBI tomograms. The normalcy rate was 86% by quantitative analysis. Overall sensitivity, specificity, and diagnostic accuracy for detection of individual stenosed vessels were 84%, 87%, and 85%, respectively. In patients with one-vessel CAD (n = 24), sensitivity and diagnostic accuracy in the detection of individual stenosed vessels were significantly (p &amp;lt; 0.05) higher compared with patients with multivessel CAD (n = 31). Moreover, 75% of patients with one-vessel disease showed a scintigraphic pattern characterized by the presence of perfusion defects in only one coronary artery territory, and 74% of patients with multivessel disease showed a scintigraphic pattern characterized by the presence of perfusion defects in two or more coronary artery territories. Sensitivity, specificity, and diagnostic accuracy for detecting individual diseased vessels were similar in patients without previous myocardial infarction (n = 18) compared with those with previous myocardial infarction (n = 39). In myocardial territories related to noninfarcted areas (n = 124), sensitivity and specificity in the detection of stenosed vessels were 75% and 88%. In infarcted areas (n = 47), sensitivity and specificity in the detection of stenosed vessels were 98% and 80% (differences not significant vs noninfarcted areas). Adenosine-controlled coronary vasodilation combined with quantitative 99mTc-labeled MIBI tomography is accurate for identifying patients with CAD and localizing individual stenosed coronary arteries.

Journal of Nuclear Cardiology, 2000

Background This study was designed to compare the results of rest-redistribution thallium-201 im... more Background This study was designed to compare the results of rest-redistribution thallium-201 imaging with those of rest technetium 99m furifosmin single photon emission computed tomography in the same patients with chronic ischemic left ventricular (LV) dysfunction. Methods Twenty-one patients (mean age 62±9 years) with chronic myocardial infarction and LV dysfunction (mean LV ejection fraction 34%±8%) underwent rest-redistribution thallium imaging and resting furifosmin

88%) and 17 had abnormal echocardiographic study (sensitivity 68%, p < 0.05 versus 99mTc-tetro... more 88%) and 17 had abnormal echocardiographic study (sensitivity 68%, p < 0.05 versus 99mTc-tetrofosmin).Agreement for the iden tification of patients with CAD between adenosine 99mTc-tetrofos- min tomography and echocardiography was observed in 21 (81%) of the total 26 patients, with a kappa value of 0.45. Overall sensitivity, specificity and diagnostic accuracy for detection of individual ste nosed vessels were 79%, 88% and 83% for ""Tc tetrofosmin and 57%, 68% and 61% (all p < 0.05 versus ""Tc-tetrofosmin) for echocardiography. Concordance between adenosine 99rnTc-tetro- fosmin tomography and echocardiography in the detection of indi vidual stenosed coronary vessels was observed in 57 (73%) of the 78 vascular territories, with a kappa value of 0.36. Conclusion: Adenosine-induced coronary vasodilation associated with quantita tive ""Tc-tetrofosmin tomography is more accurate than adeno

PLoS ONE, 2014

Spinocerebellar ataxia type 2 (SCA2) is the second most frequent autosomal dominant inherited ata... more Spinocerebellar ataxia type 2 (SCA2) is the second most frequent autosomal dominant inherited ataxia worldwide. We investigated the capability of magnetic resonance imaging (MRI) to track in vivo progression of brain atrophy in SCA2 by examining twice 10 SCA2 patients (mean interval 3.6 years) and 16 age-and gender-matched healthy controls (mean interval 3.3 years) on the same 1.5 T MRI scanner. We used T1-weighted images and tensor-based morphometry (TBM) to investigate volume changes and the Inherited Ataxia Clinical Rating Scale to assess the clinical deficit. With respect to controls, SCA2 patients showed significant higher atrophy rates in the midbrain, including substantia nigra, basis pontis, middle cerebellar peduncles and posterior medulla corresponding to the gracilis and cuneatus tracts and nuclei, cerebellar white matter (WM) and cortical gray matter (GM) in the inferior portions of the cerebellar hemisphers. No differences in WM or GM volume loss were observed in the supratentorial compartment. TBM findings did not correlate with modifications of the neurological deficit. In conclusion, MRI volumetry using TBM is capable of demonstrating the progression of pontocerebellar atrophy in SCA2, supporting a possible role of MRI as biomarker in future trials. Citation: Mascalchi M, Diciotti S, Giannelli M, Ginestroni A, Soricelli A, et al. (2014) Progression of Brain Atrophy in Spinocerebellar Ataxia Type 2: A Longitudinal Tensor-Based Morphometry Study. PLoS ONE 9(2): e89410.

Leukemia & Lymphoma, 2007

This study aimed at evaluating the role of consolidation radiation in a setting of Hodgkin&am... more This study aimed at evaluating the role of consolidation radiation in a setting of Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lymphoma (HL) patients, using event-free survival (EFS) as end point. Among 260 patients treated with induction chemotherapy for bulky HL, 160 patients achieved negative residual masses at 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) scans. They were randomly divided into two well-matched groups to receive either 32 Gy radiotherapy to bulky area or no further therapy. At a median follow-up of 40 months, histology showed a malignancy in 14% of patients in the chemotherapy-only group (HL, 11 patients) and in 4% of patients in the chemotherapy + radiotherapy group (HL, 2 patients; carcinoma in previously irradiated area, 1 patient) (P = 0.03). All the relapses in the chemotherapy-only group involved the bulky site and the contiguous nodal regions. Thus, the overall diagnostic accuracy of FDG-PET to exclude future relapses in the patients nonprotected by radiotherapy was 86% with a false-negative rate of 14%. Our study suggests that the addition of irradiation helps improve EFS in HL patients with post-chemotherapy FDG-PET-negative residual masses.

Journal of Nuclear Cardiology, 1995

Journal of Nuclear Cardiology - J NUCLEAR CARDIOLOGY, 2000

Background This study was designed to determine the most effective quantitative threshold for th... more Background This study was designed to determine the most effective quantitative threshold for thallium-201 and technetium 99m sestamibi uptake on tomographic imaging after rest injection for the detection of myocardial viability in patients with chronic myocardial infarction. Methods and Results Thallium and sestamibi cardiac tomography at rest was performed in 43 patients with chronic myocardial infarction and impaired left ventricular (LV) function undergoing coronary revascularization. In all patients, echocardiography and radionuclide angiography were performed at baseline and repeated 12 months later to evaluate recovery of regional LV function and LV ejection fraction, respectively. Optimal threshold cutoff points to separate reversible from irreversible dysfunction were determined by receiver operating characteristic analysis. When all dysfunctional segments were considered, the best cutoff point in the identification of reversible LV dysfunction for both thallium and sesta...

Journal of Nuclear Cardiology, 1996

Pharmacologic coronary vasodilation with adenosine, combined with myocardial scintigraphy, is a u... more Pharmacologic coronary vasodilation with adenosine, combined with myocardial scintigraphy, is a useful test for the diagnosis of coronary artery disease (CAD) in patients unable to exercise. It has been demonstrated recently that exercise 99mTc-labeled tetrofosmin cardiac imaging can be used for the detection of CAD. However, no data are available comparing 99mTc-labeled tetrofosmin adenosine and exercise tests in the same patients. The results of adenosine and exercise 99mTc-labeled tetrofosmin myocardial tomography were compared in 41 patients (37 men and four women; mean age 53 +/- 8 years) with suspected or known CAD who underwent coronary angiography. All patients were submitted, on separate days, to three injections of 99mTc-labeled tetrofosmin (740 MBq intravenously): one at rest, one during bicycle exercise, and one during adenosine infusion (140 micrograms/kg/min for 6 minutes with injection of 99mTc-labeled tetrofosmin at 4 minutes). A total of 902 myocardial segments were analyzed quantitatively. One patient had normal coronary vessels, 19 patients had single-vessel CAD, 12 patients had two-vessel CAD, and nine patients had three-vessel CAD (&amp;gt; 50% coronary stenosis) on coronary angiography. Adenosine induced a significant increase in heart rate (88 +/- 16 beats/min at peak vs 72 +/- 11 beats/min at rest; p &amp;lt; 0.01). Systolic and diastolic blood pressure was not significantly different after adenosine infusion compared with rest. Double product was 22931 +/- 7039 at peak exercise and 11229 +/- 3413 after adenosine (p &amp;lt; 0.01). Agreement on the presence of abnormal single-photon emission computed tomography by adenosine and exercise was 100% by quantitative analysis. In all segments a significant relationship between exercise and adenosine 99mTc-99m-labeled tetrofosmin uptake was observed (r = 0.90; p &amp;lt; 0.001). Segmental agreement for regional 99mTc-labeled tetrofosmin uptake score between exercise and adenosine was observed in 737 (82%) of the 902 segments (kappa value of 0.66). Concordance between the two studies for identification of perfusion status was observed in 809 (90%) of the segments (kappa value of 0.80). Sensitivity and specificity for detection of stenosed vessels were not different for dynamic exercise stress testing and adenosine 99mTc-labeled tetrofosmin cardiac tomography. Despite different hemodynamic effects, adenosine and dynamic exercise 99mTc-labeled tetrofosmin single-photon emission computed tomographic imaging provides similar information in the diagnosis and localization of CAD.

Acromegalic patients are considered to be exposed to a doubled mortality rate, mostly for cardiov... more Acromegalic patients are considered to be exposed to a doubled mortality rate, mostly for cardiovascular diseases. This open prospec- tive study was designed to evaluate whether the impairment of car- diac performance could be reversed by the long-term suppression of GH and insulin-like growth factor I (IGF-I) levels. Eighteen patients with active acromegaly were studied before and 5 yr after surgery, followed by sc octreotide in 11 patients. Disease control (GH levels #1 mg/L after glucose load or #2.5 mg/L after fasting, respectively, together with normalized IGF-I levels for age) was achieved in seven patients after surgery and in six patients after 0.3- 0.6 mg/day sc octreotide. Five patients were not controlled during the 5-yr follow-up. Cardiac performance at rest and at peak exercise was assessed by equilibrium radionuclide angiography at study entry and 5 yr after surgery alone or plus octreotide. Thirty-six sex- and age-matched healthy subjects served as controls. At study ...

Gastroenterology, 2013

See Covering the Cover synopsis on page 493; see editorial on page 500.

European Journal of Nuclear Medicine, 1994

European Journal of Nuclear Medicine, 1992

The accuracy and repeatability of a new ambulatory radionuclide detector (VEST) for left ventricu... more The accuracy and repeatability of a new ambulatory radionuclide detector (VEST) for left ventricular systolic (ejection fraction) and diastolic (peak filling rate) measurements were assessed. Seventeen patients underwent equilibrium radionuclide angiography immediately before and immediately after a VEST study. The accuracy was evaluated at the beginning and at the end of the VEST studies. Limits of agreement for the ejection fraction were -1%:2% at the beginning of the VEST study and -4%:4% at the end. Limits of agreement for the peak filling rate were -0.6:0.6 at the beginning of the VEST study and -0.7:0.5 at the end. For both measurements the limits of agreement were well within the clinical range. Repeatability was evaluated in a second group of 11 patients who underwent VEST studies in 2 separate days. The coefficient of repeatability (twice the standard deviation of the differences between the 2 studies) was 13 for the ejection fraction and 0.4 for the peak filling rate. Thus, the VEST is an accurate and repeatable method to measure both the ejection fraction and peak filling rate.

European Journal of Nuclear Medicine - EUR J NUCL MED, 1995

The results of resting planar ECG-gated technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) ima... more The results of resting planar ECG-gated technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) imaging were compared with those of thallium-201 (TI) reinjection after exercise-redistribution scintigraphy in 20 patients (19 men, 1 woman, mean age 53±10 years) with angiographically proven coronary artery disease. Eight normal subjects (seven men, one woman, mean age 50±8 years) constituted the control group. In these subjects, only resting99mTc-MIBI imaging was performed. The standardized percent count increase from end-diastole to end-systole was calculated as an index of wall thickening in 13 segments for each study. Regional wall thickening index (WTI) and99mTc-MIBI uptake were significantly different (P99mTc-MIBI uptake were significantly higher (PPPP99mTc-MIBI regional wall thickening, myocardial perfusion and TI uptake after reinjection. The results of this study suggest that regional WTI decreased significantly as myocardial perfusion decreased. In addition, regional wall thicke...

European Journal of Gastroenterology & Hepatology, 2002

Objective The effects of carbonated beverages on the gastrointestinal tract have been poorly inve... more Objective The effects of carbonated beverages on the gastrointestinal tract have been poorly investigated. Therefore, this study aims to assess the effect of carbonated water intake in patients with functional dyspepsia and constipation.