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Papers by roberto mucelli
La radiologia medica, 2012
The book Ultrasonography of the Pancreas represents the state of the art in this field and is the... more The book Ultrasonography of the Pancreas represents the state of the art in this field and is the result of the contribution of a group of authors of internationally renowned authors and, primarily, of the editor.
Radiologic Clinics of North America, 2012
Although the pancreas is often thought of as an organ that is difficult to explore using ultrasou... more Although the pancreas is often thought of as an organ that is difficult to explore using ultrasound (US), because of its deep retroperitoneal location, with the appropriate technique it can be studied successfully in most patients. In this article, the authors discuss the use of available US techniques in the diagnosis of the most common pancreatic diseases, the use of US intraoperatively, and the use of sonographic guidance for diagnostic and therapeutic procedures. The authors also briefly discuss the potential use of elastosonography techniques in the evaluation of pancreatic disease.
European Radiology, 2014
To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of f... more To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis. MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement. Signal intensity abnormalities were localized in the head in 10/26 (38.5%) and in the body-tail in 16/26 (61.5%) patients. MRCP showed a single MPD stenosis in 12/26 (46.1%) and multiple MPD stenosis in 14/26 (53.8%) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6%) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2%) patients with contrast retention. MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma. • MRI represents the gold standard in the diagnosis of AIP. • MRCP is an increasingly useful technique in the diagnosis of focal AIP. • MRCP could be a problem-solving tool in the differential diagnosis of AIP.
MRI of the Female and Male Pelvis, 2014
MRI of the Female and Male Pelvis, 2014
La radiologia medica, 2013
Three separate venous systems drain the blood returning from the heart walls. These veins are cha... more Three separate venous systems drain the blood returning from the heart walls. These veins are characterised by remarkable variability in terms of frequency, size and course. The knowledge of cardiac venous anatomy is of primary importance during interventional cardiac procedures that require catheterisation of cardiac veins. Some anatomical variants may hinder or contraindicate access to target veins. Coronary angiography (CA) with multidetector computed tomography (MDCT-CA) and multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D reconstructions provides noninvasive visualisation of normal cardiac veins and anatomical variants. The purpose of this pictorial review is to describe by MDCT-CA the anatomy and main variants of the cardiac venous system.
European Radiology, 2014
Purpose To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs help... more Purpose To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs helpful in the differential diagnosis between serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs), arising from the body/tail of the pancreas. Material and methods This retrospective study had institutional review board approval and informed consent was waived. Fifty-three patients with non-communicating cystic pancreatic neoplasm of the body/tail, undergoing MR/MRCP, were included. Qualitative image analysis assessed the macroscopic pattern, number of cysts, presence of central scar, contrast enhancement of peripheral wall, and mural nodules. Quantitative analysis assessed the maximum diameter of the neoplasm, thickness of the peripheral wall, and calibre of the upstream main pancreatic duct. Results Histopathology results revealed that 27/53 (51 %) were SCAs, 26/53 (49 %) were MCNs. Microcystic pattern was observed in 88.2 % of SCAs and 11.8 % of MCNs; macrocystic pattern was observed in 90.5 % of MCNs and 9.5 % of SCAs (p<0.0001). Central scar was detected in 29.6 % of SCAs and no MCNs (p=0.003). Contrast enhancement of the peripheral wall was evident in 99.5 % of MCNs and 11.5 % of SCAs (p<0.0001); mural nodules were depicted in 94.1 % of MCNs and 5.9 % of SCAs (p<0.0001). Median maximum diameter was 54 mm for MCNs, 32 mm for SCAs (p=0.001); median wall thickness was 4 mm for MCNs, 2 mm for SCAs (p<0.0001). Conclusions Macrocystic pattern, enhancement of a peripheral wall and mural nodules are suggestive of MCNs; whereas microcystic pattern, lack of peripheral wall and central scar are suggestive of SCAs. Key Points • MCNs have macrocystic patterns, contrast enhancement of the peripheral wall and mural nodules • Microcystic pattern and central scar are suggestive of SCA • Mural nodules detected in MCNs correlate with epithelial dysplasia • Chronic obstructive pancreatitis is equally depicted in patients with MCNs and SCAs
La radiologia medica, 2013
This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary a... more This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup. Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary). Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol. The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.
Medical Radiology, 2009
ABSTRACT Pseudocysts are fluid filled masses with a wall made of inflammatory and fibrotic tissue... more ABSTRACT Pseudocysts are fluid filled masses with a wall made of inflammatory and fibrotic tissue rather than a true epithelial lining. They develop from a fluid collection following a pancreatic injury and are circumscribed by a pseudo-capsule (Fig. 15.1) (Hammond et al. 2002; Kim et al. 2005). Fig. 15.1. Contrast enhanced CT (CECT), portal phase, axial plane: typical pseudocyst following acute pancreatitis. The lesion is characterized by homogenous fluid content and thin pseudocapsule
Magnetic Resonance Cholangiopancreatography (MRCP), 2013
Magnetic Resonance Cholangiopancreatography (MRCP), 2013
Magnetic Resonance Cholangiopancreatography (MRCP), 2013
MRI of the Female and Male Pelvis, 2014
MRI of the Female and Male Pelvis, 2014
Inflammatory Bowel Disease and Familial Adenomatous Polyposis, 2006
ABSTRACT
Clinical MRI of the Abdomen, 2009
Clinical MRI of the Abdomen, 2009
Abdominal Imaging, 2013
ABSTRACT Ultrasound is the first modality used in the evaluation of pancreatic disease. The pancr... more ABSTRACT Ultrasound is the first modality used in the evaluation of pancreatic disease. The pancreas can be visualized at US in most patients, independent of gastrointestinal gas interference and fat.
La radiologia medica, 2009
La radiologia medica, 2012
The book Ultrasonography of the Pancreas represents the state of the art in this field and is the... more The book Ultrasonography of the Pancreas represents the state of the art in this field and is the result of the contribution of a group of authors of internationally renowned authors and, primarily, of the editor.
Radiologic Clinics of North America, 2012
Although the pancreas is often thought of as an organ that is difficult to explore using ultrasou... more Although the pancreas is often thought of as an organ that is difficult to explore using ultrasound (US), because of its deep retroperitoneal location, with the appropriate technique it can be studied successfully in most patients. In this article, the authors discuss the use of available US techniques in the diagnosis of the most common pancreatic diseases, the use of US intraoperatively, and the use of sonographic guidance for diagnostic and therapeutic procedures. The authors also briefly discuss the potential use of elastosonography techniques in the evaluation of pancreatic disease.
European Radiology, 2014
To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of f... more To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis. MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement. Signal intensity abnormalities were localized in the head in 10/26 (38.5%) and in the body-tail in 16/26 (61.5%) patients. MRCP showed a single MPD stenosis in 12/26 (46.1%) and multiple MPD stenosis in 14/26 (53.8%) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6%) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2%) patients with contrast retention. MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma. • MRI represents the gold standard in the diagnosis of AIP. • MRCP is an increasingly useful technique in the diagnosis of focal AIP. • MRCP could be a problem-solving tool in the differential diagnosis of AIP.
MRI of the Female and Male Pelvis, 2014
MRI of the Female and Male Pelvis, 2014
La radiologia medica, 2013
Three separate venous systems drain the blood returning from the heart walls. These veins are cha... more Three separate venous systems drain the blood returning from the heart walls. These veins are characterised by remarkable variability in terms of frequency, size and course. The knowledge of cardiac venous anatomy is of primary importance during interventional cardiac procedures that require catheterisation of cardiac veins. Some anatomical variants may hinder or contraindicate access to target veins. Coronary angiography (CA) with multidetector computed tomography (MDCT-CA) and multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D reconstructions provides noninvasive visualisation of normal cardiac veins and anatomical variants. The purpose of this pictorial review is to describe by MDCT-CA the anatomy and main variants of the cardiac venous system.
European Radiology, 2014
Purpose To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs help... more Purpose To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs helpful in the differential diagnosis between serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs), arising from the body/tail of the pancreas. Material and methods This retrospective study had institutional review board approval and informed consent was waived. Fifty-three patients with non-communicating cystic pancreatic neoplasm of the body/tail, undergoing MR/MRCP, were included. Qualitative image analysis assessed the macroscopic pattern, number of cysts, presence of central scar, contrast enhancement of peripheral wall, and mural nodules. Quantitative analysis assessed the maximum diameter of the neoplasm, thickness of the peripheral wall, and calibre of the upstream main pancreatic duct. Results Histopathology results revealed that 27/53 (51 %) were SCAs, 26/53 (49 %) were MCNs. Microcystic pattern was observed in 88.2 % of SCAs and 11.8 % of MCNs; macrocystic pattern was observed in 90.5 % of MCNs and 9.5 % of SCAs (p<0.0001). Central scar was detected in 29.6 % of SCAs and no MCNs (p=0.003). Contrast enhancement of the peripheral wall was evident in 99.5 % of MCNs and 11.5 % of SCAs (p<0.0001); mural nodules were depicted in 94.1 % of MCNs and 5.9 % of SCAs (p<0.0001). Median maximum diameter was 54 mm for MCNs, 32 mm for SCAs (p=0.001); median wall thickness was 4 mm for MCNs, 2 mm for SCAs (p<0.0001). Conclusions Macrocystic pattern, enhancement of a peripheral wall and mural nodules are suggestive of MCNs; whereas microcystic pattern, lack of peripheral wall and central scar are suggestive of SCAs. Key Points • MCNs have macrocystic patterns, contrast enhancement of the peripheral wall and mural nodules • Microcystic pattern and central scar are suggestive of SCA • Mural nodules detected in MCNs correlate with epithelial dysplasia • Chronic obstructive pancreatitis is equally depicted in patients with MCNs and SCAs
La radiologia medica, 2013
This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary a... more This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup. Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary). Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol. The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.
Medical Radiology, 2009
ABSTRACT Pseudocysts are fluid filled masses with a wall made of inflammatory and fibrotic tissue... more ABSTRACT Pseudocysts are fluid filled masses with a wall made of inflammatory and fibrotic tissue rather than a true epithelial lining. They develop from a fluid collection following a pancreatic injury and are circumscribed by a pseudo-capsule (Fig. 15.1) (Hammond et al. 2002; Kim et al. 2005). Fig. 15.1. Contrast enhanced CT (CECT), portal phase, axial plane: typical pseudocyst following acute pancreatitis. The lesion is characterized by homogenous fluid content and thin pseudocapsule
Magnetic Resonance Cholangiopancreatography (MRCP), 2013
Magnetic Resonance Cholangiopancreatography (MRCP), 2013
Magnetic Resonance Cholangiopancreatography (MRCP), 2013
MRI of the Female and Male Pelvis, 2014
MRI of the Female and Male Pelvis, 2014
Inflammatory Bowel Disease and Familial Adenomatous Polyposis, 2006
ABSTRACT
Clinical MRI of the Abdomen, 2009
Clinical MRI of the Abdomen, 2009
Abdominal Imaging, 2013
ABSTRACT Ultrasound is the first modality used in the evaluation of pancreatic disease. The pancr... more ABSTRACT Ultrasound is the first modality used in the evaluation of pancreatic disease. The pancreas can be visualized at US in most patients, independent of gastrointestinal gas interference and fat.
La radiologia medica, 2009