Evaluation of Gd-enhancement in brain MR of multiple sclerosis: image subtraction with and without magnetization transfer

The aim of our study was to test the possibility of using image subtraction in detecting enhancing lesions in brain MR scans with and without magnetization transfer (MT) in multiple sclerosis (MS). Ten MS patients underwent 1.5-T MR imaging of the brain with spin-echo T1-weighted sequences with and without MT, repeated after 0.1 mmol/kg of an usual two-compartment paramagnetic contrast agent (Gadoteridol, Gd-HP-DO3A). Precontrast images were subtracted from postcontrast. Enhancing lesions were counted on the postcontrast images only (post-Gd), comparing pre- and postcontrast images by direct visual control (pre/post-Gd), and on the subtracted images (SI) only. Without MT, 36 enhancing lesions were counted on post-Gd, 36 on pre/post-Gd, and 59 on SI; using MT, 69, 52, and 50, respectively. Significant differences were found for pre/post-Gd without MT vs SI without MT ( p=0.028) and vs pre/post-Gd with MT ( p=0.012) as well as for pre/post-Gd with MT vs post-Gd with MT ( p=0.028). With pre/post-Gd, MT allowed the detection of 1.6 enhancing lesions per patient more than without MT. Whereas the SI without MT allow the detection of an increased number of enhancing lesions, SI with MT do not. An off-site final assessment allowed calculation of sensitivity and positive predictive value as follows: without MT were 63 and 94% (post-Gd), 67 and 100% (pre/post-Gd), 96 and 88% (SI); and with MT were 93 and 73% (post-Gd), 96 and 100% (pre/post-Gd), 91 and 98% (SI), respectively. Thus, SI seem to increase the sensitivity without MT; moreover, they could be used to correct the pseudoenhancement that impair post-Gd images with MT

Multimodality imaging in transcatheter aortic valve implantation: key steps to assess procedural feasibility

Transcatheter aortic valve implantation (TAVI) has been an important breakthrough in the treatment of patients with symptomatic, severe aortic stenosis and contraindications for surgical aortic valve replacement. Accurate aortic root measurements and evaluation of spatial relationships with the coronary ostia are crucial in pre-operative TAVI assessment. In addition, characterisation of the peripheral artery anatomy and aorta is an important key step in the procedural feasibility evaluation. The present review article provides a practical approach, based on multimodality imaging, to select candidates for TAVI and to evaluate the procedural feasibility.Vascular Biology and Interventio

The italian multi-center project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanità, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases

The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk.

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanità, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases

The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanit\ue0, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases

Strumenti e indicazioni di governance transfrontaliera. Piano d’azione e linee guida del progetto IMPACT [Instruments et indications pour la gouvernance transfrontalière. Plan d’action et lignes directrices du projet IMPACT]

Il presente documento restituisce una sintesi delle attività del progetto IMPACT ed è diviso in due parti. La prima parte evidenzia gli strumenti completati durante la durata del progetto, in particolare la rete di radar costieri per il monitoraggio delle correnti marine e la piattaforma webGIS per la consultazione dei dati raccolti ed elaborati dai partner di progetto. La seconda parte capitalizza sui suddetti strumenti per fornire sia indicazioni metodologiche che di governance. Nello specifico, la rete di radar costieri viene utilizzata per creare mappe di potenziale contaminazione e indicare in che condizioni le attività portuali possano essere più sostenibili. Le misure demografiche e i calcoli di ritenzione indicano il livello d’efficacia delle dimensioni attuali delle AMP mentre le misure di contaminazione suggeriscono di considerare un numero maggiore di stazioni nell’ottica di migliorare i piani di monitoraggio esistenti. In quest’ottica, le indicazioni rappresentano il piano d’azione e le linee guida del progetto. L’ulteriore espansione della rete di radar costieri prevista nei progetti SICOMAR plus e SINAPSI è la prova che la conclusione delle attività del progetto IMPACT sia in realtà solo un importante punto di partenzaCe document donne un résumé des activités du projet IMPACT et est divisé en deux parties. La première partie met en évidence les instruments réalisés pendant la durée du projet, en particulier le réseau de radars côtiers pour la surveillance des courants marins et la plate-forme webGIS pour la consultation des données collectées et traitées par les partenaires du projet. La deuxième partie s’appuie sur ces outils pour fournir des orientations à la fois méthodologiques et de gouvernance. Plus précisément, le réseau de radars côtiers est utilisé pour créer des cartes de contamination potentielle et indiquer dans quelles conditions les activités portuaires peuvent être plus durables. Les mesures démographiques et les calculs de rétention indiquent le niveau d’efficacité de la taille actuelle des AMP, tandis que les mesures de contamination suggèrent que davantage de stations devraient être envisagées en vue d’améliorer les plans de surveillance existants. Dans cette perspective, les indications représentent le plan d’action et les lignes directrices du projet. La poursuite de l’extension du réseau de radars côtiers prévue dans les projets SICOMAR plus et SINAPSI est la preuve que la conclusion des activités du projet IMPACT n’est en fait qu’un point de départ important