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Article ; Online: Image quality and radiation dose reduction in chest CT in pulmonary infection.

Cristofaro, Massimo / Busi Rizzi, Elisa / Piselli, Pierluca / Pianura, Elisa / Petrone, Ada / Fusco, Nicoletta / Di Stefano, Federica / Schinina', Vincenzo

La Radiologia medica

2020 Volume 125, Issue 5, Page(s) 451–460

Abstract: Purpose: To evaluate the effect of dose reduction with iterative reconstruction (IR) on image quality of chest CT scan comparing two protocols.: Materials and methods: Fifty-nine patients were enrolled. The two CT protocols were applied using ... ...

Abstract	Purpose: To evaluate the effect of dose reduction with iterative reconstruction (IR) on image quality of chest CT scan comparing two protocols. Materials and methods: Fifty-nine patients were enrolled. The two CT protocols were applied using Iterative Reconstruction (ASIR™) 40% but different noise indexes, recording dose-length product (DLP) and volume computed tomography dose index (CTDI Results: An average 50.4% reduction in CTDI Conclusion: Dose reduction achieved in the follow-up CT scans, although a lower IQ still allows a good diagnostic confidence.
MeSH term(s)	Adult ; Area Under Curve ; Data Interpretation, Statistical ; Female ; Humans ; Image Processing, Computer-Assisted/methods ; Lung/diagnostic imaging ; Lung Diseases/diagnostic imaging ; Male ; Middle Aged ; Observer Variation ; Radiation Dosage ; Radiation Exposure/prevention & control ; Radiographic Image Interpretation, Computer-Assisted/methods ; Radiography, Thoracic/adverse effects ; Radiography, Thoracic/methods ; Respiratory Tract Infections/diagnostic imaging ; Signal-To-Noise Ratio ; Technology, Radiologic ; Tomography, X-Ray Computed/adverse effects ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2020-02-11
Publishing country	Italy
Document type	Comparative Study ; Journal Article
ZDB-ID	205751-7
ISSN	1826-6983 ; 0033-8362
ISSN (online)	1826-6983
ISSN	0033-8362
DOI	10.1007/s11547-020-01139-5
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Article ; Online: Patient Access to an Online Portal for Outpatient Radiological Images and Reports: Two Years' Experience.

Cristofaro, Massimo / Piselli, Pierluca / Pianura, Elisa / Petrone, Ada / Cimaglia, Claudia / Di Stefano, Federica / Albarello, Fabrizio / Schininà, Vincenzo

Journal of digital imaging

2020 Volume 33, Issue 6, Page(s) 1479–1486

Abstract: To assess the incidence of outpatient examinations delivered through a web portal in the Latium Region in 2 years and compare socio-demographic characteristics of these users compared to the total of examinations performed. All radiological exams ( ... ...

Abstract	To assess the incidence of outpatient examinations delivered through a web portal in the Latium Region in 2 years and compare socio-demographic characteristics of these users compared to the total of examinations performed. All radiological exams (including MRI, X-ray and CT) performed from March 2017 to February 2019 were retrospectively analysed. For each exam, anonymized data of users who attended the exam were extracted and their characteristics were compared according to digital access to the reports. Overall, 9068 exams were performed in 6720 patients (55.8% males, median age 58 years, interquartile range (IQR) 46-70) of which 90.2% residents in Rome province, mainly attending a single radiological examination (77.3%). Among all exams, 446 (4.9%) were accessed, of which 190 (4.4%) in the first and 5.4% in the second year (p < 0.041). MRI was the type of exams mostly accessed (175, 7.0%). Being resident in the provinces of the Latium Region other than Rome was associated with a higher access rate (OR = 1.84, p = 0.001). Considering the overall costs sustained to implement a web portal which allows users a personal access to their own reports, if all users would have accessed/downloaded their exams, an overall users' and hospital savings up to €255,808.28 could have been determined. The use of a web portal could represent a consistent economical advantage for the user, the hospital and the environment. Even if increasing over time, the use of web portal is still limited and strategies to increase the use of such systems should be implemented.
MeSH term(s)	Adult ; Aged ; Electronic Health Records ; Female ; Humans ; Male ; Middle Aged ; Outpatients ; Radiography ; Radiology ; Retrospective Studies
Language	English
Publishing date	2020-06-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1033897-4
ISSN	1618-727X ; 0897-1889
ISSN (online)	1618-727X
ISSN	0897-1889
DOI	10.1007/s10278-020-00359-5
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Article ; Online: Increased Radiation Dose Exposure in Thoracic Computed Tomography in Patients with Covid-19

Massimo Cristofaro / Nicoletta Fusco / Ada Petrone / Fabrizio Albarello / Federica Di Stefano / Elisa Pianura / Vincenzo Schininà / Stefania Ianniello / Paolo Campioni

Radiation, Vol 1, Iss 14, Pp 153-

2021 Volume 161

Abstract: The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to ... ...

Abstract	The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to evaluate the outcomes. The aim of this study is to evaluate the radiation dose for chest CT scans in COVID-19 patients compared to a cohort with pulmonary infectious diseases at the same time of the previous year to value if there is any modification of exposure dose. The analysis of our data shows an increase in the overall mean dose in COVID-19 patients compared with non-COVID-19 patients. In our results, the higher dose increase occurs in the younger age groups (+86% range 21–30 years and +67% range 31–40 years). Our results show that COVID-19 patients are exposed to a significantly higher dose of ionizing radiation than other patients without COVID infectious lung disease, and especially in younger age groups, although some authors have proposed the use of radiotherapy in these patients, which is yet to be validated. Our study has limitations: the use of one CT machine in a single institute and a limited number of patients.
Keywords	COVID-19 ; diagnostic imaging ; chest ; CT-scan ; radiation dose ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Subject code	610
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Coronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19.

Pianura, Elisa / Di Stefano, Federica / Cristofaro, Massimo / Petrone, Ada / Fusco, Nicoletta / Albarello, Fabrizio / Lapa, Daniele / Cicalini, Stefania / Campioni, Paolo / Schininà, Vincenzo

Radiology. Cardiothoracic imaging

2020 Volume 2, Issue 2, Page(s) e200162

Language	English
Publishing date	2020-04-23
Publishing country	United States
Document type	Journal Article
ISSN	2638-6135
ISSN (online)	2638-6135
DOI	10.1148/ryct.2020200162
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Article ; Online: Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients.

Vergori, Alessandra / Pianura, Elisa / Lorenzini, Patrizia / D'Abramo, Alessandra / Di Stefano, Federica / Grisetti, Susanna / Vita, Serena / Pinnetti, Carmela / Donno, Davide Roberto / Marini, Maria Cristina / Nicastri, Emanuele / Ianniello, Stefania / Antinori, Andrea

Annals of medicine

2021 Volume 53, Issue 1, Page(s) 295–301

Abstract: Introduction: Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now ... ...

Abstract	Introduction: Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. Materials and methods: We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy. Results: Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis. Conclusions: Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.
MeSH term(s)	Aged ; Aged, 80 and over ; Anticoagulants/adverse effects ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/virology ; Critical Illness/mortality ; Critical Illness/therapy ; Female ; Glucocorticoids/therapeutic use ; Hematoma/chemically induced ; Hematoma/diagnosis ; Hematoma/drug therapy ; Hematoma/epidemiology ; Heparin, Low-Molecular-Weight ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Italy/epidemiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscular Diseases ; Psoas Muscles/diagnostic imaging ; SARS-CoV-2/isolation & purification ; SARS-CoV-2/pathogenicity ; Severity of Illness Index ; Thrombophilia/drug therapy ; Thrombophilia/etiology ; Tomography, X-Ray Computed ; Treatment Outcome ; COVID-19 Drug Treatment
Chemical Substances	Anticoagulants ; Glucocorticoids ; Heparin, Low-Molecular-Weight
Language	English
Publishing date	2021-01-24
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	1004226-x
ISSN	1365-2060 ; 1651-2219 ; 0785-3890 ; 1743-1387
ISSN (online)	1365-2060 ; 1651-2219
ISSN	0785-3890 ; 1743-1387
DOI	10.1080/07853890.2021.1875498
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Article ; Online: 2019-novel Coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation.

Albarello, Fabrizio / Pianura, Elisa / Di Stefano, Federica / Cristofaro, Massimo / Petrone, Ada / Marchioni, Luisa / Palazzolo, Claudia / Schininà, Vincenzo / Nicastri, Emanuele / Petrosillo, Nicola / Campioni, Paolo / Eskild, Petersen / Zumla, Alimuddin / Ippolito, Giuseppe

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2020 Volume 93, Page(s) 192–197

Abstract: Introduction: Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients.!## ...

Abstract	Introduction: Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients. Objective: We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS). Results: Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes. Conclusions: Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.
MeSH term(s)	Adult ; Betacoronavirus/isolation & purification ; COVID-19 ; China ; Coronavirus Infections/diagnostic imaging ; Disease Progression ; Humans ; Italy ; Lung/diagnostic imaging ; Lung/pathology ; Middle East Respiratory Syndrome Coronavirus ; Pandemics ; Pneumonia, Viral/diagnostic imaging ; Respiratory Distress Syndrome/diagnostic imaging ; Respiratory Distress Syndrome/virology ; Severe acute respiratory syndrome-related coronavirus ; SARS-CoV-2 ; Tomography, X-Ray Computed
Keywords	covid19
Language	English
Publishing date	2020-02-26
Publishing country	Canada
Document type	Case Reports ; Journal Article
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2020.02.043
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Article ; Online: An explainable AI system for automated COVID-19 assessment and lesion categorization from CT-scans.

Pennisi, Matteo / Kavasidis, Isaak / Spampinato, Concetto / Schinina, Vincenzo / Palazzo, Simone / Salanitri, Federica Proietto / Bellitto, Giovanni / Rundo, Francesco / Aldinucci, Marco / Cristofaro, Massimo / Campioni, Paolo / Pianura, Elisa / Di Stefano, Federica / Petrone, Ada / Albarello, Fabrizio / Ippolito, Giuseppe / Cuzzocrea, Salvatore / Conoci, Sabrina

Artificial intelligence in medicine

2021 Volume 118, Page(s) 102114

Abstract: COVID-19 infection caused by SARS-CoV-2 pathogen has been a catastrophic pandemic outbreak all over the world, with exponential increasing of confirmed cases and, unfortunately, deaths. In this work we propose an AI-powered pipeline, based on the deep- ... ...

Abstract	COVID-19 infection caused by SARS-CoV-2 pathogen has been a catastrophic pandemic outbreak all over the world, with exponential increasing of confirmed cases and, unfortunately, deaths. In this work we propose an AI-powered pipeline, based on the deep-learning paradigm, for automated COVID-19 detection and lesion categorization from CT scans. We first propose a new segmentation module aimed at automatically identifying lung parenchyma and lobes. Next, we combine the segmentation network with classification networks for COVID-19 identification and lesion categorization. We compare the model's classification results with those obtained by three expert radiologists on a dataset of 166 CT scans. Results showed a sensitivity of 90.3% and a specificity of 93.5% for COVID-19 detection, at least on par with those yielded by the expert radiologists, and an average lesion categorization accuracy of about 84%. Moreover, a significant role is played by prior lung and lobe segmentation, that allowed us to enhance classification performance by over 6 percent points. The interpretation of the trained AI models reveals that the most significant areas for supporting the decision on COVID-19 identification are consistent with the lesions clinically associated to the virus, i.e., crazy paving, consolidation and ground glass. This means that the artificial models are able to discriminate a positive patient from a negative one (both controls and patients with interstitial pneumonia tested negative to COVID) by evaluating the presence of those lesions into CT scans. Finally, the AI models are integrated into a user-friendly GUI to support AI explainability for radiologists, which is publicly available at http://perceivelab.com/covid-ai. The whole AI system is unique since, to the best of our knowledge, it is the first AI-based software, publicly available, that attempts to explain to radiologists what information is used by AI methods for making decisions and that proactively involves them in the decision loop to further improve the COVID-19 understanding.
MeSH term(s)	Artificial Intelligence ; COVID-19 ; Humans ; Lung/diagnostic imaging ; SARS-CoV-2 ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-05-21
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645179-2
ISSN	1873-2860 ; 0933-3657
ISSN (online)	1873-2860
ISSN	0933-3657
DOI	10.1016/j.artmed.2021.102114
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Article ; Online: Spontaneous ilio-psoas haematomas (IPHs)

Alessandra Vergori / Elisa Pianura / Patrizia Lorenzini / Alessandra D’Abramo / Federica Di Stefano / Susanna Grisetti / Serena Vita / Carmela Pinnetti / Davide Roberto Donno / Maria Cristina Marini / Emanuele Nicastri / Stefania Ianniello / Andrea Antinori

Annals of Medicine, Vol 53, Iss 1, Pp 295-

a warning for COVID-19 inpatients

2021 Volume 301

Abstract: AbstractIntroduction Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is ...

Abstract	AbstractIntroduction Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment.Materials and methods We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy.Results Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis.Conclusions Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients.KEY MESSAGECritically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended.Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases.An incidence of 7.6 cases per 1000 admission of IPHs was reported.Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.
Keywords	Ilio-psoas haematoma ; heparin ; COVID-19 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
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Article: Central Nervous System involvement in tuberculosis: An MRI study considering differences between patients with and without Human Immunodeficiency Virus 1 infection.

Di Napoli, Alberto / Cristofaro, Massimo / Romano, Andrea / Pianura, Elisa / Papale, Gioia / Di Stefano, Federica / Ronconi, Edoardo / Petrone, Ada / Rossi Espagnet, Maria Camilla / Schininà, Vincenzo / Bozzao, Alessandro

Journal of neuroradiology = Journal de neuroradiologie

2019 Volume 47, Issue 5, Page(s) 334–338

Abstract: Background: Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV- patients with CNSTB. The aim of the present study was ...

Abstract	Background: Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV- patients with CNSTB. The aim of the present study was to identify MRI differences in CNSTB between HIV+ and HIV- patients and possibly find early characteristics that could raise the suspect of this disease. Methods: We included all patients admitted in our institution between 2011 and 2018 with confirmed diagnosis of CNSTB, and MRI performed in the first week. Patients with preexisting brain pathology or immunodeficiency not HIV related were excluded. We compared CNSTB MRI features between the two groups. Results: Sixty-nine patients were included (19 HIV+; 50 HIV-). Findings in HIV+ group: 6 lung TB, 5 hydrocephalus, 4 meningeal enhancement, 6 stroke, 2 hemorrhages, and 10 tuberculomas. HIV- group: 22 lung tuberculosis, 15 hydrocephalus, 21 meningeal enhancement, 5 stroke, 4 hemorrhages, 20 tuberculomas. The only statistically significant difference between the two groups was in the stroke occurrence, more frequent in the HIV+ group (P=.028), all involving the basal ganglia. Conclusions: Stroke involving the basal ganglia best differentiates CNSTB patients who are HIV+ from those HIV-. This finding was not correlated with meningeal enhancement suggesting that small arteries involvement might precede it. Therefore, we think that HIV+ patients with a new onset of stroke should be evaluated for CNSTB. Follow-up MRI should also be planned since meningeal enhancement might appear in later stages of the disease.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Contrast Media ; Female ; HIV Infections/complications ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Retrospective Studies ; Tuberculosis, Central Nervous System/diagnostic imaging
Chemical Substances	Contrast Media
Language	English
Publishing date	2019-09-17
Publishing country	France
Document type	Journal Article
ZDB-ID	131763-5
ISSN	1773-0406 ; 0150-9861
ISSN (online)	1773-0406
ISSN	0150-9861
DOI	10.1016/j.neurad.2019.07.008
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Article ; Online: Coronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID 19

Pianura, Elisa / Di Stefano, Federica / Cristofaro, Massimo / Petrone, Ada / Fusco, Nicoletta / Albarello, Fabrizio / Lapa, Daniele / Cicalini, Stefania / Campioni, Paolo / Schininà, Vincenzo

Radiol Cardiothorac Imaging

Keywords	covid19
Publisher	PMC
Document type	Article ; Online
DOI	10.1148/ryct.2020200162
Database	COVID19

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