Caustic ingestion: CT findings of esophageal injuries and thoracic complications

Ingestion of caustic substances, whether accidental or for the purpose of suicide, can cause severe lesions of the lips, oral cavity, pharynx, upper gastrointestinal system, and upper airways. In particular, caustic agents could be responsible for severe esophageal injuries resulting in short- and long-term complications. Because of these important clinical implications, timely diagnosis and appropriate management are crucial. In the evaluation of esophageal injuries, thoraco-abdominal computed tomography (CT) is preferable to endoscopy as it avoids the risk of esophageal perforation and allows the evaluation of esophageal injuries as well as of the surrounding tissue. In this review, we re…

Renal endometriosis mimicking complicated cysts of kidney: report of two cases

Endometriosis is a common gynecologic disorder characterized by ectopic endometrial tissue growth outside the uterine cavity. Although usually occurring in pelvic organs, endometrial lesions may involve urinary tract. Renal endometriosis is extremely rare and it has only occasionally been reported in the past. We report two cases of patients with renal cystic lesions, incidentally found at imaging techniques during oncologic follow-up for gastric sarcoma and melanoma, initially misinterpreted as complicated haemorrhagic cysts and then histologically characterized as renal localizations of extragenital endometriosis.

Ruolo dell'ecografia con mezzo di contrasto ecografico nella stadiazione dei tumori vescicali.

A Predictive System to Classify Preoperative Grading of Rectal Cancer Using Radiomics Features

Although preoperative biopsy of rectal cancer (RC) is an essential step for confirmation of diagnosis, it currently fails to provide prognostic information to the clinician beyond a rough estimation of tumour grade. In this study we used a risk classification to stratified patient in low-risk and high-risk patients in relation to the disease free survival and the overall survival using histopathological post-operative features. The purpose of this study was to evaluate if low-risk and high-risk RC can be distinguished using a CT-based radiomics model. We retrospectively reviewed the preoperative abdominal contrast-enhanced CT of 40 patients with RC. CT portal-venous phase was used for manua…

CT imaging findings of abdominopelvic vascular compression syndromes: what the radiologist needs to know.

AbstractAbdominopelvic vascular compression syndromes include a variety of uncommon conditions characterized by either extrinsic compression of blood vessels by adjacent anatomical structures (i.e., median arcuate ligament syndrome, nutcracker syndrome, May-Thurner syndrome) or compression of hollow viscera by adjacent vessels (i.e., superior mesenteric artery syndrome, ureteropelvic junction obstruction, ureteral vascular compression syndromes, portal biliopathy). These syndromes can be unexpectedly diagnosed even in asymptomatic patients and the predisposing anatomic conditions can be incidentally discovered on imaging examinations performed for other indications, or they can manifest wit…

Deep Learning-Based Methods for Prostate Segmentation in Magnetic Resonance Imaging

Magnetic Resonance Imaging-based prostate segmentation is an essential task for adaptive radiotherapy and for radiomics studies whose purpose is to identify associations between imaging features and patient outcomes. Because manual delineation is a time-consuming task, we present three deep-learning (DL) approaches, namely UNet, efficient neural network (ENet), and efficient residual factorized convNet (ERFNet), whose aim is to tackle the fully-automated, real-time, and 3D delineation process of the prostate gland on T2-weighted MRI. While UNet is used in many biomedical image delineation applications, ENet and ERFNet are mainly applied in self-driving cars to compensate for limited hardwar…

Aortic valve and vascular calcium score in pre-TAVI CT: correlation with early post-procedural complications

Abstract Purpose The aim of our study was to evaluate the prevalence of early complications after Transcatheter Aortic Valve Implantation (TAVI) and their correlation with the Calcium Score (CS) of the aortic valve, aorta and ilio-femoral arteries derived from pre-procedural computed tomography (CT). Materials and methods We retrospectively reviewed 226 patients (100 males, mean age 79.4 ± 6.7 years) undergoing 64-slice CT for pre-TAVI evaluation from January 2018 to April 2021. The population was divided into CS quartiles. Results Overall, 173 patients underwent TAVI procedure, of whom 61% presented paravalvular leak after the procedure, 28% presented bleeding or vascular complications, 25…

Sonografic examination of epiaortic vessels in patients with peripheral vertigo

Abstract Introduction: To evaluate the utility of echo-color-Doppler ultrasonography (CDU) of extracranial brain-supplying vessels in patients with peripheral vertigo of unknown origin. Materials and methods: One-hundred-fifty-six patients (study group; 42 male and 114 female; mean age 61.86 14.14) and 161 patients (control group; 80 male and 81 female; mean age 62.31 13.69) were prospectively evaluated with CDU of extracranial brain-supplying vessels. Plaques in common and/or internal carotid artery (CA), arterial wall intima-media thickness (IMT) of common CA and peak systolic velocity (PSV) and resistive index (RI) of vertebral arteries (VA) were evaluated. Parametric (t-test) and non-pa…

Radiomics Analyses of Schwannomas in the Head and Neck: A Preliminary Analysis

The purpose of this preliminary study was to evaluate the differences in Magnetic Resonance Imaging (MRI)-based radiomics analysis between cerebellopontine angle neurinomas and schwannomas originating from other locations in the neck spaces. Twenty-six patients with available MRI exams and head and neck schwannomas were included. Lesions were manually segmented on the precontrast and postcontrast T1 sequences. The radiomics features were extracted by using PyRadiomics software, and a total of 120 radiomics features were obtained from each segmented tumor volume. An operator-independent hybrid descriptive‐inferential method was adopted for the selection and reduction of the features, while d…

PI-RADS 3 Lesions: Role of Prostate MRI Texture Analysis in the Identification of Prostate Cancer

Abstract Purpose To determine the diagnostic performance of texture analysis of prostate MRI for the diagnosis of prostate cancer among Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Materials and Methods Forty-three patients with at least 1 PI-RADS 3 lesion on prostate MRI performed between June 2016 and January 2019 were retrospectively included. Reference standard was pathological analysis of radical prostatectomy specimens or MRI-targeted biopsies. Texture analysis extraction of target lesions was performed on axial T2-weighted images and apparent diffusion coefficient (ADC) maps using a radiomic software. Lesions were categorized as prostate cancer (Gleason score [GS] …

Imaging features of solid renal masses

The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The "classical angiomyolipoma" is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign …

Hybrid descriptive-inferential method for key feature selection in prostate cancer radiomics

In healthcare industry 4.0, a big role is played by radiomics. Radiomics concerns the extraction and analysis of quantitative information not visible to the naked eye, even by expert operators, from biomedical images. Radiomics involves the management of digital images as data matrices, with the aim of extracting a number of morphological and predictive variables, named features, using automatic or semi-automatic methods. Multidisciplinary methods as machine learning and deep learning are fully involved in this field. However, the large number of features requires efficient and effective core methods for their selection, in order to avoid bias or misinterpretations problems. In this work, t…

Heterogeneous delayed enhancement of hepatic parenchyma after intravenous infusion of sonographic contrast agent: a new hypothesis

Purpose. The aim of this paper was to report a heterogeneous latephase hepatic enhancement pattern observed after administration of a sonographic contrast agent and to present an aetiological hypothesis for the phenomenon. Materials and methods. A total of 1,729 (1,012 women and 717 men; age range 28–82; mean age 51) patients underwent contrastenhanced sonography of the liver. The examination was performed with a low mechanical index (MI <0.09) after injection of sulphur-hexafluoride-filled microbubbles, using different fonographic equipment and different contrast-specific algorithms. Results. Heterogeneous delayed liver enhancement was observed in six patients in the late phase (180 s), wi…

Radiomics: A New Biomedical Workflow to Create a Predictive Model

‘Radiomics’ is utilized to improve the prediction of patient overall survival and/or outcome. Target segmentation, feature extraction, feature selection, and classification model are the fundamental blocks of a radiomics workflow. Nevertheless, these blocks can be affected by several issues, i.e. high inter- and intra-observer variability. To overcome these issues obtaining reproducible results, we propose a novel radiomics workflow to identify a relevant prognostic model concerning a real clinical problem. In the specific, we propose an operator-independent segmentation system with the consequent automatic extraction of radiomics features, and a novel feature selection approach to create a…

Bladder tumor staging: comparison of contrast-enhanced and gray-scale ultrasound

OBJECTIVE. The purpose of this study was to evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle- infiltrating and superficial neoplasms of the urinary bladder. SUBJECTS AND METHODS. Conventional and contrast-enhanced sonography were performed on 34 consecutively registered patients with bladder tumors. All examinations were reviewed by two independent sonologists. At gray-scale sonography, interruption of the hyperechoic bladder wall was considered the main diagnostic criterion for differentiating superficial and infiltrating tumors. At contrast-enhanced sonography, a tumor was considered superficial when the hypoen…

Hippocampal reversible lesions in a case of transient global amnesia

We report the case of 55-year-old man that after an emotional stress showed retrograde and anterograde amnesia with impairment of orientation in space and time but undisturbed consciousness. A neurological examination excluded other neurological signs or symptoms. The amnesic syndrome resolved spontaneously within 24 hours and the hypothesis of transient global amnesia was placed. Brain CT scan and conventional MRI sequences did not show any relevant pathological findings but diffusion-weighted imaging (DWI) showed two millimetric bright spot of restricted diffusion in the right hippocampus; in a brain MRI follow-up those findings were no more appreciable. The diagnosis of transient global …

PERFORMANCE OF DIFFUSION KURTOSIS IMAGING FOR CHARACTERIZATION OF PROSTATE LESIONS USING 1.5T MAGNETIC RESONANCE IMAGING SCANNER

The aim of the study is to evaluate the diagnostic performance of apparent diffusion coefficient (ADC) and apparent kurtosis coefficient (Kapp) for the characterization of prostate lesions on 1.5T MRI. This retrospective study included 34 patients with at least one lesion with PI-RADS score≥ 3. Performances of ADC and Kapp were evaluated using the Mann-Whitney U test and receiver operating characteristics curve (AUROC). Lesions with Gleason score≥6 had significantly lower Kapp compared to benign lesions (p=0.025). The ADC-ratio was the only significantly different parameter between GS≥7 and GS=6 lesions (p=0.039). Kapp showed the largest AUROC for the diagnosis of GS≥6 prostate cancers (AUR…

CT and MR imaging of cystic renal lesions

AbstractCystic renal lesions are a common incidental finding on routinely imaging examinations. Although a benign simple cyst is usually easy to recognize, the same is not true for complex and multifocal cystic renal lesions, whose differential diagnosis includes both neoplastic and non-neoplastic conditions. In this review, we will show a series of cases in order to provide tips to identify benign cysts and differentiate them from malignant ones.

RISONANZA MAGNETICA (RM) MORFOLOGICA E FUNZIONALE NELLO STUDIO DELL'ADENOCARCINOMA PROSTATICO (CAP)

Obiettivi didattici. Illustrare i reperti morfologici e funzionali del CaP, all'imaging RM. Introduzione. La RM è una metodica fondamentale nello studio del CaP; oltre all'imaging morfologico, permette importanti acquisizioni funzionali che aumentano la sua performance diagnostica. Tecnica d'esame. Lo studio RM della prostata prevede sequenze assiali t1, assiali, coronali e sagittali T2, DWI, sequenze spettroscopiche e sequenze perfusioni (GE T1w 3d fat-sat). In T1 la prostata ha intensità di segnale medio-bassa omogenea, senza possibilità di distinzione dell'anatomia zona e ghiandolare o d'identificazione di eventuali CaP. Queste sequenze permettono la visualizzazione di eventuali residui …

Deep Learning Networks for Automatic Retroperitoneal Sarcoma Segmentation in Computerized Tomography

The volume estimation of retroperitoneal sarcoma (RPS) is often difficult due to its huge dimensions and irregular shape; thus, it often requires manual segmentation, which is time-consuming and operator-dependent. This study aimed to evaluate two fully automated deep learning networks (ENet and ERFNet) for RPS segmentation. This retrospective study included 20 patients with RPS who received an abdominal computed tomography (CT) examination. Forty-nine CT examinations, with a total of 72 lesions, were included. Manual segmentation was performed by two radiologists in consensus, and automatic segmentation was performed using ENet and ERFNet. Significant differences between manual and automat…

Congenital pulmonary airway malformation in adult: report of two rare cases and literature review

Congenital pulmonary airway malformations (CPAMs) are a heterogeneous group of congenital, non-hereditary lesions of the lung, cystic and non-cystic type with clear developmental anomalies and evident malformative changes, which derive from the excessive proliferation of the tubular bronchial structures. We described two rare cases of type IV CPAM detected in adult patients with different clinical presentation: one of these cases was symptomatic, complaining of cough and hemoptysis. Conversely, the other case was reported as incidental findings in patient with abdominal pain without respiratory symptoms. Chest computed tomography (CT) scan was performed showing voluminous cystic formations …

Intravenous Contrast Agent in Abdominal CT: Is It Really Needed to Identify the Cause of Bowel Obstruction? Proof of Concept

Background. To compare sensitivity of unenhanced computed tomography (CT) and contrast-enhanced CT for the identification of the etiology of bowel obstruction.Materials and Methods. We retrospectively evaluated abdominal CT scans of patients operated for bowel obstruction from March 2013 to October 2017. Two radiologists evaluated CT scans before and after contrast agent in two reading sessions. Then, we calculated sensitivity of CT in the diagnosis of bowel obstruction and determined in which cases the etiology of bowel obstruction was detected on both unenhanced and enhanced CT or on enhanced CT only. The reference standard was defined as the final diagnosis obtained after surgery.Results…

RUOLO DEL COEFFICIENTE DI DIFFUSIONE APPARENTE (ADC) NELLO STUDIO DELLA PROSTATA IN RISONANZA MAGNETICA (RM)

Outcome of LR-3 and LR-4 observations without arterial phase hyperenhancement at Gd-EOB-DTPA-enhanced MRI follow-up

Objective: The aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up. Methods: Forty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated. Results: Seventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A d…

Impact of structured report on the quality of preoperative CT staging of pancreatic ductal adenocarcinoma: assessment of intra- and inter-reader variability

Purpose: To evaluate whether a structured radiology report improves the completeness of preoperative CT staging of pancreatic ductal adenocarcinoma (PDA) compared to conventional free-text reports. Methods: We retrospectively included 27 patients (mean age, 64 ± 11.1 years) referred for pancreatic preoperative CT scan for staging of PDA between 2015 and 2018 and in whom a diagnosis of pancreatic adenocarcinoma was ultimately confirmed. Four readers independently reported CT scans with both conventional free-text and structured reports. Differences in reported morphologic and vascular features with the two reports were assessed through McNemar Test. Intra-reader and inter-reader were calcula…

The role of PET radiomic features in prostate cancer: a systematic review

Aim: This systematic review aims to present the available evidence on the use of radiomic features (RFs) extracted from PET imaging in patients with prostate cancer (PCa). Materials and methods: A comprehensive literature search of studies on the utility of PET-derived RFs in patients with PCa was performed in the PubMed/MEDLINE database through February 24th, 2021 using the following search string: [“positron-emission tomography” (MeSh terms) OR “positron emission tomography computed tomography” (MeSh terms) OR “positron-emission tomography” (all fields) OR “positron emission tomography computed tomography” (all fields) OR “PET” (all fields)] AND [“radiomics” (all fields) OR “radiomic” (al…

The "spoke wheel" sign in mesenteric carcinoid.

Radiomics and Prostate MRI: Current Role and Future Applications

Multiparametric prostate magnetic resonance imaging (mpMRI) is widely used as a triage test for men at a risk of prostate cancer. However, the traditional role of mpMRI was confined to prostate cancer staging. Radiomics is the quantitative extraction and analysis of minable data from medical images; it is emerging as a promising tool to detect and categorize prostate lesions. In this paper we review the role of radiomics applied to prostate mpMRI in detection and localization of prostate cancer, prediction of Gleason score and PI-RADS classification, prediction of extracapsular extension and of biochemical recurrence. We also provide a future perspective of artificial intelligence (machine …

VALUTAZIONE DELLA PERFUSIONE CEREBRALE CON ECOGRAFIA TRANSCRANICA (TCCD) E MEZZO DI CONTRASTO (MDC) IN PAZIENTI DIABETICI: STUDIO CASO-CONTROLLO

Surface Characterization of Organic Films for the Conservation of Bronze Archaeological Artefacts

RUOLO DEL COEFFICIENTE APPARENTE DI DIFFUSIONE (ADC) NELLO STUDIO DELLA PROSTATA IN RISONANZA MAGNETICA (RM)

Materiali e Metodi: La nostra popolazione è costituita da 25 di età compresa tra 50 e 81 anni (media 63.95 +/- 9.54) sottoposti ad esame RM della prostata con apparecchiatura da 1.5 T mediante l'ausilio di bobina endorettale. Oltre al protocollo morfologico (T1w-T2w) , la valutazione spettroscopica e dinamica post-contrastografica, sono state acquisite sequenze DWI sul piano assiale con valori di b pari a 800/mm2. E' stato calcolato il valore di ADC in regioni di interesse poste in corrispondenza di aree di zona periferica (ZP) con aspetto normale ed aree che presentavano segnale ipointenso enne sequenze T2w e/o che mostravano restrizione della diffusione dell'acqua nelle sequenze DWI. All'…

Preoperative imaging findings in patients undergoing transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy

AbstractThe prevalence and impact of imaging findings detected during screening procedures in patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy for functional neurological disorders has not been assessed yet. This study included 90 patients who fully completed clinical and neuroradiological screenings for tcMRgFUS in a single-center. The presence and location of preoperative imaging findings that could impact the treatment were recorded and classified in three different groups according to their relevance for the eligibility and treatment planning. Furthermore, tcMRgFUS treatments were reviewed to evaluate the number of transducer elements turned off after…

Non-alcoholic Wernicke's encephalopathy: From MRI findings of a case to differential diagnosis checklist

Wernicke's encephalopathy is a serious neurological disorder secondary to thiamine deficiency in alcoholics. However, rarely it affects non-alcoholics. Here we present a case of Wernicke's encephalopathy in a non-alcoholic 56-year-old female, treated by endoscopic surgery for a duodenal ulcer two years before. She came to our attention for a sudden onset of a neurological syndrome characterized by visual deficits, diplopia, confusion, spatial disorientation and loss of short-term memory. An MRI scan showed the typical MRI findings of Wernicke's encephalopathy, which are discussed together with the possible differential diagnosis.

Intraoperative Ultrasound: Emerging Technology and Novel Applications in Brain Tumor Surgery

Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery. We present data from our case series of brain tumor surgery performed with the aid of IOUS in order to identify IOUS advantages and crucial aspects that may improve the management of neurosurgical procedures for brain tumors. From January 2021 to September 2021, 17 patients with different brain tumors underwent brain tumor surgery aided by the use of IOUS. During surgery, the procedure was supported by the use of multiples ultrasonographic modalities in addition to standard B-mode: Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS). In selected cas…

Prevalence and clinical significance of incidental findings on multiparametric prostate MRI.

Purpose: To assess the prevalence and clinical significance of incidental findings (IFs) detected at multiparametric prostate MRI examination. Materials and methods: Multiparametric prostate MRIs of 647 consecutive patients (mean age 67.1 ± 8.0 years) were retrospectively evaluated by two radiologists recording the presence of all extra-prostatic IFs. Findings were classified as related to or not related to genitourinary system and divided into three classes, according to their clinical significance, as follows: group 1, not significant or scarcely significant; group 2, moderately or potentially significant; and group 3, significant. Differences in distribution of IFs between patients ≤ 65 …

Diagnostic performance of qualitative and radiomics approach to parotid gland tumors: which is the added benefit of texture analysis?

Objective: To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological approach. Methods: Patients with parotid gland tumors who underwent salivary glands MRI between 2008 and 2019 were retrospectively selected. MRI analysis included a qualitative assessment by two radiologists (one of which subspecialized on head and neck imaging), and texture analysis on various sequences. Diagnostic performances including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of qualitative features, radiologists’ diagnosis, and radiomic models were evaluated. Result…

Anatomical and clinical study on effects of sonography with pulse inversion and microbubble contrast in rabbit kidney

Imaging appearance of treated hepatocellular carcinoma

Surgical resection and imaging guided treatments play a crucial role in the management of hepatocellular carcinoma (HCC). Although the primary end point of treatment of HCC is survival, radiological response could be a surrogate end point of survival, and has a key role in HCC decision-making process. However, radiological assessment of HCC treatment efficacy is often controversial. There are few doubts on the evaluation of surgical resection; in fact, all known tumor sites should be removed. However, an unenhancing partial linear peripheral halo, in most cases, surrounding a fluid collection reducing in size during follow-up is demonstrated in successfully resected tumor with bipolar radio…

Computer tomography features of pulmonary vascular involvement in Behçet's disease

Behçet’s disease is a chronic and multisystemic inflammatory vascular disease of unknown etiology, affecting vessels of all kinds and sizes. The involvement of the vascular system is observed in approximately 5-30% of patients. The most frequent vascular manifestations are venous thrombosis followed by arterial aneurysms and arterial thrombosis. The identification of vascular involvement is very important for prognosis, indeed the rupture of an arterial aneurysm represents the leading cause of sudden death in patients with Behçet’s disease. Computed tomography (CT) plays a crucial role in the identification and in the follow-up of vascular involvement. In this paper, we report the case of a…

Ultrasonic evaluation with second harmonic imaging and SonoVue in the assessment of cerebral perfusion in diabetic patients: a case-control study

The purpose was to compare human brain tissue perfusion in diabetic patients and healthy subjects with second harmonic imaging ultrasound and SonoVue to test the hypothesis that brain tissue perfusion differences are present in these two groups of patients. In a prospective case-control study, second harmonic examinations performed in 20 patients with type II diabetes mellitus and in 20 matched control patients were compared. After administration of 2.5 ml of SonoVue, 60 time-triggered images were recorded. Time-intensity curves, including peak intensity and positive gradient normalized to the middle cerebral artery, were calculated to quantify ultrasound intensity in a region of interest. …

Sequenze di diffusione (DWI) nello studio del carcinoma prostatico: confronto tra b700 e b1400. Nostra esperienza

Materiali e metodi: e' stato analizzato retrospettivamente un campione di 24 pazienti nei quali è stato posto il sospetto RM di CaP confermato all'esame istologico in 20 pazienti. Questi, di età compresa tra 47 e 76 anni (media 64+/- 10), hanno costituito la nostra popolazione. L'esame RM è stato eseguito con un'apparecchiatura da 1.5 T mediante l'ausilio di bobina endorettale. Oltre al protocollo (T2, T1), la valutazione spettroscopica e dinamica postcontrastografica sono state acquisite sequenze DWI sul piano assiale con valori di b pari a 700 e 1400 s/mm2. Le immagini morfologiche e di diffusione sono state analizzate da due radiologi in consenso. E' stato calcolato il coefficiente di di…

Imaging of Hepatic Focal Nodular Hyperplasia: Pictorial Review and Diagnostic Strategy

Focal nodular hyperplasia (FNH) is the second most common benign solid liver lesion after hemangioma, occurring more frequently in young women. The prime differential diagnoses include hepatocellular adenoma, hepatocellular carcinoma, and hypervascular metastasis. As the management of FNH is typically conservative, imaging plays a key role in diagnostic pathway, and misdiagnosis may have a major clinical effect. In this article, we describe the ultrasound, computed tomography, and magnetic resonance imaging features of FNH, underlining the importance of typical radiological features that allow a specific noninvasive diagnosis. We present a large spectrum of a typical imaging findings that F…

TYPICAL AND ATYPICAL HEPATOBILIARY PHASE (HB PHASE) APPEARANCES OF FOCAL NODULAR HYPERPLASIA (FNH)

Role of apparent diffusion coefficient values in prostate diseases characterization on diffusion-weighted magnetic resonance imaging.

BACKGROUND: To evaluate if normal and pathological prostate tissue can be distinguished by using apparent diffusion coefficient (ADC) values on magnetic resonance imaging (MRI) and to understand if it is possible to differentiate among pathological prostate tissues using ADC values.METHODS:Our population consisted in 81 patients (mean age 65.4 years) in which 84 suspicious areas were identified. Regions of interest were placed over suspicious areas, detected on MRI, and over areas with normal appearance, and ADC values were recorded. Statistical differences between ADC values of suspicious and normal areas were evaluated. Histopathological diagnosis, obtained from targeted biopsy using MRI-…

CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain

AbstractEpiploic appendagitis is a rare cause of acute abdominal pain, determined by a benign self-limiting inflammation of the epiploic appendages. It may manifest with heterogeneous clinical presentations, mimicking other more severe entities responsible of acute abdominal pain, such as acute diverticulitis or appendicitis. Given its importance as clinical mimicker, imaging plays a crucial role to avoid inaccurate diagnosis that may lead to unnecessary hospitalization, antibiotic therapy, and surgery. CT represents the gold standard technique for the evaluation of patients with indeterminate acute abdominal pain. Imaging findings include the presence of an oval lesion with fat-attenuation…

Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT

We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A bett…

Hepatocellular carcinoma enhancement on contrast-enhanced CT and MR imaging: response assessment after treatment with sorafenib: preliminary results

PURPOSE: This study was undertaken to compare response evaluation criteria in solid tumours (RECIST) 1.1 and modified RECIST (mRECIST) in patients with unresectable hepatocellular carcinoma (HCC) on sorafenib, and to describe HCC enhancement changes before and after sorafenib treatment. METHODS AND MATERIALS: Seventeen patients (12 men, 5 women; mean age 69 years; age range 58-79 years) were included. Tumour response was assessed according to RECIST and mRECIST. Two readers placed a region of interest (ROI) within each target lesion, on the portion showing enhancement during the arterial phase. The lesion attenuation values measured within the ROIs on computed tomography or the signal inten…

Images - Computed tomography urographic appearance of traumatic rupture of renal cyst into the pyelocaliceal system.

Spontaneous or traumatic rupture of renal cysts, documented by radiological imaging, occurs infrequently. The pathogenesis of a cyst rupture is still unclear, except when it has occurred following trauma or when the cyst has become infected. Imaging plays a crucial role in the diagnosis, management, surveillance, and choice of lesions that need treatment.

Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound with a 1.5 Tesla Scanner: A Prospective Intraindividual Comparison Study of Intraoperative Imaging

Background: High-quality intraoperative imaging is needed for optimal monitoring of patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy. In this paper, we compare the intraoperative imaging obtained with dedicated FUS-Head coil and standard body radiofrequency coil in tcMRgFUS thalamotomy using 1.5-T MR scanner. Methods: This prospective study included adult patients undergoing tcMRgFUS for treatment of essential tremor. Intraoperative T2-weighted FRFSE sequences were acquired after the last high-energy sonication using a dedicated two-channel FUS-Head (2ch-FUS) coil and body radiofrequency (body-RF) coil. Postoperative follow-ups were performed at 48 h usin…

Congenital Cystic Lesions of the Bile Ducts: Imaging-Based Diagnosis

Congenital cystic lesions of the bile ducts represent a spectrum of liver and biliary system lesions, resulting from abnormal embryologic development of the ductal plate. These disorders include Caroli disease, choledochal cysts, autosomal dominant polycystic liver disease, congenital hepatic fibrosis, and biliary hamartomas. Each disorder carries a peculiar clinical presentation, prognosis, and risk of complications. Knowledge of radiological findings of fibropolycystic liver diseases is crucial for their appropriate detection and for differential diagnosis with other similar hepatic cystic lesions, in order to avoid relevant misdiagnosis. The aim of this review is to provide an illustrati…

Malignancy course of pituitary adenoma in MEN1 syndrome: Clinical-Neuroradiological signs

Pituitary carcinomas (PCa) are extremely rare, indistinguishable from pituitary adenomas on histopathological grounds and have a poor prognosis. Most PCa start as PRL or ACTH secreting tumors in males, with relapsing invasive behaviour, refractoriness to medical and radiotherapy and increasing hormonal levels. The presence of distant metastases is still required for the diagnosis of PCa. The association with genetic endocrine diseases must be taken into account, since it adds further risk of evolution towards malignancy. Intradural spinal metastases have also been reported, so a complete craniospinal MR evaluation is recommended, when clinically indicated. We report a case of PCa, associate…

Ultrastructural biologic effects of sonography with pulse inversion and microbubble contrast in rabbit liver

Purpose This prospective study was conducted to evaluate the biologic effects of microbubble destruction with pulse-inversion harmonic imaging on rabbit liver parenchyma. Methods The livers of 6 albino rabbits were examined sonographically by a single investigator. Three rabbits underwent contrast-enhanced sonography, with scanning starting 5 seconds after injection by using pulse-inversion harmonic imaging with a mechanical index of 1.2. Four time-triggered images were recorded at a rate of 1 frame every 2 seconds. For comparison, 3 control rabbits had pulse-inversion harmonic imaging with a mechanical index of 1.2 only, without contrast medium. Immediately after sonography, the animals we…

IMAGING OF VESTIBULAR SCHWANNOMA [Chapter 4]

Lesions of the cerebellopontine angle and internal auditory canal are a frequent finding in neuroradiological examinations and their detection may represent a diagnostic challenge. Among these lesions, vestibular schwannomas and meningiomas are certainly the most frequent and account for up to 90% of all cerebellopontine angle tumours. The remaining ones are a group of lesions arising from the different structures found in these anatomical regions such as haemangiomas, lipomas, lymphomas, facial nerve tumours, and aneurysms. This chapter will introduce this topic focusing on a practical coverage of the typical and atypical neuroradiological signs that will drive towards the most correct dif…

Sonographic examination of epiaortic vessels in patients with peripheral vertigo

To evaluate the utility of echo-color-Doppler ultrasonography (CDU) of extracranial brain-supplying vessels in patients with peripheral vertigo of unknown origin.One-hundred-fifty-six patients (study group; 42 male and 114 female; mean age 61.86 ± 14.14) and 161 patients (control group; 80 male and 81 female; mean age 62.31 ± 13.69) were prospectively evaluated with CDU of extracranial brain-supplying vessels. Plaques in common and/or internal carotid artery (CA), arterial wall intima-media thickness (IMT) of common CA and peak systolic velocity (PSV) and resistive index (RI) of vertebral arteries (VA) were evaluated. Parametric (t-test) and non-parametric (Mann-Whitney U-test and Kolmogoro…

CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists

Contrast-enhanced CT is not routinely indicated in uncomplicated urinary infections, but it may be necessary in patients with specific risk factors (i.e., diabetes, immunocompromised patients, history of stones, or prior renal surgery) or in patients not responding to antibiotics and in detecting complications of pyelonephritis. CT is the gold standard for imaging assessment of pyelonephritis severity. Imaging appearance of acute pyelonephritis, including focal (i.e., wedge-shaped zones of decreased attenuation or hypodense mass) and diffuse (i.e., global enlargement, poor parenchymal enhancement, lack of excretion of contrast, fat stranding) forms, needs to be differentiated from renal inf…

Nuclear Medicine Methods in Scrotal Imaging

In patients with acute scrotal pain scrotal scintigraphy can be used to exclude torsion of the testicle, which presents with unilateral decrease in activity on the affected side.The role of nuclear medicine methods, however, faded in the last years after the introduction of high performance color Doppler ultrasound equipment. Lymphoscintigraphy can be used in patients with testicular cancer to demonstrate the lymphatic drainage pathway of the neoplasm. Several studies suggest that 18FDG-PET/CT might have a role in the staging germ cell tumors, in identification of recurrent/residual disease, to monitor the treatment response and during the follow-up. Other investigations, however, did not c…

Cerebral Vessels.

Coplanar Indirect-Navigated Intraoperative Ultrasound: Matching Un-navigated Probes With Neuronavigation During Neurosurgical Procedures. How We Do It.

BACKGROUND Intraoperative ultrasound (IOUS) is becoming more and more adopted in neurosurgery, since it has been associated to greater extent of resection (EOR) and to gross total resection (GTR) during brain tumor surgery. IOUS main limitations are spatial resolution, width and orientation of the field of view and scan quality, which are operator-dependent. Furthermore, most neurosurgeons are not confident with this technique, which needs a long learning curve in order to identify and interpret anatomic structures. OBJECTIVE To describe an effective procedure to take advantages of both IOUS and neuronavigation in case of lack of a navigated ultrasound system. METHODS We propose a reliable …

Texture analysis in susceptibility-weighted imaging may be useful to differentiate acute from chronic multiple sclerosis lesions.

To evaluate the diagnostic performance of texture analysis (TA) applied on non-contrast-enhanced susceptibility-weighted imaging (SWI) to differentiate acute (enhancing) from chronic (non-enhancing) multiple sclerosis (MS) lesions. We analyzed 175 lesions from 58 patients with relapsing-remitting MS imaged on a 3.0 T MRI scanner and applied TA on T2-w and SWI images to extract texture features. We evaluated the presence or absence of lesion enhancement on T1-w post-contrast images and performed a computational statistical analysis to assess if there was any significant correlation between the texture features and the presence of lesion activity. ROC curves and leave-one-out cross-validation…

Comparison of the Enhancement Pattern of Hepatic Hemangioma on Magnetic Resonance Imaging Performed With Gd-EOB-DTPA Versus Gd-BOPTA

Abstract Purpose To compare magnetic resonance imaging (MRI) findings with gadoxetic acid and gadobenate dimeglumine for the diagnosis of hepatic hemangiomas. Materials and Methods In this retrospective study, we included 26 hemangiomas (mean size was 14 mm ± 10 mm) in 19 patients (mean age 60 ± 14 years) scanned with both gadobenate dimeglumine MRI and gadoxetic acid MRI. For each patient, we collected multiple lesion variables including location, number, size and enhancement pattern on arterial, portal venous, 3-minute and hepatobiliary phases with both gadoxetic acid and gadobenate dimeglumine. The enhancement pattern with the two contrast agents was then compared. Results The typical en…

Deep Learning Network for Segmentation of the Prostate Gland With Median Lobe Enlargement in T2-weighted MR Images: Comparison With Manual Segmentation Method

Purpose: Aim of this study was to evaluate a fully automated deep learning network named Efficient Neural Network (ENet) for segmentation of prostate gland with median lobe enlargement compared to manual segmentation. Materials and Methods: One-hundred-three patients with median lobe enlargement on prostate MRI were retrospectively included. Ellipsoid formula, manual segmentation and automatic segmentation were used for prostate volume estimation using T2 weighted MRI images. ENet was used for automatic segmentation; it is a deep learning network developed for fast inference and high accuracy in augmented reality and automotive scenarios. Student t-test was performed to compare prostate vol…