0000000000398695
AUTHOR
Maria Chiara Terranova
Unusual case of continuous urinary dribbling in a young female due to unknown complex urogenital malformation: magnetic resonance features
Congenital anomalies of kidney and urinary tract (CAKUT) occur in up to 3.2% of infants, and in almost one third of cases they are associated to genital aberrations. DMSA renal scintigraphy is considered the gold standard in CAKUT patients, to assess renal function, depict and locate ectopic kidney and to guide eventual surgical management. Recent cases have shown the noticeable limit of scintigraphy in detecting poorly functional renal moieties and associated genital anomalies; thus leading to a substantial delay in therapy, and, in females, to severe uro-gynecological complications. We herein describe a case of a young girl with unusual urinary dribbling, where DSMA scintigraphy was not d…
Role of Imaging in the Assessment of Age Estimation
Age assessment by skeletal age estimation of unknown individuals is of paramount importance in forensic science, both for assessing imputability (if the author of a crime is old enough to be tried and judged), both in case of unaccompanied minors, or whether refugees and asylum seekers are adults or juveniles, which implies different legal issues and procedures. The aim of this article is to review the age estimation methods used in forensic practice.
CEUS LI-RADS: a pictorial review
AbstractContrast-enhanced ultrasound (CEUS) greatly improved the diagnostic accuracy of US in the detection and characterization of focal liver lesions (FLLs), and it is suggested and often included in many international guidelines as an important diagnostic tool in the imaging work-up of cirrhotic patients at risk for developing hepatocellular carcinoma (HCC). In particular, CEUS Liver Imaging Reporting and Data System (LI-RADS) provides standardized terminology, interpretation, and reporting for the diagnosis of HCC. The aim of this pictorial essay is to illustrate CEUS features of nodules discovered at US in cirrhotic liver according to LI-RADS categorization.
Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging
The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass dis…
Patient centring and scan length: how inaccurate practice impacts on radiation dose in CT colonography (CTC).
Objective: The aim of this study was to acknowledge errors in patients positioning in CT colonography (CTC) and their effect in radiation exposure. Materials and methods: CTC studies of a total of 199 patients coming from two different referral hospitals were retrospectively reviewed. Two parameters have been considered for the analysis: patient position in relation to gantry isocentre and scan length related to the area of interest. CTDI vol and DLP were extracted for each patient. In order to evaluate the estimated effective total dose and the dose to various organs, we used the CT-EXPO ® software version 2.2. This software provides estimates of effective dose and doses to the other vario…
Imaging features of pancreatic metastases: A comparison with pancreatic ductal adenocarcinoma
Purpose: To compare imaging features of pancreatic metastases (PM) with those of pancreatic ductal adenocarcinomas (PDAC). Methods: CT and MR scans of 24 patients with 54 PM and 30 patients with PDAC were reviewed to evaluate the imaging features, which were compared by using a Chi square test. Results: We found a statistically significant difference between PM and PDAC based on location (P < 0.001), margins (P < 0.001), arterial enhancement (P = 0.004), rim enhancement (P < 0.001), pancreatic duct dilatation (P = 0.01), common bile duct dilatation (P = 0.003), vascular involvement (P = 0.02), parenchymal atrophy (P < 0.001), peripancreatic fluid (P = 0.03). Conclusion: Imaging features mig…
Swallowing impairment in neurologic disorders: The role of videofluorographic swallowing study
Patients with neurologic diseases almost inevitably develop various degrees of swallowing disorders during their life. Dysphagia is one of the main negative prognostic factors in this class of patients, leading to severe morbidity (i.e. aspiration pneumonia, dehydration, malnutrition, and life quality deterioration) and to a noticeable increase in public health spending. Videofluorographic swallowing study is considered the gold standard technique for swallowing impairment assessment. It is aimed at early identification of the risk of aspiration, definition of the kind and grade of dysphagia, and an indication to suspend oral nutrition and adopt other feeding strategies, and define when the…
A kernel support vector machine based technique for Crohnâs disease classification in human patients
In this paper a new technique for classification of patients affected by Crohnâs disease (CD) is proposed. The proposed technique is based on a Kernel Support Vector Machine (KSVM) and it adopts a Stratified K-Fold Cross-Validation strategy to enhance the KSVM classifier reliability. Traditional manual classification methods require radiological expertise and they usually are very time-consuming. Accordingly to three expert radiologists, a dataset composed of 300 patients has been selected for KSVM training and validation. Each patient was codified by 22 extracted qualitative features and classified as Positive or Negative as the related histological specimen result showed the CD. The eff…
A Novel System for Multi-level Crohn’s Disease Classification and Grading Based on a Multiclass Support Vector Machine
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can highly alter patient’s quality of life. Diagnostic imaging, such as Enterography Magnetic Resonance Imaging (E-MRI), provides crucial information for CD activity assessment. Automatic learning methods play a fundamental role in the classification of CD and allow to avoid the long and expensive manual classification process by radiologists. This paper presents a novel classification method that uses a multiclass Support Vector Machine (SVM) based on a Radial Basis Function (RBF) kernel for the grading of CD inflammatory activity. To validate the system, we have used a dataset composed of 800 E-MRI…
Post-mortem Foetal Imaging
The gold standard for the diagnosis of foetal death is known to be the autopsy examination, which is sometimes supplemented by chromosomal and/or genetic studies. Nevertheless, autopsy rates are continuously declining, due to multifactorial and complex reasons, even anatomical, social and psychological ones, thus impacting the rate of radiological post-mortem foetal examinations.
Imaging assessment of paediatric Crohn's disease: A literature review
Owing to the frequent absence of specific symptoms, diagnosis of Crohn's disease may be delayed, potentially leading to important patient morbidity, growth failure, pubertal delay, or a complicated form of the disease. In paediatric patients with Crohn's disease, radiation protection requires special consideration, and choosing the most appropriate imaging modality is crucial. All radiologists should be familiar with the main imaging characteristics of Crohn's disease. Therefore, the present study reviews the current literature on imaging modalities and main imaging characteristics of Crohn's disease. Magnetic resonance imaging is recommended for diagnosis of Crohn's disease in paediatric p…
Evaluation of a Support Vector Machine Based Method for Crohn’s Disease Classification
Crohn’s disease (CD) is a chronic, disabling inflammatory bowel disease that affects millions of people worldwide. CD diagnosis is a challenging issue that involves a combination of radiological, endoscopic, histological, and laboratory investigations. Medical imaging plays an important role in the clinical evaluation of CD. Enterography magnetic resonance imaging (E-MRI) has been proven to be a useful diagnostic tool for disease activity assessment. However, the manual classification process by expert radiologists is time-consuming and expensive. This paper proposes the evaluation of an automatic Support Vector Machine (SVM) based supervised learning method for CD classification. A real E-…
Hyaline fibromatosis syndrome (juvenile hyaline fibromatosis): whole-body MR findings in two siblings with different subcutaneous nodules distribution.
Abstract: Hyaline fibromatosis syndrome (juvenile hyaline fibromatosis) is a rare, progressive, autosomal recessive disorder whose main hallmark is the deposition of amorphous hyaline material in soft tissues, with an evolutionary course and health impairment. It may present involvement of subcutaneous or periskeletal soft tissue, or may develop as a visceral infiltration entity with poor prognosis. Very few radiological data about this inherited condition have been reported, due to the extreme rarity of disease. We herein present a case of two siblings, affected by different severity of the disease, with different clinical features. They were examined by whole-body MR (WBMR) in order to as…
Up-to-date imaging review of paediatric soft tissue vascular masses, focusing on sonography
The purpose of this article is to provide an up-to-date overview on imaging of paediatric vascular soft tissue masses, including both neoplastic and non-neoplastic lesions. We describe the-often challenging-imaging diagnosis-mainly performed by ultrasound (and secondarily by MRI) and differential diagnosis of vascular soft tissue lesions in children. We underline how important it is to determine whether a vascular anomaly has a regional vascular origin, or if there are other entities, ranging from benign to malignant lesions, which have flow-signal or blood degradation products. Even though clinical examination and patient's history are the first and indispensable steps in the initial diagn…
Useless and limits of Postmortem CT (PMCT) in a complex case of preterm infant murder
The present case-report empathizes the usefulness of post-mortem computed tomography (PMCT) in the detection of live birth signs in a baby found dead, comparing the results with standard autoptic, histologic and immunohistochemical examinations.The report describes the case of a new-born who was thrown out on the footpath from a window of the fifth floor according to the investigative police, whilst the mother has hidden herself immediately after childbirth.PMCT showed diffusely aerated lung parenchyma with signs of severe lung distress, air in the airways with no fluid inside, and air in the upper gastro-intestinal tract, in absence any resuscitation manoeuvres performed on the baby at del…
Lie Detection: fMRI
Objective detection of deception was extensively studied, starting from polygraph to more modern techniques, the functional MR (fMRI), and they are based on neural (sympathetic) activation that is evoked in stressful conditions, such as lying. The role of fMRI in neurophysiology has been extensively developed and studied, and its principles lie in the correlation between the brain demand of energy during determined task and its supply. Although being extensively studied, its role for judiciary purpose presents many shortcomings.
Swallowing evaluation with videofluoroscopy in the paediatric population
Valutazione della funzione deglutitoria in videofluoroscopia nei pazienti pediatrici.I disturbi della deglutizione in età pediatrica possono essere dovuti a diverse cause, dalla condizione di prematurità e patologie malformative sino al reflusso gastro-esofageo o a patologie infettive od infiammatorie del primo tratto gastroenterico. Nei neonati il processo della deglutizione è involontario e basato su meccanismi riflessi. In seguito, nell’ infanzia, la fase orale diventa volontaria , mentre le fasi faringea ed esofagea rimangono involontarie. I disordini della deglutizione possono severamente compromettere le capacità respiratorie e l’apporto nutrizionale dei pazienti pediatrici. La videof…
Whole-body magnetic resonance imaging in the diagnosis and follow-up of multicentric infantile myofibromatosis: A case report
Myofibromatosis is an uncommon disorder of infancy, characterized by proliferation of myofibroblasts in solitary or multiple nodules. The clinical characteristics depend on the involved sites: Myofibromatosis may develop as a musculoskeletal form, with non-painful swellings and eventual mass effect symptoms, or as a generalized form with visceral involvement and organ failure. Prognosis and therapy vary between the abovementioned patterns. When there is no visceral involvement, the tumors may regress spontaneously; however, the visceral form may represent a lifethreatening condition with poor outcome and it requires aggressive management. Imaging assessment of disease spread is mandatory to…
Are we overusing abdominal computed tomography scans in young patients referred in an emergency for acute abdominal pain?
Purpose: The primary objective was to assess the frequency of appropriateness of computed tomography (CT) for acute abdominal pain (AAP) in the emergency department; the secondary aim was to compare the diagnostic accuracy of ultrasound (US) and CT in the diagnosis of the aetiology of AAP for diseases that can be diagnosed by US; and the third objective was to assess extent to which inappropriate CT examinations for AAP result in ionizing radiation exposure. Material and methods: In this retrospective single-centre study, we included patients aged between 15 and 46 years referred to the emergency department for AAP in 2016 and submitted to abdominal CT scans, collecting a total of 586 patie…
Preventable fatal injury during rally race: a multidisciplinary approach
Abstract Introduction The motor vehicle crash (MVC) constitutes an important challenge for forensic pathology in order to identify the manner and cause of death. Our study focuses on a fatal accident during a rally race corresponding to MVC sub-category. Materials and method Postmortem computed tomography (PMCT) was performed before the conventional autopsy. Autoptic and PMCT data were compared. Data collection allowed analyzing biomechanical dynamics of the incident and post-traumatic injuries through qualitative-statistics and solicitation quantitative indices. Results Photo and circumstantial evidence analysis showed a wrong installation of double shoulder belt system of head and neck su…