Multifocal Biliary Cystadenocarcinoma of the Liver: CT and Pathological Findings

Biliary cystadenocarcinoma is a rare tumor that originates from the hepatobiliary epithelium. Although this tumor can affect any portion of the biliary tree, intrahepatic location is more common. It is usually a slow growing tumor and often asymptomatic until it reaches a considerable size. The lesion is most often solitary and large when discovered; multiple lesions or metastases within the liver are very rare. A 63-year-old man was referred to our institute for weight loss, abdominal discomfort, worsening bulky symptoms in the right upper abdominal quadrant, and an increase in serum aminotransferases that had been present for several months. Spiral CT of the abdomen demonstrated two lesi…

High Resolution CT Angiography in Detection of an Aneurysm of the Vein of Galen as a Source of Intracranial Haemorrhage in a Newborn.

Cerebral haemorrhage is a rare condition in infants and carries a known poor prognosis. Common causes of spontaneous haemorrhage include various vascular venous lesions due to incomplete hydrovenous maturation, among them Galen vein aneurysm may be a very rare cause of cerebral haemorrhage. This report emphasizes the role of multidector CT with high resolution CT angiography in a newborn with cerebral hemorrhage caused by Galen vein aneurysm rupture. MDCT with high resolution CT angiography helps to differentiate the cause of haemorrhage, and to address the appropriate treatment.

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…

IMPATTO DEL TEMA DELLA RADIOPROTEZIONE NELLA LETTERATURA RADIOLOGICA ITALIANA

Evaluate the interest aroused in the Italian radiological literature by radioprotection in the period 2004-2014, and its impact and development in national scientific research

Effects of the static magnetic field generated by 0.5 T MRI unit on TNF-α release of human PBMC from patients with rheumatoid arthritis.

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.

Sialographic findings in Wharton duct evagination

Ductal evagination is a rare condition affecting the Wharton duct. The aim of this study was to establish the incidence, imaging features and clinical significance of ductal evagination in patients undergoing submandibular gland sialography. The sialographic findings and reports of 322 patients undergoing submandibular gland sialography during the period 1998-2007 were retrospectively reviewed. Ductal evagination was identified on sialograms as a unique diverticulum, filled with contrast medium, of the Wharton duct, with a narrow neck and a blind end. A ductal evagination was found in 5/322 patients with swelling and pain in the submandibular gland. It was always located in the middle tract…

Conventional Radiology in the Evaluation of the Small Bowel

For many years, the small bowel has been considered as the “black box” of the gastrointestinal system because it could not be evaluated through endoscopy. For this reason, the conventional radiological methods, such as small bowel enteroclysis and small bowel follow-through, have been considered the standard approach for the evaluation of the small bowel in the diagnosis and management of Crohn’s disease for years. However, due to technological limits, the study of small bowel through conventional radiology has been focused mainly on its function than on its anatomy. To date, the conventional examination with the study of intestinal transit is now rarely used, if not obsolete, but it has st…

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…

Pediatric sialolithiasis distinctive characteristic in radiological imaging.

Aim of the present paper was to investigate the imaging and related clinical characteristics of sialolithiasis in Italian pediatric population trying to determine the difference between pediatric and adult. Twenty-nine pediatric patients (age range 1-17 years) with pain and postprandial swelling and/or purulent discharge in the salivary gland areas were referred to radiology department after pediatric ear, nose and throat (ENT) evaluation. They all were submitted to ultrasound examination of the main salivary glands. Multidetector computed tomography (MDCT) only was performed in 2/6 patients, in 2/6 patients both sialography and MDCT were performed due to inconclusive MDCT features, 2/6 onl…

Evaluation of pelvic floor dysfunctions with Defeco-MR: an accurate MR protocol and a radiological template.

Learning objectives Background Findings and procedure details Conclusion Personal information References

A simple technique of oblique anastomosis can prevent stricture formation in primary repair of esophageal atresia

Abstract Background Anastomotic stricture is an important problem after esophageal atresia (EA) repair. This study evaluates a technique of oblique esophageal anastomosis without use of a flap in order to prevent stricture formation. Methods Medical records of 16 patients (14 with EA type III and 2 with EA type IV Ladd-Gross classification) who underwent primary repair of EA at birth without anastomotic tension were reviewed, evaluating long-term follow-up results. All patients were studied with esophageal contrast study, pH-multichannel intraluminal impedance, and endoscopy. The incidence of complications and their management were analysed. Results Contrast esophagogram and esophagoscopy a…

Diverticoli duttali delle ghiandole salivari maggiori.

Cardiac rupture caused by traffic accident: Case reports and a literature review.

The commonest cause of blunt cardiac injuries is from traffic accidents followed by violent falls, sport activities, accidents or a fight but rupture of the heart is rare and lethal. The precise incidence of cardiac injury after a blunt chest trauma is unknown as rates vary greatly in the literature from between 7% and 76% of cases. Autopsy studies have shown that the right ventricle is the most frequently ruptured, followed by the left ventricle, right atrium, intraventricular septum, left atrium and interatrial septum with decreasing frequency. Post-mortem imaging is a rapidly advancing field of post-mortem investigations of trauma victims. The available literature dealing with the compa…

An edge-driven 3D region growing approach for upper airways morphology and volume evaluation in patients with Pierre Robin sequence

In this paper, a semi-automatic approach for segmentation of the upper airways is proposed. The implemented approach uses an edge-driven 3D region-growing algorithm to segment ROIs and 3D volume-rendering technique to reconstruct the 3D model of the upper airways. This method can be used to integrate information inside a medical decision support system, making it possible to enhance medical evaluation. The effectiveness of the proposed segmentation approach was evaluated using Jaccard (92.1733%) and dice (94.6441%) similarity indices and specificity (96.8895%) and sensitivity (97.6682%) rates. The proposed method achieved an average computation time reduced by a 16x factor with respect to m…

DIFFERENT LOCATIONS OF ENDOMETRIOSIS IN 86 PATIENTS: A SINGLE- CENTRE STUDY.

Endometriosis is an important gynecologic disorder defined as the presence of functional endometrial glands and stroma outside the uterine cavity. Prevalence of endometriosis is 6-10% in the general population, but rises to 35-50% in women with pelvic pain or infertility or both. The aim of this study was to retrospectively review the different locations of pelvic and extrapelvic endometriosis occurred in our Department during last 3 years.

Regression of benign hepatic lesions associated with exogenous estrogens withdrawal

Learning objectives Background Findings and procedure details Conclusion Personal information References

Effects of the static magnetic field generated by a 0.5 MRI unit on intracellular calcium concentration and IFN- g release of human CD4 T cells

Interpretation of Diagnostic Imaging for Medicolegal Issues

Forensic radiology is a relative recently emergent part of forensic medicine characterized by the application of radiological methods in criminal investigations, such as the forensic M.E’s radiological reports in civil or penal matters for judicial technical advice. The various imaging modalities like X-rays, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasonography can be used depending on various forms of cases and their requirements in routine investigations.

MDCT and virtual angioscopy in spontaneous aortocaval fistula

Aortocaval fistula is a rare, less than 1%, but life threatening complication, of abdominal aortic aneurysm. Mortality is high but prompt recognition of the fistula can reduce mortality rate. The multidetector row CT (MDCT) findings in a 69-year-old patient with a complex medical history characterized by previous episodes of myocardial ischemia, is reported. MDCT shows an early homogeneous enhancement of the inferior vena cava, slightly dilated at the liver level and markedly narrowed above the renal vein due to aneurysm compression. The patient underwent to emergency laparotomy but died during surgery for cardiac arrest. MDCT allows a prompt recognition of the fistula and different compute…

Specific codon 13 K-ras mutations are predictive of clinical outcome in colorectal cancer patients, whereas codon 12 K-ras mutations are associated with mucinous histotype

Background: K-ras mutations, one of the earliest events observed in colorectal carcinogenesis, are mostly found in codons 12 and 13, and less frequently in codon 61, all three of which are estimated to be critical for the biological activity of the protein. Nevertheless the prognostic significance of such mutations remains controversial. Our purpose was to assess whether any or specific K-ras mutations in primary colorectal cancer had prognostic significance and were linked to clinico-pathological parameters. Patients and methods: Paired tumor and normal tissue samples from a consecutive series of 160 untreated patients (median of follow up 71 months), undergoing resective surgery for prima…

BRONCHIAL ARTERY EMBOLIZATION IN CYSTIC FIBROSIS PATIENTS: A SINGLE CENTRE EXPERIENCE

National guidelines for dental diagnostic imaging in the developmental age

This document aims to support the dental professional in choosing the adequate diagnostic technique, minimising the radiation dose in observance of the As Low As Reasonably Achievable (ALARA) principle (7). This principle states that the biological cost can only be justifed when the beneft, that is, the diagnosis, outweighs the risk related to radiation exposure. In this guideline paper, we report recommendations for radiologists, medical physicists, paediatrician, dentists and maxillofacial surgeons, with reference to the specifc felds.

Radiological Follow-Up of Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBD) are chronic gastrointestinal diseases that typically affect the young working-age population. Patients with IBD, both asymptomatic and symptomatic, often develop complications during their clinical course. This is particularly true in patients with Crohn’s disease (CD) and biological signs of inflammation, despite being asymptomatic. In addition, it seems clear that the absence of symptoms does not imply an absence of inflammation. For all the above mentioned reasons, patients should be followed up and objectively evaluated. IBD are idiopathic diseases characterized by periods of remission and frequent exacerbations. To appreciate the impact of disease pr…

Anomalous origin of bronchial arteries in patients with cystic fibrosis: therapeutic implications for embolisation.

Bronchial artery embolisation (BAE) is an accepted method of controlling haemoptysis in patients with cystic fibrosis. However, anomalous origin of the bronchial arteries, documented in anatomical and angiographic studies, makes the procedure more difficult and increases the number of recurrences. Clinical records and films from three patients affected by cystic fibrosis with haemoptysis, in which the origin of the bleeding vessels was considered anomalous, out of a total of seven patients who underwent BAE, were reviewed. In two patients the source of bleeding was identified from, respectively, the left and the right internal mammary artery and in one from the left thyrocervical trunk. All…

EMOTTISI IN FC: DALLA ETIOLOGIA ALLA TERAPIA

Analisi retrospettiva degli errori di posizione dei pazienti e l'impatto della dose nella colonscopia virtuale mediante TCMS: esperienza di un singolo centro

La Colonscopia virtuale (CV) tramite tomografia computerizzato multi-strato (TCMS) è una nota e valida tecnica alternativa alla colonscopia ottica per la valutazione della parete del colon e la individuazione di nuove lesioni. Lo svantaggio principale per la sua esecuzione è l’esposizione del paziente alle radiazioni ionizzanti. Questo è il motivo per cui linee guida raccomandano procedure di acquisizione a basso dosaggio standardizzate volte a ridurre al minimo le radiazioni di esposizione. Abbiamo retrospettivamente esaminato l'impatto in termini di esposizione alle radiazioni ionizzanti in base alla posizione del paziente e la durata della scansione. [1].

Aspetti radiologici in 6 casi di fistole salivari.

Efficacy of raw implementation and reduction dose protocols in CT colonoscopy: a single centre 4 years retrospective review

Aims and objectives Methods and materials Results Conclusion Personal information References

Awareness of radiation protection issue in paediatric trainees. A questionnaire study.

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…

Cumulative radiation CT dose in young traumatic patients: a single centre 5 years retrospective review

Analisi della Conoscenza del rischio da radiazioni ionizzanti tra giovani radiologi e studenti in medicina. Indagine mediante questionario

Prognostic significance of p16INK4a alterations and 9p21 loss of heterozigosity in locally advanced laryngeal squamous cell carcinoma

The p16INK4a gene, localized within chromosome 9p21, has been identified as a cyclin-dependent kinase inhibitor and may negatively regulate the cell cycle acting as a tumor suppressor. Genetic alterations involving the 9p21 region are common in human cancers. A consecutive series of 64 untreated patients (median of follow up 53 months) undergoing surgical resection for locally advanced laryngeal squamous-cell carcinomas (LSCCs) has been studied prospectively. Our purpose was to investigate p16 alterations (9p21 allelic loss, hypermethylation and point mutations) and their possible association with clinico-pathological data and flow cytometric variables (DNA-ploidy and S-phase fraction (SPF)…

Overdiagnosis and overimaging: an ethical issue for radiological protection

Aims and objectives: This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. Materials and methods: In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. Results: The direct follow of overdiagnosis and overi…

Relationship between anxiety level and radiological investigation. Comparison among different diagnostic imaging exams in a prospective single-center study

Objective: Every patient could feel anxious when he waits in a radiological department to undergo diagnostic exams. The aim of our study is to evaluate the impact of the radiological exams on patient anxiety. Materials and methods: We evaluated 343 patients (mean age 54.83 years) who underwent different types of diagnostic exams in the Department of Diagnostic Imaging at our Hospital from April 2013 to August 2014. We administered to patients the State and Trait Anxiety Inventory Test, which detected with high sensitivity both state anxiety and trait anxiety. A team of clinical psychologists and radiologists evaluated the scores obtained. Results: 83 out of 343 patients were excluded becaus…

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…

PREOPERATIVE ASSESSMENT OF RECTAL CANCER: AN ACCURATE MRI PROTOCOL A RADIOLOGICAL TEMPLATE

Learning objectives Background Findings and procedure details Conclusion Personal information References

Tubular carcinoma of the breast: Outcome and loco-regional recurrence in 307 patients

Abstract Purpose The aim of this study is to describe the University of Florence experience in evaluating clinical, pathologic and treatment factors as they are related to the outcome and loco-regional recurrence in patients with tubular breast carcinoma. Material and methods Three hundred and seven patients (median age 56.4 years, range 26–91 years) with histological verified tubular carcinoma of the breast were consecutively treated at University of Florence from 1976 to 2001. All patients were followed for a median of 8.4 years (range 3 months to 20 years). Thirty-seven women underwent mastectomy and 270 underwent breast conserving surgery. Positive axillary nodes were found in 15% of pa…

A kernel support vector machine based technique for Crohn’s disease classification in human patients

In this paper a new technique for classification of patients affected by Crohn’s 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…

Violence and Abuse: Battered Child

Battered child is a crucial social and medical issue, which represents a major cause of morbidity and mortality among children. The ‘child abuse syndrome’ is a clinical condition in young children who have received serious physical abuse, and should be considered in any child exhibiting evidence of fracture of any bone, subdural haematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. A clinical-radiological-forensic collaboration is crucial for its identification.

Diffusion weighted magnetic resonance imaging at 1.5 Tesla in paediatric patients with Crohn's disease

Aim of our study was to investigate role of ADC values at b=0, 500, 800, and at multi-b in the evaluation of PCD

Intestinal malrotation in a female newborn affected by Osteopathia Striata with Cranial Sclerosis due to a de novo heterozygous nonsense mutation of the AMER1 gene

Abstract Background Osteopathia Striata with Cranial Sclerosis (OS-CS), also known as Horan-Beighton Syndrome, is a rare genetic disease; about 90 cases have been reported to date. It is associated with mutations (heterozygous for female subjects and hemizygous for males) of the AMER1 gene, located at Xq11.2, and shows an X-linked pattern of transmission. Typical clinical manifestations include macrocephaly, characteristic facial features (frontal bossing, epicanthal folds, hypertelorism, depressed nasal bridge, orofacial cleft, prominent jaw), hearing loss and developmental delay. Males usually present a more severe phenotype than females and rarely survive. Diagnostic suspicion is based o…

Congenital syphilis in a preterm newborn with gastrointestinal disorders and postnatal growth restriction.

Abstract Background Congenital syphilis (CS) depends on the placental transmission of Treponema pallidum (TP) spirochetes from an infected mother to fetus during pregnancy. It shows a wide clinical variability with cutaneous and visceral manifestations, including stillbirths, neonatal death, and asymptomatic cases. Preterm infants with CS may have more severe features of disease than the term ones, due to the combined pathogenic effect of both CS and prematurity. Case presentation We report on a female preterm (32+6 weeks of gestation) newborn showing most of the typical CS manifestations, in addition to gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorp…

Shot-dead CT-virtopsy: our experience

Learning objectives Background Findings and procedure details Conclusion Personal information References

Key-points to evaluate correctly the placement of umbilical venous catheters in infants on frontal radiographs

Provide basic key-points to evaluate placement of umbilical venous catheters (UVC) using a simplified flow-chart in resident radiologist.

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%–80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the…

EVALUATION OF MESENTERIC CHANGES WITH ELASTOSONOGRAPHY AND DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING IN PATIENTS WITH CROHN'S DISEASE: PRELIMINARY RESULTS

Aims and objectives Methods and materials Results Conclusion Personal information References

Complete written/oral information about dose exposure in CT: is it really useful to guarantee the patients' awareness about radiation risks?

Aims and objectives: According to the European directive 2013/59/Euratom, starting from February 2018, the information relating to patient exposure will be part of computed tomography (CT) reports, but the impact of this information on patients has not been deeply evaluated. Aim of our study was to evaluate patients’ perception of radiation exposure related to routine CT and their understanding after communication of their dose exposure. Materials and methods: A survey, investigating patient’s knowledge of radiation dose, was given to all adult patients (> 18 years) undergoing a CT examination both before and after CT scan. The first survey was the same for all patients. After CT scan, a se…

RILEVANZA DELLA TEMATICA RADIOPROTEZIONISTICA NELLA LETTERATURA RADIOLOGICA NAZIONALE

Effects of the static magnetic field generated by 0.5 T MRI unit on human CD4+ T cells activation patterns.

DNA ploidy and S-phase fraction, but not p53 or NM23-H1 expression, predict outcome in colorectal cancer patients. Result of a 5-year prospective study.

Purpose: The aim of this study was to determine TP53 and NM23-H1 immunoreactivity, DNA ploidy, and S-phase fraction (SPF) in a series of 160 patients undergoing resective surgery for primary operable colorectal cancer (CRC) and to establish whether these alterations have any clinical value in predicting CRC patients' prognosis. Methods: TP53 and NM23-H1 expressions were evaluated on paraffin-embedded tissue by immunohistochemistry and DNA-ploidy and SPF on frozen tissue by flow-cytometric analysis. Results: The median follow-up time in our study group was 71 months (range 34-115 months). P53 protein expression was associated with distal tumors (P < 0.05) and DNA aneuploid tumors (P < …

EFFECTS OF THE STATIC MAGNETIC FIELD GENERATED BY 0.5 T MRI UNIT ON INTRACELLULAR CALCIUM CONCENTRATION AND TNF-ALPHA RELEASE OF HUMAN MACROPHAGES

Cumulative radiation CT dose in non-oncological patients : a single centre 5 years retrospective review

Unusual spontaneous salivary fistula: A retrospective review of the last 12 years

Interstitial deletions of chromosome 1p: novel 1p31.3p22.2 microdeletion in a newborn with craniosynostosis, coloboma and cleft palate, and review of the genomic and phenotypic profiles

Abstract Background Rearrangements of unstable DNA sequences may alter the structural integrity or the copy number of dose-sensitive genes, resulting in copy number variations. They may lead more frequently to deletions, in addition to duplications and/or inversions, which are the underlying pathogenic mechanism of a group of conditions known as genomic disorders (or also contiguous gene syndromes). Interstitial deletions of the short arm of chromosome 1 are rare, and only about 30 patients have been reported. Their clinical features are variable, in respect of the extent of the deleted region. They include global developmental delay, central nervous system (CNS) malformations, craniosynost…

MRI Enteroclysis and Enterography

Magnetic Resonance is actually the most complete and less invasive imaging technique in the evaluation of Crohn’s disease. Compared to Computed Tomography and Ultrasound, Magnetic Resonance allows both a morphological and qualitative evaluation of the disease at the same time, thus allowing an evaluation of its extension in the gastrointestinal tract and of its grade of activity, obtaining an accurate relation with the clinical status of the patient. This is possible thanks to its intrinsic characteristics, as multiplanarity, high contrast resolution, and the possibility to make a functional assessment; moreover, there is no use of ionizing radiation. For all these reasons, this technique h…

Urgenza in terapia intensiva neonatale: la distensione addominale

MR Imaging of Perianal Crohn Disease: The Role of Contrast-enhanced Sequences

The MR imaging protocol described by the authors includes contrast-enhanced T1-weighted imaging with fat saturation in all patients except those with poor renal function. Horsthuis et al demonstrated in 2009 the usefulness of contrast-enhanced MR imaging for determining disease activity. Contrast agent administration is also required in case of suspicion of neoplastic tissue complicating fistulas. The joint European Crohn’s and Colitis Organisation–European Society of Gastointestinal and Abdominal Radiology guidelines report that T2-weighted images and contrast-enhanced T1-weighted images are included in the MR imaging protocol for the evaluation of perianal CD. However, as we have demonstr…

Editorial from guest editors current Euratom legislation (DE 59/2013): new patient management in radiation protection.

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Practical recommendations for the application of DE 59/2013

The changes introduced with Council Directive 2013/59/Euratom will require European Member States adapt their regulations, procedures and equipment to the new high standards of radiation safety. These new requirements will have an impact, in particular, on the radiology community (including medical physics experts) and on industry. Relevant changes include new definitions, a new dose limit for the eye lens, non-medical imaging exposures, procedures in asymptomatic individuals, the use and regular review of diagnostic reference levels (including interventional procedures), dosimetric information in imaging systems and its transfer to the examination report, new requirements on responsibiliti…

Comparison of US Strain Elastography and Entero-MRI to Typify the Mesenteric and Bowel Wall Changes during Crohn’s Disease: A Pilot Study

Purpose. To evaluate and compare the mesenteric and bowel wall changes during Crohn’s disease (CD) on ultrasonography (US) Strain Elastography (SE) and Enterography Magnetic Resonance Imaging (E-MRI). Methods. From July 2014 to September 2016, 35 patients with ileocolonoscopy diagnosis of CD were prospectively examined with E-MRI and in the same time with US and SE. Results. A total of 41 affected bowel segments and 35 unaffected bowel segments in 35 patients were evaluated. US-SE color-scale coding showed a blue color pattern in the fibrotic mesentery and bowel wall in 15 patients and a green color pattern in the edematous ones in 20 patients. The signal of the bowel wall and mesenteric fa…

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.

Role of virtopsy in the post-mortem diagnosis of drowning.

Purpose: Due to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning. Materials and methods: We retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy. Conclusion: To date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in tha…

Anatomic variants of the biliary tree at MRCP: still too rarely reported!

Aims and objectives Methods and materials Results Conclusion Personal information References

Protecting sensitive patient groups from imaging using ionizing radiation: effects during pregnancy, in fetal life and childhood

The frequency of imaging examinations requiring radiation exposure in children (especially CT) is rapidly increasing. This paper reviews the current evidence in radiation protection in pediatric imaging, focusing on the recent knowledge of the biological risk related to low doses exposure. Even if there are no strictly defined limits for patient radiation exposure, it is recommended to try to keep doses as low as reasonably achievable (the ALARA principle). To achieve ALARA, several techniques to reduce the radiation dose in radiation-sensitive patients groups are reviewed. The most recent recommendations that provide guidance regarding imaging of pregnant women are also summarized, and the…

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…

EFFECTS OF THE STATIC MAGNETIC FIELD GENERATED BY 0.5 T MRI UNIT ON INTRACELLULAR CALCIUM CONCENTRATION AND IFN-GAMMA RELEASE OF HUMAN CD4+ T CELLS.

Postmortem Computed Tomography: From Acquisition to Reporting

PMCT in a noninvasive, fast, and quite available method which coroners and forensic experts tend to use more and more often, especially when a crime is suspected. PMCT proved to be an excellent tool for detection and assessment of bone fracture injuries due to sharp trauma and bullet trajectories.

MR IMAGING IN A CASE OF PRIMARY EPIPLOIC APPENDAGITIS IN A 12 YEARS GIRL

Correlation between clinical response and urinary interleukin levels using different doses and intravesical administration schedules of interferon-alpha-2b combined with epirubicin: a pilot study

A total of 62 patients at high risk for recurrence of superficial bladder cancer were selected for a study designed to compare the prophylactic efficacy of different doses and schedules of sequential intravesical instillations of epirubicin and interferon-alpha-2b and to evaluate which sequence could enhance the release of cytokines in the urine. Our investigations showed a significant increase in urinary concentrations of interleukins in patients who received the sequential intravesical administration of epirubicin and interferon-alpha-2b. Higher urinary concentrations of interleukins and a lower recurrence rate were detected in patients who received interferon-alpha-2b 24 h after epirubic…

Effects of the static magnetic field generated by 0.5 T MRI unit on intracellular calcium concentration and TNF-α release of human macrophages

La lipomatosi congenita infiltrante del volto. Caso Clinico

Congenital infiltrating lipomatosis of the face, first described by Beck in 1836, is a rare condition of unknown etiology, characterized by widespread infiltration of mature fat cells in the context of tissues softening of the face, with associated consequent bone deformities. It is presented as an isolated or associated condition hemimegalencephaly and neurocutaneous syndromes. We describe the case of a 10-year-old patient with known lipomatosis congenital of the face, arrived at our structure for follow up with Computed Tomography (CT) and Resonance Magnetic (RM) ..

Role of MSCT scan in management of patients with primary epiploic appendagitis; our experience

Purpose Methods and Materials Results Conclusion References Personal Information

CT exposure in adult and paediatric patients: a review of the mechanisms of damage, relative dose and consequent possible risks.

An increase has been observed not only in the absolute number of CT examinations but also in the length of coverage and number of scanning phases, with the result that exposure to ionising radiation from CT is becoming an increasingly serious problem. The extent of the problem is not entirely known and cannot be adequately addressed without proper knowledge of all the phases that leads to the effective dose calculation. In light of the growing awareness of the issue of ionising radiation dose and the possible risk for the individual and the population, there is a need for radiologists, medical physicists and radiographers to play an active role in dose management. In this review, the author…

Leucodistrofia metacromatica e poliposi colecisti: una rara associazione

Gallbladder polyposis is a rare and poorly described condition in the pediatric literature. We report the case of one 6-year-old girl with metachromatic leukodystrophy and with incidental evidence of gallbladder polyposis ultrasound. The presented case highlights the importance of the association of cholecistic polyposis with various syndromes including metachromatic leukodystrophy.

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-…

Radiation protection in paediatrics age

Radiological protection in paediatric population from medical imaging is a subject promoted by various international associations and it is becoming a main field of interest. Paediatric patients have a significant risk from ionizing radiation (IR) following X-ray examination (chest, abdomen and skeletal segments), multidetector CT (MDCT) and PET imaging [1]. Their greater damage’s risk is due to: growing tissues with elevated turnover and high radio sensitivity cellular, the high water content which amplifies the damage, the small body size that involves the exposure of large areas associated with the expectation of long- life makes possible the development of diseases resulting from geneti…

TC MULTIDETETTORE NELLO STUDIO DELL’EPATOCARCINOMA DI TIPO INFILTRATIVO

Small Bowel Perforations: What the Radiologist Needs to Know

The incidence of small bowel perforation is low but can develop from a variety of causes including Crohn disease, ischemic or bacterial enteritis, diverticulitis, bowel obstruction, volvulus, intussusception, trauma, and ingested foreign bodies. In contrast to gastroduodenal perforation, the amount of extraluminal air in small bowel perforation is small or absent in most cases. This article will illustrate the main aspects of small bowel perforation, focusing on anatomical reasons of radiological findings and in the evaluation of the site of perforation using plain film, ultrasound, and multidetector computed tomography equipments. In particular, the authors highlight the anatomic key notes…

EVALUATION OF RESPONSE IN MALIGNANT TUMORS TREATED WITH TARGETED AGENTS.

Learning objectives Background Findings and procedure details Conclusion Personal information References

Bronchial to subclavian shunt in a CF patient. A potential pitfall for embolization

Bronchial artery embolization is a well accepted and widely used technique in the management of massive haemoptysis in cystic fibrosis (CF). It can be a complex procedure requiring a deep knowledge of the bronchial artery anatomy including the possible bronchial anastomoses. We report a case of complex vascular anatomy of the left bronchial artery with multiple anastomoses with the ipsilateral subclavian artery as cause of non-attempted embolization. © 2003 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Effetti biologici del campo magnetico statico da 0,5 T generato da un tomografo RM sul rilascio di citochine da linfociti e macrofagi

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation

Abstract Purpose Functional bowel outcome in patients with anorectal malformation often is poor. For fecal incontinence resulting from sphincter dysfunction, biofeedback (BFB) training appears to be effective. The aim of study was to investigate the bowel function in incontinent children treated for ARM, using a clinical score, a manometric and pelvic magnetic resonance evaluation, in order to establish predictive parameters of response after BFB. Methods 25 children (median age of 6.5years) with true fecal incontinence were evaluated by clinical score, anorectal manometry and magnetic resonance imaging (MRI). According to these evaluations patients were divided in 4 groups: group 1 (favora…

p53 mutations in L3-loop zinc-binding domain, DNA-ploidy, and S phase fraction are independent prognostic indicators in colorectal cancer: A prospective study with a five-year follow-up

p53 gene alterations are among the most common events observed in colorectal cancer,and are accompanied frequently by DNA aneuploidy and high proliferative activity. The prognostic significance of such mutations remains controversial. We prospectively evaluated the prognostic significance of p53 mutations, DNA-ploidy, and S phase fraction (SPF) in a consecutive series of 160 colorectal cancer patients (median follow-up 71 months). Tumor DNA was screened for p53 mutations by PCR/single-strand conformational polymorphism/sequencing. DNA-ploidy and SPF were assessed by DNA flow cytometry. p53 mutations were detected in 68 of 160 (42.5%) cases. In 56% (38 of 68) of these, p53 mutations were fou…

MULTI-DETECTOR CT STUDIES IN CHILDREN: A COMPARISON OF RADIATION DOSES BETWEEN PAEDIATRIC AND NON-PAEDIATRIC RADIOLOGY UNITS. RESULTS FROM THE FIRST 2011 ITALIAN SIRM SURVEY

EFFECTS OF THE STATIC MAGNETIC FIELD GENERATED BY 0.5 T MRI UNIT ON TNF-alpha RELEASE OF HUMAN PBMC FROM PATIENTS WITH RHEUMATOID ARTHRITIS.

DOSE CUMULATIVA IN TCMD IN UN GRUPPO DI PAZIENTI GIOVANI SOTTOPOSTI A TC PER TRAUMA MAGGIORE: STUDIO MONOCENTRICO RETROSPETTIVO DEGLI ULTIMI 5 ANNI.

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…

Radiation dose in non-dental cone beam CT applications: a systematic review.

Background: Radiation-induced health risks are broadly questioned in the literature. As cone beam computed tomography (CBCT) is increasingly used in non-dental examinations, its effective dose needs to be known. This study aimed to review the published evidence on effective dose of non-dental CBCT for diagnostic use by focusing on dosimetry system used to estimate dose. Materials and methods: A systematic review of the literature was performed on 12 November 2017. All the literature up to this date was included. The PubMed and web of science databases were searched. Studies were screened for inclusion based on defined inclusion and exclusion criteria according to the preferred reporting ite…

Multiple Congenital Colonic Stenosis: Case Report and Review of the Literature

Congenital malformations affecting the colon are rare pediatric conditions often presenting as obstruction. Colonic atresia accounts for 5-­‐10% of atresia in newborns, stenosis is even more rare.Since 1968, only 16 cases of CCS have been reported in literature (Table 1). Because of the rarity of the disease, little is known about this uncommon condition and management is still controversial. We present a case of multiple congenital colonic stenosis and review the literature with a special focus on management of CCS. To the authors' knowledge, multiple congenital colonic stenosis has not been reported previously in the literature.

Radiation risks knowledge in resident and fellow in paediatrics: a questionnaire survey

Background: Analyse through a multi-choice anonymous questionnaire the knowledge's level in paediatric residents and fellows in two different main Italian hospital, looking mainly to the information to patients and relatives related to risks of ionizing radiation used in common radiological investigations in children. Methods: 65 multi choice questionnaires were distributed to paediatric residents and fellows of two different hospitals, an University Hospital (A.O.U.P. "P. Giaccone"- University of Palermo) and a national reference centre for paediatrics (Ospedale Pediatrico Bambino Gesù - Rome). The questionnaire included twelve multiple-choice questions with the aim of analyzing the knowle…

Pediatric radiation doses from multi-detector CT exams: preliminary results from the first 2011 Italian national survey

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…

Angiomiolipomi renali sanguinanti.Rilievi con TC

To describe our experience in three cases of abdominal haemorrhage caused by bleeding renal angiomyolipomas, which were studied with Computed Tomography (CT). MATERIALS AND METHODS: A retrospective study carried out at our archives identified 3 patients (aged 58.6 on average) with renal angiomyolipomas clinically manifested with acute abdomen and haemorrhage. The patients underwent an emergency CT scan of the abdomen. One patient also under-went a subsequent renal angiography. All patients had surgery and histological characterizations of the renal lesions. RESULTS: The CT study on all three patients allowed detection of a lesion in the kidneys with inhomogeneous density due to haemorrhage.…

Subcutaneous rupture of hepatic hydatid cyst: CT findings.

Is MRI imaging in pediatric age totally safe? A critical reprisal.

Current radiological literature is strongly focussed on radiation imaging risks. Indeed, given there is a small but actual augment in cancer risk from exposure to ionizing radiation in children, it is important to understand what the risk of alternative techniques could be. We retrospectively review literature data concerning possible MR imaging risks, focussing on the biological effects of MR, sedation and gadolinium compound risks when dealing with infant patients. The main concerns can be summarized in: (1) Biological effects of non-ionizing electromagnetic fields (EMF) employed—whose mechanisms of interaction with human tissues are polarization, induced current, and thermal heating, res…

MR Imaging of Uterus Didelphys Transverse Vaginal Septum Causing Hematometrocolpos and Renal Agenesis

The association of uterus didelphys and unilateral blind vagina with ipsilateral renal agenesis is an infrequent urogenital malformation distinguished by a lesion of the mesonephric duct. In most patients, symptoms are present at the beginning of the menstrual cycle because a transverse vaginal septum on one side obstructs the flow of menses, which consequently collect. Magnetic resonance imaging allows a precise delineation of this congenital abnormality, clearly demonstrating the transverse vaginal septum with hematometrocolpos and uterus didelphys. Extending the magnetic resonance study to the abdomen and employing coronal sections with a wide field of view is important to search for ass…

IMPACT OF RADIATION DOSE AND PROTECTION IN THE ITALIAN PAEDIATRIC RADIOLOGICAL LITERATURE

Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients

Background Preoperative lymphoscintigraphy is without doubt a valid method for the detection of the sentinel lymph node (SLN). There has been considerable debate regarding the optimal site for the introduction of the tracer; various sites include peritumoral (PT), periareolar (PA), subdermal, and intradermal injection. Purpose To evaluate retrospectively the lymphoscintigraphic identification rate of peritumoral (PT) injection versus subdermal periareolar (PA) injection in the detection of SLNs in breast cancer. Material and Methods Between October 2002 and December 2011, a cohort of 906 consecutive patients with biopsy proven breast cancer underwent 914 SLN biopsy procedures. A total of 33…

Imaging for Ballistic Trauma: Other Applications of Forensic Imaging in the Living

Firearms are mechanical instruments that allow launching remote specific bodies with mass (bullets) exploiting burst gas energy. The role of imaging for ballistic trauma is crucial in order to define the main characteristics for both judiciary and nonjudiciary purpose, which are the intracorporeal trajectory, the entrance and exit wounds, and the general characteristics of gunshot injuries.

Umbilical venous catheters placement evaluation on frontal radiogram: application of a simplified flow-chart for radiology residents

Background: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. Method: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluate…

Spontaneous Resorption of an Occipital Meningocele: Computed Tomography and Magnetic Resonance Imaging Evaluation

Cranial meningocele is a very rare variant of encephalocele. Meningocele can be associated with other disorders and may cause complications. Therapy is usually based on surgical treatment. To our knowledge, we describe the first case of spontaneous resorption of an occipital meningocele in a full-term newborn boy. A full-term newborn was noted to have a large non-skin covered, semitransparent cystic lump in the occipital bone. He underwent computed tomography and a diagnosis of meningocele was proposed. After a few hours, the cystic lump spontaneously readsorbed. After 1 week the patient underwent magnetic resonance. Histology confirmed the diagnosis.

Adult exposures from MDCT including multiphase studies: first Italian nationwide survey.

To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population.This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest–abdomen–pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDIvol) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure.The 75th percentiles of CTDIvol (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm…

Static magnetic fields generated by a 0.5T MRI unit affects in vitro expression of activation markers and interleukin release in human peripheral blood mononuclear cells (PBMC)

To investigate the effects of the static magnetic field (SMF) generated by a 0.5 T superconducting MRI unit on in vitro activation marker expression and interleukin release in human peripheral blood mononuclear cell (PBMC) samples from healthy volunteers.PBMC samples were split into two groups: exposed and sham-exposed under isothermal conditions. PBMC were exposed for 2 h at 24 degrees C to the SMF of a 0.5 T superconducting MRI unit. Immediately after exposure, both samples were cultured for 24 h at 37 degrees C with or without mitogenic stimulation by phytohaemagglutinin (PHA). PBMC were examined for expression of CD25, CD69 and CD71 by immunofluorescence analysis and supernatants were a…

FISTOLA AORTO-CAVALE SPONTANEA STUDIATA MEDIANTE TC MULTISTRATO ED ANGIOSCOPIA VIRTUALE

Radiation protection in non-ionizing and ionizing body composition assessment procedures

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The pur…

Analisi retrospettiva delle embolizzazioni bronchiali in Fibrosi cistica e follow up a lungo termine

Reversible effect of MR and ELF magnetic fields (0.5 T and 0.5 mT) on human lymphocyte activation patterns.

Purpose: The aim of this study was to investigate the effects of magnetic fields (MF) of different intensity generated by a magnetic resonance (MR) unit (0.5 Tesla) and a double cylindrical coil (0.5 mTesla) on human CD4+ T cell lines. Materials and methods: CD4+ T cells were exposed for two hours under isothermal conditions (37 ± 0.5°C) to the above mentioned MF; a control group was provided for each exposed sample. After exposure, the samples were analysed in the laboratory for the following endpoints: Release of cytokines, expression of surface markers, cell proliferation and levels of cytosolic free-calcium. Results: Exposure to MF for 2 h and subsequent in vitro stimulation in the pres…

Sialodochoplasty in the treatment of salivary-duct stricture in chronic sialoadenitis: technique and results

PURPOSE: This study was undertaken to investigate peroral balloon angioplasty of salivary-duct strictures (sialodochoplasty) in chronic sialadenitis, analysing the technique, results and limitations. MATERIALS AND METHODS: Nine patients underwent sialodochoplasty: seven for Stensen''s-duct strictures and two for Wharton''s-duct strictures. One patient had a double stricture of Stensen''s duct and another a salivary stone associated with a Wharton''s-duct stricture. All patients were subjected to preliminary sialography to evaluate stricture site, length and grade. Sialodochoplasty was performed after local anaesthesia and progressive dilation of the salivary-duct orifice. RESULTS: The stric…

KEY POINTS PER LA DETERMINAZIONE RADIOGRAFICA DELL’ERRATO POSIZIONAMENTO DEI CATETERI VENOSI OMBELICALI (CVO) E VALUTAZIONE RETROSPETTIVA IN 235 MAL POSIZIONAMENTI

CT AND MRI OF THYROGLOSSAL DUCT CYST

Aims and objectives Methods and materials Results Conclusion Personal information References

Interventional treatment of sialoliths in main salivary glands

Purpose. The aim of our study was to demonstrate the effectiveness of interventional radiology in the treatment of sialolithiasis, as the first-choice treatment for the removal of stones located in the middle and proximal tracts of the main salivary ducts, and to assess its limitations and contraindications. Material and methods. Between February 1998 and May 2001 eleven interventional removals of sialoliths were performed for recurrent obstruction of the main salivary duct associated with chronic sialadenitis. Patients were selected on the basis of a preliminary sialogram, designed to determine the location and size of the stone. Exclusion criteria were location of the stone in the gland h…

Gastrointestinal Stromal Tumors: Diagnosis, Follow-up and Role of Radiomics in a Single Center Experience

: Gastrointestinal stromal tumors (GISTs) arise from the interstitial cells of Cajal in the gastrointestinal tract and are the most common intestinal tumors. Usually GISTs are asymptomatic, especially small tumors that may not cause any symptoms and may be found accidentally on abdominal CT scans. Discovering of inhibitor of receptor tyrosine kinases has changed the outcome of patients with high-risk GISTs. This paper will focus on the role of imaging in diagnosis, characterization and follow-up. We shall also report our local experience in radiomics evaluation of GISTs.

Cumulative doses analysis in young trauma patients: a single-centre experience

Multidetector computed tomography (MDCT) represents the main source of radiation expo- sure in trauma patients. The radiation exposure of young patients is a matter of considerable medical concern due to possible long-term effects. Multiple MDCT stud- ies have been observed in the young trauma population with an increase in radiation exposure. We have identi- fied 249 young adult patients (178 men and 71 women; age range 14-40 years) who had received more than one MDCT study between June 2010 and June 2014. According to the International Commission on Radio- logical Protection publication, we have calculated the cumulative organ dose tissue-weighting factors by using CT-EXPO software ® . We…

SEMI-AUTOMATIC VOLUMETRIC SEGMENTATION OF THE UPPER AIRWAYS IN PATIENTS WITH PIERRE ROBIN SEQUENCE

Pierre Robin malformation is a rare craniofacial dysmorphism whose pathogenesis is multifactorial. Although there is some agreement in non-invasive treatment in less severe cases, the dispute is still open on cases with severe respiratory impairment. We present a semi-automatic novel diagnostic tool for calculating upper airway volume, in order to eventually address surgery in patients with Pierre Robin Sequence (PRS). Multidetector CT datasets of two patients and two controls were tested to assess the proposed method for ROI segmentation, upper airway volume computation and three-dimensional reconstructions. The experimental results show an irregular pattern and a severely reduced cross-s…

Primary epiploic appendagitis in a pediatric patient: prominent role of Magnetic Resonance Imaging in the diagnosis

Awarness of radiation protection issue in paediatric trainees. A questionnaire study.

Patients perception of ionising radiation risks in CT ionising exposure. Does dose bill works?

Communicating to patients the magnitude of risk related to ionizing radiation exposure is problematic because of the uncertainty in estimates derived principally from epidemiological studies of large populations [1-6]. Euratom directive 59/2013 requires that dose bill will be part of the radiological report in European Countries [7]. However, how a risk is framed has a profound effect on risk perception. To date, no previous studies evaluated which could be the best way to make patient friendly dose bill. Our aim was to evaluate patients' perception of radiation exposure related to routine CT and their understanding after dose bill.

MRI findings in lingual venous malformations.

To describe the plain and enhanced MRI findings of lingual venous malformations and to discuss the importance of contrast medium in the differential diagnosis of high intensity lesions of the tongue on T(2) weighted images.The clinical records and MR images of eight patients affected by a lingual venous malformation were retrospectively reviewed. Patients presented with a palpable submucosal bluish-red soft mass in the tongue. MRI examinations were performed on a 0.5 T superconducting unit. Plain and enhanced SE (spin echo) T(1) weighted and FSE (fast spin echo) T(2) weighted images were acquired in axial, sagittal and coronal planes. Axial SPGR (spoiled gradient recalled echo) T(1) weighte…

EFFECTS OF ELECTROMAGNETIC FIELDS ON IFN-GAMMA RELEASE AND CONTENENT FROM HUMAN SUBSETS OF CD4+T CELLS.

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…

CONOSCENZA DELLA PROBLEMATICA RADIOPROTEZIONISTICA TRA ASSISTENTI IN FORMAZIONE IN PEDIATRIA: ANALISI MEDIANTE QUESTIONARIO

Utility of post mortem computed tomography in clivus fracture diagnosis. Case illustration and literature review

Clivus fractures are usually associated with head blunt trauma due to traffic accident and falls. A 23 - year-old man died immediately after a smash-up while he was stopping on his motorcycle. Post-mortem Computed tomography (PMCT), performed before autopsy, revealed a complex basilar skull base fractures associated with brainstem and cranio-vertebral junction injuries, improving the diagnostic performance of conventional autopsy. Imaging data were re-assessable and PMCT offers the possibility to perform multiplanar and volume rendered reconstructions, increasing forensic medicine knowledge related to traumatic injuries.

Radiologic team performance index: A new paradigm in KPI evaluating radiology examination volumes department performance: Results of Sicilian regional healthcare system survey

Background: Efficient management of Radiologic Operative Units (ROU) because population health needs increase while healthcare systems provide less resources expendable in technologies and employee. Purpose: Create a Key Performance Indicator (KPI) defined Radiologic Team Performance Index (RTPI) able to compare the activity and efficiency of ROU operating under different environments and with different resources. Methodology/Approach: A survey was conducted in Sicilian Public Healthcare System on behalf of Sicilian Group of Italian Society of Medical Radiology (SIRM) for a total of 63 investigated ROU. Obtained informations concern workforce, emergency care organization, technologies avail…

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.

Lateral thoracic artery embolization in cystic fibrosis. A case report

We report the embolization of an aberrant origin of haemoptysis - from the internal branch of the lateral thoracic artery - in a patient affected by cystic fibrosis. The technical implications for embolotheraphy in case of an aberrant origin of a haemorrhage are emphasized. Many different systemic arteries may contribute to the blood supply of the lung and many connections may exist between the systemic, bronchial and pulmonary circulations. The presence of non-bronchial systemic arteries supply should be investigated when inconclusive findings are seen during bronchial artery embolization for haemoptysis.

Late allergic reaction following sialography

Multifocal biliary cystadenocarcinoma of the liver: CT and pathologic findings.

Biliary cystadenocarcinoma is a rare tumor that originates from the hepatobiliary epithelium. Although this tumor can affect any portion of the biliary tree, intrahepatic location is more common. It is usually a slow growing tumor and often asymptomatic until it reaches a considerable size. The lesion is most often solitary and large when discovered; multiple lesions or metastases within the liver are very rare. A 63-year-old man was referred to our institute for weight loss, abdominal discomfort, worsening bulky symptoms in the right upper abdominal quadrant, and an increase in serum aminotransferases that had been present for several months. Spiral CT of the abdomen demonstrated two lesio…

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…

EFFECTS OF THE STATIC MAGNETIC FIELD GENERATED BY A 1.5 T MRI UNIT ON TNF ALFA RELEASE AND TNF RECEPTOR II EXPRESSION OF HUMAN MONOCYTES.

ISTIOCITOSI A CELLULE DI LANGERHANS DEI MASCELARI, ASPETI CON OPT, TC E RM.

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…

Dose assorbita negli esami TC multistrato nell'adulto. Risultati preliminari della prima Survey Nazionale SIRM 2011

RUOLO DELLA TC A FASCIO CONICO NELLA DETEZIONE DEGLI ODONTOMI

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…

RADIATION DOSE FROM MULTIDETECTOR CT EXAMINATIONS IN ADULTS IN ITALY: RESULT OF THE FIRST ITALIAN SURVEY

MR imaging of perianal fistulas in Crohn's disease: Sensitivity and specificity of STIR sequences

Introduction Although some studies proved the role of STIR sequences in the evaluation of perianal fistulas in Crohn's Disease (CD), contrast medium is still injected in many institutions since there is not a validated reference MR protocol. Our purpose was to evaluate the role of the STIR sequence in the detection and characterization of perianal fistulae comparing it to the post-contrast T1 sequence and correlating it with rectal examination under anesthesia. Materials and methods We retrospectively reviewed all clinical records of 31 CD patients, suspected of having perianal fistulas, who had been submitted to an MR study before and after contrast medium injection and surgical exploratio…

Effects of the static magnetic field generated by a 1,5 T MRI unit on TNF-a release and TNF-receptor II expression of human monocyes

Intraoperative ultrasound-assisted approach for endoscopic treatment of vesicoureteral reflux in children

Purpose Despite minimal invasiveness and high success rate, guidelines still prescribe voiding Cystourethrogram (VCUG) after endoscopic treatment for vesicoureteral reflux (VUR) in children. The aim of this paper was to analyze whether intraoperative ultrasound (IO-US) could improve surgical accuracy and perioperative counseling, thus potentially decreasing the need for postoperative VCUG. Methods We selected children treated for moderate to high grade VUR, renal scarring or repeated infections under antibiotic prophylaxis from January to December 2015. Endoscopic injection was combined with IO-US to detect optimal needle placement and to guide mound formation. IO-US findings were compared …

RUOLO DELL’ANGIOSCOPIA VIRTUALE CON TC NEL FOLLOW UP DEI PAZIENTI CON ENDOPROTESI AORTICHE

L’EMBOLIZZAZIONE BRONCHIALE NEI PAZIENTI CON EMOTTISI IN FIBROSI CISTICA HA UN IMPATTO NEGATIVO SUL DECORSO CLINICO? ANALISI COMPARATIVA IN DUE POPOLAZIONI.

Reversible effect of magnetic fields on human lymphocyte activation patterns: different sensitivity of naive and memory lymphocyte subsets.

The aim of this study was to investigate the influence of 50 Hz magnetic or static magnetic fields of 0.5 mT on subsets of human CD4(+) T cells in terms of cytokine release/content, cell proliferation and intracellular free calcium concentration. CD4(+) T cells can be divided into different subsets on the basis of surface marker expression, such as CD45, and T cells can be divided into naive (CD45RA(+)) and memory (CD45RA(-)) cells. In this study, the effects of magnetic fields after 24 and 48 h of cell culture were analyzed. We found that the CD4(+)CD45RA(-) T subset were more sensitive after 2 h of exposure. Decreases in the release/content of IFN-gamma, in cell proliferation and in intra…

MRI DEFECOGRAPHY: TECHNIQUE, INDICATIONS AND CLINICAL FINDINGS NOT ONLY IN OBSTRUCTED DEFECATION SYNDROME

Learning objectives Background Findings and procedure details Conclusion Personal information References

Useful Evidence by Post-Mortem CT and Stereomicroscopy in Bone Injury: A Case Series from Forensic Practice

The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims to share with the scientific community how we approached two cases of very different bone injuries and the techniques used to differentiate relevant pathology findings of bone fragments. Two cases are analyzed from the case history of the forensic medicine institute of Palermo. PMCT made it possible to differentiate heat bone lesions from traumatic lesions. The stereomicroscope was superior to PMCT in being able to better characte…

Italian inter-society expert panel position on radiological exposure in Neonatal Intensive Care Units.

Abstract Background In the recent years, clinical progress and better medical assistance for pregnant women, together with the introduction of new complex technologies, has improved the survival of preterm infants. However, this result requires frequent radiological investigations mostly represented by thoracic and abdominal radiographs in incubators. This document was elaborated by an expert panel Italian inter-society working group (Radiologists, Paediatricians, Medical Physicists) with the aim to assist healthcare practitioners in taking choices involving radiation exposures of new-born infants and to provide practical recommendations about justification and optimization in Neonatal Inte…

A novel automated tool for calculating upper airways volume in patients with isolated Pierre Robin Sequence (IPRS).

Purpose Methods and Materials Results Conclusion References Personal Information

Imaging Evaluation of Facial Complex Strut Fractures

High-resolution multidetector computed tomography with multiplanar reformations and 3-D postprocessing often provides the detail necessary for preoperative assessment of facial injuries. Maxillofacial fractures are classified in the following manner: upper face fractures, midface fractures (the most frequent), Le Fort fractures, and lower face or mandible fractures. The facial skeleton is a framework of vertical and horizontal buttresses that ensures a better resistance to trauma, but serves also as reference for maxillofacial surgery to restore facial size and shape. Radiologists should know how to diagnose and report the main types of facial fracture.

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…

Impatto del tema della radioprotezione nella letteratura radiologica nazionale italiana

Evaluate the interest aroused in the Italian radiological literature by radioprotection in the period 2004-2014 and its impact and development in national scientific research.

Concordance of Radiological, Laparoscopic and Laparotomic Scoring to Predict Complete Cytoreduction in Women with Advanced Ovarian Cancer

Objective: To identify the best method among the radiologic, laparoscopic and laparotomic scoring assessment to predict the outcomes of cytoreductive surgery in patients with advanced ovarian cancer (AOC). Methods: Patients with AOC who underwent pre-operative computed tomography (CT) scan, laparoscopic evaluation, and cytoreductive surgery between August 2016 and February 2021 were retrospectively reviewed. Predictive Index (PI) score and Peritoneal Cancer Index (PCI) scores were used to estimate the tumor load and predict the residual disease in the primary debulking surgery (PDS) and interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT) groups. Concordance percentages we…

Analisi della tollerabilità dell'indagine scialografica.

Role of post mortem computed tomography in diagnosis of upper cervical fractures in child due to road accident: A case report and literature review

The upper cervical spine has unique anatomical features that distinguish it from the remainder of the cervical spine. Its motion segments make up a large amount of total cervical spine motion and, as a result,predispose it to a unique set of injuries. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to section of the spinal cord. The use of post mortem CT (PMCT), and the subsequent multi-planar and volume rendering reconstruction techniques can provide non-invasive, objective operator-independent imaging data set that may be further reviewed by other specialists. and can substantially add to forensic examinations of the skeleton, especial…

APPLICATION OF A FLOW CHART TO EVALUATE PLACEMENT OF UMBILICAL VENOUS CATHETERS ON FRONTAL RADIOGRAM IN RADIOLOGIST RESIDENT

Aims and objectives Methods and materials Results Conclusion Personal information References

Radiation dose from multidetector CT studies in children: results from the first Italian nationwide survey

Background Multidetector CT (MDCT) scanners have con- tributed to the widespread use of CT in paediatric imaging. However, concerns are raised for the associated radiation exposure. Very few surveys on radiation exposure from MDCT studies in children are available. Objective The aim of this study was to outline the status of radiation exposure in children from MDCT practice in Italy. Materials and methods In this retrospective multicentre study we asked Italian radiology units with an MDCT scanner with at least 16 slices to provide dosimetric and acquisition param- eters of CT examinations in three age groups (1–5, 6–10, 11– 15 years) for studies of head, chest and abdomen. The dosi- metric…

PAEDIATRIC SIALOLITHIASIS:MDCT AND SIALOGRAPHY ASPECTS. A SINGLE CENTRE EXPERIENCE

Ottimizzazione dei protocolli con le nuove TC: compromesso tra dose e qualità diagnostica. Il rischio espositivo.

The role of DWI sequences in preclinical investigations of the sacroiliac joints anomalies in patients with Crohn's disease. Our experience

Learning objectives Background Findings and procedure details Conclusion Personal information References

APPLICATION OF AN AUTOMATIC COMPUTERIZED ALGORITHM FOR THE ANALYSIS OF UPPER AIRWAYS REDUCTION IN PATIENTS WITH PIERRE ROBIN SEQUENCE STUDIED BY MDCT

An edge-driven 3D region-growing approach for upper airway morphology and volume evaluation in patients with Pierre Robin sequence

Abstract: Pierre Robin sequence (PRS) is a pathological condition responsible for a sequence of clinical events, such as breathing and feeding difficulties, that must be addressed to give the patient at least a chance to survive. By using medical imaging techniques, in a non-intrusive way, the surgeon has the opportunity to obtain 3D views, reconstruction of the regions of interest (ROIs), useful to increase understanding of the PRS patient’s condition. In this paper, a semi-automatic approach for segmentation of the upper airways is proposed. The implemented approach uses an edge-driven 3D region-growing algorithm to segment ROIs and 3D volume-rendering technique to reconstruct the 3D mode…