Caustic ingestion: CT findings of esophageal injuries and thoracic complications

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

Computed Tomography of HCC

Contrast-enhanced CT allows an accurate noninvasive diagnosis of Hepatocellular Carcinoma (HCC) nodules, and assessment of hepatic vascular anatomy and patency. The use of state-of-the-art equipment and of a tailored protocol is crucial. CT results help to detect and stage HCC, select the best treatment option, and evaluate response to therapy. In this chapter, the CT protocol for the cirrhotic liver, the CT features of HCC before and after treatment and of portal vein thrombosis will be described.

Tumor enhancement at contrast-enhanced CT and Gd-enhanced MRI for the assessment of treatment response of hepatocellular carcinoma (HCC) after sorafenib

Scopo: To investigate whether arterial enhancement of advanced HCC during pre-treatment and follow-up contrast-enhanced CT (CECT) or Gd-enhanced MRI (Gd-MRI) can be used to predict tumor response to sorafenib. Materiali e metodi: Seventeen patients (12M, 5F; mean age: 69 years) receiving sorafenib for inoperable HCC between 2007 and 2010 were included. Median interval time between pre-treatment and follow-up CECT or Gd-MRI was 160 days. Tumor arterial enhancement was measured at baseline and follow-up: (tumor attenuation/intensity on arterial phase – tumor attenuation/intensity on unenh! anced images)/(tumor attenuation/intensity on unenhanced images) x 100. Response was assessed according …

Focal hepatic intrinsically hyperattenuating lesions at unenhanced CT: Not always calcifications.

Due to the growing use of CT, there has been an increase in the frequency of detecting focal liver lesions. Intrinsically hyperattenuating hepatic lesions or pseudolesions are not uncommon at unenhanced CT. Hyperattenuating hepatic lesions can be divided into non-calcified and calcified. Causes of intrinsic hyperattenuation include hemorrhage, thrombosis, and calcifications. Focal liver lesions can show hyperattenuation on unenhanced CT in case of severe liver steatosis. Recognition of etiologies associated with hyperattenuation on unenhanced CT can help the radiologist in characterizing focal liver lesions and pseudolesions. In this paper, we describe the spectrum of intrinsically hyperatt…

GROWTH RATE OF SMALL (≤2CM) HCC IN CIRRHOTIC PATIENTS: DETERMINING OPTIMAL SCREENING INTERVAL WITH SERIAL CT AND MRI

Computerised tomography and magnetic resonance imaging of laryngeal squamous cell carcinoma: A practical approach

Squamous cell carcinoma is the most common head and neck cancer. This review describes the state-of-the-art computerised tomography and magnetic resonance imaging protocols of the neck and the normal larynx anatomy, and provides a practical approach for the diagnosis and staging of laryngeal squamous cell carcinoma.

Small solid renal masses: Characterization by diffusion-weighted MRI at 3 T

AIM: To describe the appearance of small solid renal lesions (≤3 cm) on diffusion-weighted magnetic resonance imaging (MRI) and to determine whether ADC measurements may help to differentiate benign from malignant small solid renal masses. METHODS AND MATERIALS: Thirty-five patients with 47 small renal masses (23 malignant, 24 benign) who underwent 3 T MRI of the kidney using diffusion-weighted sequences (b values of 0 and 1000 s/mm(2)) were retrospectively evaluated. Qualitative and quantitative analysis of diffusion-weighted images was performed. RESULTS: Most lesions were hyperintense to kidney on high b-value diffusion-weighted images and hypointense on apparent diffusion coefficient (A…

Role of preoperative CT angiography with multimodality imaging reconstruction to perform laparoscopic Complete Mesocolic Excision (CME) and Central Vascular Ligation (CVL) in right-sided colon cancer: Is it really useful? A prospective clinical study.

Background: The concept of complete mesocolic excision (CME) and central vascular ligation (CVL) in right colonic resections appears to improve the oncological outcomes. The highest rate of complications reported in the literature in patients undergoing CME is related to difficult surgical manuevers and intraoperative bleeding due to the central vascular dissection. Methods: We used preoperative findings obtained with the CT angiography, multiplanar reformation (MPR), maximum intesity projection (MIP) and 3D volume rendering (VR) technique to verify if this preoperative radiological assessment had significant benefits regarding the difficulty of dissection of the embryological planes, the i…

Convegno su "Procreazione assistita: problemi e prospettive"

La cooperazione degli organi del Tribunale speciale per il Libano nella tutela dei diritti dei detenuti in attesa di giudizio

Ad un anno dall’inizio del funzionamento del tribunale Speciale per il Libano, questo articolo ne esamina l’operato in materia di diritti dei detenuti in attesa di giudizio. Nonostante si tratti del primo tribunale penale internazionale competente a conoscere crimini perpetrati in un paese dell’area araba, esso si pone pienamente nel solco evolutivo tracciato dai suoi predecessori ed anzi compie alcuni notevoli passi in avanti in tema di tutela dei diritti dei detenuti. All’interno dell’articolo viene esaminato l’operato di tutti i principali organi del Tribunale, mostrando come la tutela dei diritti umani sia stata una costante che ne ha innervato tutta l’attività, sia quella a carattere n…

Imaging features of solid renal masses

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

Hepatocellular carcinoma (HCC) with indeterminate findings at initial CT or MRI: Does imaging follow-up allow detection of conclusive imaging findings before significant tumor growth?

Multiple sclerosis: High prevalence of the ‘central vein’ sign in white matter lesions on susceptibility-weighted images

Purpose The aim of this study was to determine the occurrence and distribution of the ‘central vein’ sign in white matter lesions on susceptibility-weighted magnetic resonance images in patients with multiple sclerosis (MS) and cerebral small vessel disease (CSVD). Materials and methods T2-weighted and fluid-attenuated inversion recovery magnetic resonance images of 19 MS patients and 19 patients affected by CSVD were analysed for the presence and localisation of focal hyperintense white matter lesions. Lesions were subdivided into periventricular or non-periventricular (juxtacortical, subcortical, deep white matter and cerebellar) distributed. The number and localisation of lesions present…

CT and MR imaging of cystic renal lesions

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

Unusual imaging manifestation of severe bilateral cochlear otosclerosis: a case report

Assessment of cerebral microbleeds by susceptibility-weighted imaging in Alzheimer's disease patients: A neuroimaging biomarker of the disease.

Purpose The objective of this study was to correlate the presence and distribution of cerebral microbleeds in Alzheimer’s disease patients with cerebrospinal fluid biomarkers (amyloid-beta and phosphorylated tau 181 protein levels) and cognitive decline by using susceptibility-weighted imaging magnetic resonance sequences at 1.5 T. Material and methods Fifty-four consecutive Alzheimer’s disease patients underwent brain magnetic resonance imaging at 1.5 T to assess the presence and distribution of cerebral microbleeds on susceptibility-weighted imaging images. The images were analyzed in consensus by two neuroradiologists, each with at least 10 years’ experience. Dementia severity was assess…

Optimizing diagnostic approach to drug-induced liver injury

Drug-induced liver injury (DILI) is often a trial even to expert clinicians, because sometimes diagnosis is not easy to be made. Guidelines of the American College of Gastroenterology (ACG) yielded in 2014, help to better understand the problem. The diagnosis of DILI is made through a detailed evaluation of clinical, serological, radiological and histological aspects. Biochemical data include liver function tests that allow to assess the pattern of damage, such as hepatocellular, cholestatic and mixed liver injury; serological data include testing for major and possibly minor hepatotropic viruses, non-organ specific autoantibodies. Clinical scenario might include jaundice, nausea, vomiting …

Whole-body magnetic resonance imaging and FDG-PET/CT for lymphoma staging: Assessment of patient experience

Purpose: To compare patient experience of whole-body MRI and FDG-PET/CT performed for lymphoma staging. Methods: One-hundred-fifteen patients (59 males, 56 females; 53 Hodgkin, 62 non-Hodgkin; mean age: 43.8 years) with lymphoma underwent whole-body MRI and FDG-PET/CT for staging and filled a questionnaire regarding their experience of the examinations using a 4-point Likert scale (1, very good; 4,very bad). Differences were evaluated using Wilcoxon signed-rank test. Patients were asked to express their preference on both techniques. Preferences were compared on the basis of gender, age, and Ann Arbor stage using the chi-square test. A p-value ≤ .05 was considered significant. Results: Most…

Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI: intermodality agreement and comparison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines

OBJECTIVE:To evaluate agreement between contrast-enhanced ultrasound (CEUS), multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) for the assessment of typical and atypical enhancement patterns of small hepatocellular carcinoma (HCC); and to compare diagnostic sensitivity of 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines. MATERIALS AND METHODS: Between January 2008 and December 2009, we included cirrhotic patients with newly diagnosed 10-20 mm HCC imaged at two contrast-enhanced imaging techniques among CEUS, MDCT, and MRI. Dynamic studies were reviewed by two radiologists to assess enhancement pattern. Percentage of cases…

Focal liver lesions hyperintense on T1-weighted magnetic resonance images.

This article reviews focal liver lesions hyperintense on T1-weighted magnetic resonance (MR) images and describes the underlying etiologies associated with their T1 signal intensity. Although focal liver lesions are commonly detected because of their iso- or hypointensity on T1-weighted images, lesions (benign or malignant) may present with T1 hyperintensity when they contain T1 shortening elements--such as fat, hemorrhage, copper, melanin, and highly concentrated proteins. Our discussion includes the description of state-of-the-art T1-weighted MR sequences and the imaging features of lesions on pre- and postcontrast MR images that are characteristic for lesion composition and useful for ma…

Growth rate of small (≤2 cm) HCC in cirrhotic patient: determining optimal screening interval with serial CT or MRI.

Delayed diagnosis of extrapulmonary tuberculosis in a 32-year-old man with knee pain

A 32-year-old Bangladeshi male was admitted at our emergency department for trauma of the left knee. The radiographs showed absence of fracture, and presence of an indeterminate oval lucency in the proximal tibia. Further examinations were suggested, but the patient refused. 6 months later, the patient re-presented at our emergency department. A CT scan showed progression of musculoskeletal involvement and spread to the liver. This case underlines the importance of considering tuberculosis in the differential diagnosis of indeterminate bone lesions in immigrant patients.

Imaging the COVID-19: a practical guide

The Coronavirus Disease 2019 (COVID-19) represents the first medical catastrophe of the new millennium. Although imaging is not a screening test for COVID-19, it plays a crucial role in evaluation and follow-up of COVID-19 patients. In this paper, we will review typical and atypical imaging findings of COVID-19.

Valeur de l’IRM de diffusion pour caractériser les petites masses rénales (< 3cm)

Objectifs: Décrire l’aspect des masses rénales (< 3cm) en imagerie de diffusion et déterminer le rôle de l’ADC pour la différentiation entre lésion maligne et bénigne. Matériels et méthodes: 47 tumeurs rénales < 3cm (23 malignes, 24 bénignes) furent explorées en IRM 3T incluant en sus du protocole habituel une séquence de diffusion (b1000). Une analyse rétrospective qualitative et quantitative (ADC) fut réalisée avec corrélation anatomopathologique et tests statistiques pour déterminer l’efficacité de la valeur d’ADC pour caractériser la lésion. Résultats: En diffusion, toutes les masses étaient hyperintenses au parenchyme sain. L’ADC moyen des CC RCC était supérieur à celui des angiomyolip…

Usefulness of SonoVue in the identification of sentinel nodes in patients with breast cancer

Purpose Methods and Materials Results Conclusion References Personal Information

Focal liver lesions hyperintense on T1-weighted magnetic resonance images

This article reviews focal liver lesions hyperintense on T1-weighted magnetic resonance (MR) images and describes the underlying etiologies associated with their T1 signal intensity. Although focal liver lesions are commonly detected because of their iso- or hypointensity on T1-weighted images, lesions (benign or malignant) may present with T1 hyperintensity when they contain T1 shortening elements--such as fat, hemorrhage, copper, melanin, and highly concentrated proteins. Our discussion includes the description of state-of-the-art T1-weighted MR sequences and the imaging features of lesions on pre- and postcontrast MR images that are characteristic for lesion composition and useful for ma…

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

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

Multiple sclerosis: prevalence of the ‘central vein’ sign in white matter lesions on gadolinium-enhanced susceptibility-weighted images

Aims To evaluate prospectively whether an intravenous gadolinium injection could improve the detection of the central vein sign on susceptibility-weighted imaging sequences obtained with a 1.5 T magnetic resonance scanner in patients with multiple sclerosis compared to unenhanced susceptibility-weighted images. Materials and methods This prospective, institution review board-approved study included 19 patients affected by multiple sclerosis (six men; 13 women; mean age 40.8 years, range 20–74 years). Patients had the relapsing–remitting clinical subtype in 95% of cases, and only one (5%) patient had the primary progressive clinical subtype of multiple sclerosis. T2-weighted images, fluid-at…

High-b-Value Diffusion-weighted MR Imaging of Benign Hepatocellular Lesions: Quantitative and Qualitative Analysis

PURPOSE:To analyze the signal intensity (SI) of benign hepatocellular lesions in high-b-value diffusion-weighted (DW) magnetic resonance (MR) images and to compare the apparent diffusion coefficient (ADC) values of focal nodular hyperplasias (FNHs) with those of hepatocellular adenomas (HCAs). MATERIALS AND METHODS: This retrospective study was approved by institutional review board, with waiver of informed consent. Inclusion criteria were consecutive patients with diagnosed FNH or HCA who underwent MR imaging with a DW sequence of the liver at three b values, 0, 150, and 600 sec/mm2. The final study population included 67 patients (seven men, 60 women) with 90 hepatocellular lesions (54 FN…

The cheating liver: imaging of focal steatosis and fatty sparing

ABSTRACT: Focal steatosis and fatty sparing are a frequent finding in liver imaging, and can mimic solid lesions. Liver regional variations in the degree of fat accumulation can be related to vascular anomalies, metabolic disorders, use of certain drugs or coexistence of hepatic masses. CT and MRI are the modalities of choice for the noninvasive diagnosis of hepatic steatosis. Knowledge of CT and MRI appearance of focal steatosis and fatty sparing is crucial for an accurate diagnosis, and to rule-out other pathologic processes. This paper will review the CT and MRI techniques for the diagnosis of hepatic steatosis and the CT and MRI features of common and uncommon causes of focal steatosis …

Radiomics and Prostate MRI: Current Role and Future Applications

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

Magnetic resonance imaging of the cirrhotic liver in the era of gadoxetic acid.

Gadoxetic acid improves detection and characterization of focal liver lesions in cirrhotic patients and can estimate liver function in patients undergoing liver resection. The purpose of this article is to describe the optimal gadoxetic acid study protocol for the liver, the unique characteristics of gadoxetic acid, the differences between gadoxetic acid and extra-cellular gadolium chelates, and the differences in phases of enhancement between cirrhotic and normal liver using gadoxetic acid. We also discuss how to obtain and recognize an adequate hepatobiliary phase.

Comparison between whole-body MRI and PET/CT in staging newly diagnosed FDG-avid lymphomas: our experience.

To compare whole body RMI (WB-RMI) and FDG-PET/CT for staging newly diagnosed FDG-avid lymphoma

Comparison between whole-body MRI with diffusion-weighted imaging and PET/CT in staging newly diagnosed FDG-avid lymphomas.

Abstract Objectives To compare whole body-MRI (WB-MRI) with diffusion-weighted imaging and FDG-PET/CT in staging newly diagnosed FDG-avid lymphomas. Methods 68 patients (37 males, 31 females; median age 42 years; range 15–86 years) with histologically confirmed lymphoma (37 Classical Hodgkin, 16 Diffuse large B-cell, 10 Follicular, 5 Mantle cell) underwent both MRI and FDG-PET/CT before treatment. Ann Arbor stages obtained with WB-MRI and FDG-PET/CT were compared using Cohen’s k statistics. Moreover WB-MRI and FDG-PET/CT stages were compared with the pathological stages obtained after the diagnostic iter using also bone marrow and available biopsies if clinically indicated. Results The agre…

The abnormal hepatic morphology: not always cirrhosis

Learning objectives Background Findings and procedure details Conclusion Personal information References

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

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

Imaging appearance of treated hepatocellular carcinoma

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

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). On follow-up, 5/69 nodules became HC…

INTERMODALITY AGREEMENT FOR THE DIAGNOSIS OF SMALL (≤2CM) HEPATOCELLULAR CARCINOMAS (HCCS) IN PATIENTS WITH CIRRHOSIS

Gadoxetate disodium-enhanced magnetic resonance cholangiography for the noninvasive detection of an active bile duct leak after laparoscopic cholecystectomy.

Abstract We report a case of an endoscopically confirmed biliary leak of the common hepatic duct after laparoscopic cholecystectomy that was prospectively diagnosed on gadoxetate disodium-enhanced magnetic resonance cholangiography. Whereas dynamic contrast-enhanced magnetic resonance images during the early vascular phases helped to rule out the causes of possible complications such as seroma, hematoma, or abdominal abscess, delayed hepatobiliary phase imaging was crucial for unequivocal diagnosis and location of the biliary leak. The diagnosis prompted therapeutic endoscopic retrograde cholangiography whereby a polytetrafluoroethylene-covered nitinol stent graft was successfully placed to…

Imaging features of adrenal masses

Abstract The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign …

La detención preventiva y la libertad personal en la práctica del Tribunal Especial para el Líbano

The present article analyzes the order CH/PTJ/09/06, issued by the Special Tribunal for Lebanon, on 29 April 2009, in terms of pre-trial detention, personal freedom, presumption of innocence and right to a fair and expeditious trial. From this point of view the article extend the reflection in considering the principal acts delivered by the Tribunal – Rules of Procedure and Evidence, Rules on Detention, Prosecutor’s applications and Pre-Trial Judge’s decisions – appraising its deep and concrete contribution in human rights protection. El presente artículo hace un análisis de la orden CH/PTJ/09/06 dictada por el Tribunal Especial para el Líbano con fecha de 29 de abril de 2009, referido espe…

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

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

Re: Small solid renal masses: characterization by diffusion-weighted MRI at 3 T. A reply.

Alterazioni della morfologia epatica: non sempre cirrosi

Review the CT and MRI characteristics of the cirrhotic liver; to recognize the pathological conditions that can mimic cirrhosis

Whole-Body MRI and 18F-FDG-PET-CT for Lymphoma Staging: Comparison of Patient Experience

Aims and objectives Methods and materials Results Conclusion Personal information References

Updated diagnosticprognostic paradigm for CAD: a narrative review.

Cardiovascular diseases are the first cause of death globally; early detection of coronary artery disease (CAD) is a challenge for clinicians and radiologists. Over the past 2 decades there have been several improvements in the methods for the assessment of diagnosis and prognosis in patients with suspected CAD; most of these methods are imaging methods and they operate with high-end technologies. Cardiac computed tomography (CCT) as we know it today was introduced in 1998 and has ever progressed with constant pace. The first decade was the technical validation phase of the method while the second decade was the clinical validation phase. CCT has developed an excellent diagnostic and progno…

Imaging dell’ischemia mesenterica mediante TC Multistrato

Review the etiology and pathophysiology of mesenteric ischemia with an outline of the mesenteric circulation. Describe the TC protocol to be used for the study of mesenteric ischemia and the TC signs that characterize it.

Hepatocellular Carcinoma Presenting at Contrast-Enhanced Multi–Detector-Row Computed Tomography or Gadolinium-Enhanced Magnetic Resonance Imaging as a Small (≤2 cm), Indeterminate Nodule

OBJECTIVE: The objective of the study was to measure growth rate and to determine the optimal interval time for imaging follow-up of hepatocellular carcinomas (HCCs) presenting at multi-detector-row computed tomography (MDCT) or magnetic resonance imaging (MRI) as small, indeterminate lesions. METHODS: We included patients with cirrhosis with HCC initially presenting as indeterminate lesion of 2 cm or less at MDCT or MRI August 2005 to August 2009 and with available imaging follow-up. Measures of tumor growth included tumor volume doubling time (TVDT), tumor percentual diameter increase, and tumor percentual volume increase. RESULTS: We examined 48 patients (mean age, 64 years) with 69 HCCs…

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…

VALUTAZIONE RM E TC DELLA RISPOSTA AL TRATTAMENTO CON SORAFENIB IN PAZIENTI CIRROTICI CON EPATOCARCINOMA

Value of serial magnetic resonance imaging in the assessment of brain metastases volume control during stereotactic radiosurgery

AIM To evaluate brain metastases volume control capabilities of stereotactic radiosurgery (SRS) through serial magnetic resonance (MR) imaging follow-up. METHODS MR examinations of 54 brain metastases in 31 patients before and after SRS were reviewed. Patients were included in this study if they had a pre-treatment MR examination and serial follow-up MR examinations at 6 wk, 9 wk, 12 wk, and 12 mo after SRS. The metastasis volume change was categorized at each follow-up as increased (> 20% of the initial volume), stable (± 20% of the initial volume) or decreased (< 20% of the initial volume). RESULTS A local tumor control with a significant (P < 0.05) volume decrease was observed in 25 meta…

I diritti dell’uomo nella giurisprudenza della Corte internazionale di giustizia e della Corte permanente di giustizia internazionale

Computed tomography of bowel obstruction: Tricks of the trade

Bowel obstruction (BO) is a frequent cause of hospitalization and surgical consultation for acute abdominal pain. It is usually suspected at physical examination, but clinical and laboratory data are often nonspecific. Thus, computed tomography plays a crucial role in a correct diagnosis of BO. Indeed, computed tomography can confirm a diagnosis of BO, and identify the location and cause of the obstruction. In this review, the computed tomography appearances of common and uncommon causes of BO and pseudo-obstruction are reviewed.

Re: Small solid renal masses: Characterization by diffusion-weighted MRI at 3 T. A reply.

No abstract available.

Utility of 3 Tesla diffusion-weighted magnetic resonance (DWMR) imaging for the characterisation of small solid renal tumours

Purpose: To determine the utility of apparent diffusion coefficients (ADCs) for the characterisation of small solid renal lesions. Methods and Materials: 26 patients (GFR 30-60 mL/min) with 39 small (1-3 cm) solid renal masses [16 RCCs (10 clear cell types; 6 other types); 18 AMLs (10 fat-containing; 8 minimal-fat) and 5 oncocytomas] were examined on a 3 T system using DW-SS-EPI (b-values 0, 1000 s/mm2). The ADC of the lesions and the ADC of kidney were evaluated. Receiver operator characteristic analysis was performed to evaluate the diagnostic value of ADC for differentiating clear cell RCCs from other type RCCs, AMLs and oncocytomas. Results: The mean ADC of the lesions [1.22± 0.27 28 mm…

Focal lesions in cirrhotic liver: what else beyond hepatocellular carcinoma?

Detection and characterization of focal lesions in the cirrhotic liver may pose a diagnostic dilemma. Several benign and malignant lesions may be found in a cirrhotic liver along with hepatocellular carcinoma (HCC), and may exhibit typical or atypical imaging features. In this pictorial essay, we illustrate computed tomography and magnetic resonance imaging findings of lesions such as simple bile duct cysts, hemangioma, focal nodular hyperplasia-like nodules, peribiliary cysts, intrahepatic cholangiocarcinoma, lymphoma, and metastases, all of which occur in cirrhotic livers with varying prevalences. Pseudolesions, such as perfusion anomalies, focal confluent fibrosis, and segmental hyperpla…

TAVI imaging: over the echocardiography

Aortic valve stenosis (AS) is a common valvular heart disease. Recently, transcatheter aortic valve implantation (TAVI) has changed the treatment of severe AS in elderly patients with contraindications to traditional surgical replacement. Echocardiography is conventionally used as the first imaging modality to assess the presence and severity of AS and to provide anatomical and functional information. Nowadays, imaging techniques play a crucial role in the planning of TAVI to define suitable candidates. Computed tomography (CT) is essential to display the anatomy of the aortic valve complex (including aortic annulus, Valsalva sinuses, coronary arteries ostia, sinotubular junction), thoracoa…

Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke's encephalopathy

AIM To present the typical and atypical magnetic resonance (MR) imaging findings of alcoholic and non-alcoholic Wernicke’s encephalopathy. METHODS This study included 7 patients with Wernicke’s encephalopathy (2 men, 5 women; mean age, 52.3 years) that underwent brain MR examination between January 2012 and March 2016 in a single institution. Three patients were alcoholics and 4 patients were non-alcoholics. MR protocol included a T2-weighted sequence, a fluid attenuation inversion recovery (FLAIR) sequence, a diffusion-weighted sequence (b = 0 and 1000 s/mm2), and a contrast-enhanced MR sequence. All MR images were retrospectively reviewed at baseline and follow-up by two radiologists. RES…

Международная защита прав человека и вызов новых биомедицинских технологий

Utilità del SonoVue nella identificazione del linfonodo sentinella in pazienti affette da carcinoma mammario

Scopo: Utilità del SonoVue nella identificazione e localizzazione del linfonodo sentinella in pazienti affette da carcinoma mammario. Materiali e metodi: 14 donne (età media, 61 anni; range, 39-70), affette da carcinoma mammario, sono state sottoposte ad iniezione intradermica periareolare al QSE, di 2,4 ml di SonoVue, per l' identificazione del linfonodo sentinella. Gold Standard è stata considerata la linfoscintigrafia con macroaggregati di albumina. Dopo introduzione del m.d.c. Le pazienti sono state monitorate ecograficamente per 120 minuti eseguendo un massaggio dermico. Risultati: In nessuna paziente si è identificato il linfonodo sentinella. In tutte le pazienti sono state identifica…

A rare case of ruptured aneurysm of the paramedian artery of Percheron.

Introduction The artery of Percheron is a rare anatomic variant supplying bilateral medial thalamic nuclei and a variable portion of the rostral part of midbrain. Case report A 48-year-old female with massive subarachnoid hemorrhage due to a ruptured aneurysm of the paramedian artery of Percheron presented to the emergency room. Because of significant risk of recurrent intracranial hemorrhage, it was decided to proceed with endovascular embolization of the aneurysm. The patient was ultimately sent to a rehabilitation center and her presenting neurologic deficits showed significant improvements in the weeks following endovascular embolization treatment. Discussion The paramedian artery of Pe…