Chiara Andreoli

Color Doppler sonography of focal lesions of the skin and subcutaneous tissue.

We evaluated with color Doppler sonography 71 visible and palpable nodules of the skin and subcutaneous tissue from 51 patients. The nodules were classified as avascular (type I), hypovascular with a single vascular pole (type II), hypervascular with multiple peripheral poles (type III), and hypervascular with internal vessels (type IV). Of the 32 malignant nodules, 9% showed a type I pattern, 50% had a type III pattern, and 41% had a type IV pattern; of the 39 benign nodules, 86% showed a type I pattern and 14% had a type II pattern. The sensitivity and specificity of hypervascularity in malignant lesions were 90% and 100%, respectively, whereas the sensitivity and specificity of hypovascularity in benign lesions were 100% and 90%, respectively. The authors conclude that color Doppler sonography is able to increase the specificity of ultrasonography in the evaluation of nodular lesions of the skin.

Ultrasonographic evaluation of de Quervain disease.

De Quervain disease is a job‐related tenosynovitis that affects the synovial sheath of the tendons of the abductor pollicis longus and extensor pollicis brevis muscles; it is associated with pain and functional impairment and progresses to cause local fibrosis with blockage or triggering of the thumb. High‐resolution ultrasonography of the wrist was performed in eight patients with de Quervain disease; the examination was performed in axial and coronal scans with a 13 MHz linear transducer. The evaluation of normal wrists helped to define the normal sonographic anatomy of the first extensor compartment; obvious changes of the tendon sheath were noted in all cases of de Quervain disease (thickening and edema of the synovial sheath and fluid within the sheath). We conclude that ultrasonography is able to confirm the clinical diagnosis of de Quervain disease and may have a role in the follow‐up of this disorder.

Color Doppler Sonography in the Evaluation of Superficial Lymphomatous Lymph Nodes

We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes.

3T diffusion tensor imaging and electroneurography of peripheral nerve: a morphofunctional analysis in carpal tunnel syndrome.

OBJECTIVE The aim of the study was to assess the diagnostic potential of diffusion tensor imaging (DTI) for pathologies of the peripheral nervous system (PNS) through clinical, electrophysiological and morphological evaluation of the median nerve. METHODS The present work was a multilevel prospective study involving 30 subjects, 15 of whom had carpal tunnel syndrome (CTS) and 15 healthy controls. All subjects underwent clinical evaluation through administration of the Boston Carpal Tunnel Questionnaire (BCTQ), electroneurography (ENG), 3-Tesla magnetic resonance imaging with DTI, and calculation of fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) at the flexor retinaculum. Tractography was also performed for three-dimensional reconstruction of the route of the median nerve through the carpal tunnel. The degree of functional impairment was compared with the anatomical damage to the median nerve according to ENG and DTI. RESULTS FA and ADC were significantly correlated with ENG parameters of CTS and BCTQ data. Mean FA and ADC values in the CTS patients were 0.359±0.06 and 1.866±0.050×10(-3)mm(2)/s, respectively, vs 0.59±0.014 and 1.395±0.035×10(-3)mm(2)/s, respectively, in the controls. FA was decreased and ADC increased in patients with CTS compared with healthy controls (P<0.05). CONCLUSION DTI parameters were clearly confirmed by both clinical and ENG data and, therefore, may be used for the diagnosis of CTS.

Hematocolpos in double vagina associated with uterus didelphus: US and MR findings.

The malformative syndrome of double vagina in association with uterus didelphus and kidney agenesis is a rare condition, often asymptomatic: if this condition is accompanied by imperforated obstructed hemivagina, the clinical manifestations depend on the presence of hematocolpos. MRI plays an important role for diagnosis because it allows to characterize the nature of the lesion and to evaluate the anatomical details of the uterine malformation. The authors describe this complex genital malformation and discuss the main US and MRI features.

The dynamic generation of hypertext presentations of medical guidelines

Abstract We describe a project aimed at developing a tool to generate user and context-adapted textual descriptions of clinical guidelines on the World Wide Web. ARIANNA employs two knowledge sources (a decision tree and a taxonomy of concepts in the clinical domain) and schema and ATN-based NLG techniques, to dynamically generate the hypermedia. This appears to the user as a frameset with three main components: the guideline itself, an explanation of related concepts and a justification of individual steps. Each component is adapted to the user: i) the guideline is adapted to the users goal in consulting the system (tutoring vs decision support); ii) explanations of concepts are adapted to the user knowledge and to the interaction history; iii) justifications are reserved for the tutoring consultation mode.

The key role of the radiologist in the management of polytrauma patients: indications for MDCT imaging in emergency radiology

Trauma causes greater losses of life years and it is the most common cause of death for people under the age of 45. Time is one of the most relevant factors for the survival of injured patients, particularly the time elapsed from trauma until the resuscitation procedures. As a member of the trauma team, the radiologist contributes to the rapid diagnosis of traumatic disorders, with appropriate imaging modalities. Based on the evidence, the most appropriate diagnostic tool for severe/multiple trauma is computed tomography (CT). With the advent of multidetector CT (MDCT), radiologists are able to more effectively characterize life-threatening traumatic disorders within a few seconds in stable or stabilized patients. Considering the diagnostic potential of MDCT, conventional radiographs could be virtually abandoned in the diagnostic algorithms for adult polytraumatized patients. The radiologist helps to facilitate triage and to assess the optimal individual treatment for polytrauma patients, thus contributing to the improvement of patient outcomes. In this article, the indications for MDCT in the polytrauma setting are discussed.

Early onset of posterior reversible encephalopathy syndrome (PRES) during Cyclosporine-A infusion.

Posterior reversible encephalopathy syndrome (PRES) is an ncommon but distinctive clinico-radiologic entity characterized y headache, seizures, visual disturbance and altered mental funcion associated with reversible white matter edema affecting the osterior parietal and occipital lobes of the brain [1,2]. Etioloies of PRES include hypertension, cytotoxic medications, sepsis, reeclampsia or eclampsia and multiple organ dysfunction [3]. In he context of allogeneic stem cell transplantation (HSCT), severe eurotoxicity is reported in a substantial number of patients, being yclosporine-A (CSA) most frequently indicated as the medication esponsible for the neurological alterations [4–6].

La radiologia nel DEA

Nell’ottica dell’abbattimento dei tempi di gestione del paziente traumatizzato grave e nel rispetto della golden hour, fondamentale e un’ottimale organizzazione logistica del Dipartimento di Emergenza e Accettazione (DEA) [9], costituito da un’area di emergenza multifunzionale in cui siano presenti quattro unita logistico-funzionali: la sala di rianimazione, la camera operatoria, laterapia intensiva e la radiologia, tra loro adiacenti e interconnesse ma con una gestione autonoma di spazi e personale. La letteratura internazionale basata sulle esperienze di gruppi esperti in emergenza e ben rodati riporta che un’organizzazione rigorosa della logistica contribuiscead abbattere i tempi morti dovuti all’attesa e allo spostamento del paziente, con conseguente aumento delle chance di sopravvivenza del paziente stesso: il paziente traumatizzato grave deve essere posto al centro del processo di assistenza, con tutti gli specialisti che gli ruotano intorno e deve essere spostato fisicamente il meno possibile, per evitare inutili perdite di tempo e la mancata assistenza durante lo spostamento che contribuiscono ad aumentare il rischio di peggioramento del suo stato emodinamico, molto spesso gia precario. Tra le quattro aree logistico-funzionali del DEA, la Radiologia d’Emergenza gioca un ruolo fondamentale, perche dalla rapidita e correttezza della diagnosi dipende strettamente l’efficacia e la tempestivita della decisione terapeutica [10]. La Radiologia d’Emergenza deve essere collocata accanto alla sala di rianimazione e del pronto soccorso (livello stradale), per consentire un rapido accesso del paziente, una volta che e stato stabilizzato. Lo spostamento del paziente va evitato il piu possibile perche e un momento di estremo rischio, vista la difficolta del monitoraggio delle sue funzioni vitali; purtroppo, nella pratica clinica il trasporto incide ancora per piu della meta nel tempo complessivo di assistenza del paziente: e stato infatti calcolato che l’esecuzione della TC total body nel paziente politraumatizzato richiede 40 minuti circa, suddivisi in 45% per il trasporto del paziente nell’unita radiologica e trasferimento sul lettino TC, 35% per l’acquisizione dei dati e 20% per la gestione dei dati, compreso il post-processing [11].

I traumi del bacino

Le fratture di bacino si riscontrano nel 5–8% dei traumi maggiori e, data la solidita strutturale del cingolo pelvico, sono generalmente sostenute da traumi ad alta energia cinetica (70%: incidenti stradali automobilistici e motociclistici; 10–20%: caduta dall’alto-precipitazione; 10%: incidenti sul lavoro-trauma da schiacciamento). Sono gravate da un’alta morbilita e mortalita dato che l’elevata energia richiesta per esercitare un danno su una struttura cosi solida e in grado di provocare anche lesioni viscerali e, soprattutto, il coinvolgimento di strutture vascolari arteriose evenose, la cui rottura/lacerazione puo mettere a rischio la vita del paziente per shock emorragico e necessita spesso di un trattamento chirurgico/interventistico di urgenza. L’emorragia pelvica rappresenta la principale causa di morte nel trauma pelvico (mortalita del 5–30%) [78,79].