F Turini

Role of CT colonography in inflammatory bowel disease

CT colonography (CTC), or virtual colonoscopy, is a non-invasive imaging method that uses CT data sets combined with specialized imaging software to examine the colon. CTC is not used routinely in patients with inflammatory bowel disease (IBD). However, investigating contemporarily the colon, other abdominal organs and the peritoneum with CTC is at times useful in patients with IBD, especially when other diagnostic tools fail. Furthermore, since symptoms of colorectal cancer sometimes superimpose to those of inflammatory disease, it may happen to image patients with IBD incidentally. If clinical signs are suggestive for inflammatory disease, exam technique should be modified accordingly and distinguishing radiological findings searched for.

Integrating image processing in PACS

Integration of RIS and PACS services into a single solution has become a widespread reality in daily radiological practice, allowing substantial acceleration of workflow with greater ease of work compared with older generation film-based radiological activity. In particular, the fast and spectacular recent evolution of digital radiology (with special reference to cross-sectional imaging modalities, such as CT and MRI) has been paralleled by the development of integrated RIS--PACS systems with advanced image processing tools (either two- and/or three-dimensional) that were an exclusive task of costly dedicated workstations until a few years ago. This new scenario is likely to further improve productivity in the radiology department with reduction of the time needed for image interpretation and reporting, as well as to cut costs for the purchase of dedicated standalone image processing workstations. In this paper, a general description of typical integrated RIS--PACS architecture with image processing capabilities will be provided, and the main available image processing tools will be illustrated.

CT Colonography: Role of a second reader CAD paradigm in the initial training of radiologists

PURPOSE To evaluate the influence of CAD for the evaluation of CT colonography (CTC) datasets by inexperienced readers during the attendance of a dedicated hands-on training course. METHOD AND MATERIALS Twenty-seven radiologists inexperienced in CTC (11 with no CTC training at all, 16 having previously reviewed no more than 10 CTC cases overall) attended a hands-on training course based on direct teaching on fifteen workstations (four Advantage Windows 4.4 with Colon VCAR software, GE; six CADCOLON, Im3D; five ColonScreen (Toshiba/Voxar) with ColonCAD™ API, Medicsight). During the course, readers were instructed to analyze 26 CTC cases including 38 colonic lesions obtained through low-dose MDCT acquisitions, consisting of 12 polyps sized less than 6 mm, 9 polyps sized between 6 and 10 mm, 12 polyps sized between 11 mm and 30 mm, and 5 colonic masses sized>3 cm. CTC images were reviewed by each reader both in 2D and 3D mode, respectively by direct evaluation of native axial images and MPR reconstructions, and virtual endoscopy or dissected views. Each reader had 15 min time for assessing each dataset without CAD, after which results were compared with those provided by CAD software. Global rater sensitivity for each lesion size before and after CAD usage was compared by means of two-tailed Students t test, while sensitivity of each single reader before and after CAD usage was assessed with the McNemar test. RESULTS For lesions sized<6 mm, global rater sensitivity was 0.1852±0.1656 (mean±SD) before CAD-assisted reading and 0.2345±0.1761 after CAD (p=0.0018). For lesions sized 6-9 mm, sensitivity was 0.2870±0.1016 before CAD-assisted reading and 0.3117±0.1099 after CAD (p=0.0027). For lesions sized 10-30 mm, sensitivity was 0.5308±0.2120 before CAD-assisted reading and 0.5637±0.2133 after CAD (p=0.0086), while for lesions sized>30 mm, sensitivity before CAD-assisted reading was 0.3556±0.3105 and did not change after CAD usage (p=1). Sensitivity of each single rater did not significantly differ before and after CAD for any lesion size category (McNemar test, p>0.05). Specificity was not significantly different before and after CAD for any lesion size (>96% for all size categories). CONCLUSION CAD usage led to increased overall sensitivity of inexperienced readers for all polyps sizes, except for lesions>30 mm, but sensitivity of individual raters was not significantly higher compared with CAD-unassisted reading.

Diagnostic accuracy of CT colonography in patients with positive faecal occult blood test: results of the Italian project Legatumori 2003–2006

PurposeIn the framework of the 3-year project of the Italian Legatumori (2003–2006), we evaluated the diagnostic accuracy of computed tomography (CT) colonography in detecting colorectal lesions in a screening population with positive faecal occult blood test (FOBT).Materials and methodsTwo hundred and thirty asymptomatic subjects (age range 45–80 years) were enrolled in the study. CT colonography was performed with standard patient preparation (no faecal tagging) and a 4-detector-row CT scanner. Image analysis was carried out with primary 2D analysis and the use of 3D endoluminal views to solve difficult cases. Patients were referred for conventional colonoscopy in the following situations: detection of three or more suspected lesions with maximum diameter ≤6 mm; evidence of one or more lesions with maximum diameter >6 mm; presence of colonic masses (maximum diameter >3 cm).ResultsCT colonography detected colonic masses in 12 out of 135 subjects (8%). It generated 93 false positives and 19 false negatives in the identification of diminutive lesions (≤6 mm), and 70 false positives and six false negatives in lesions >6 mm. Sensitivity was 83% in smaller lesions and 93% in lesions >6 mm; specificity was 45% and 59%, respectively.ConclusionsIn a screening population with positive FOBT, CT colonography without faecal tagging and no definite size threshold for the reporting of polyps showed very low specificity but high sensitivity in the detection of all colorectal lesions.RiassuntoObiettiviNell’ambito di un progetto triennale finanziato dalla Legatumori (2003–2006) è stata valutata l’accuratezza diagnostica della CV nel rilievo di lesioni colorettali in una popolazione di screening risultata positiva al test per il SOF.Materiali e metodiSono stati inclusi nello studio 230 soggetti asintomatici. La CV era eseguita con preparazione standard (senza fecal tagging) e apparecchiatura TC a 4 strati. L’analisi delle immagini era effettuata con valutazione primaria 2D e uso delle ricostruzioni 3D nei casi dubbi. L’esame di CC veniva indicato in presenza di: almeno 3 lesioni sospette per polipi con diametro inferiore o uguale a 6 mm, almeno 1 lesione con diametro superiore a 6 mm, o masse coliche (diametro massimo >3 cm).RisultatiLa CV ha consentito la diagnosi di masse coliche in 12/135 (8%) pazienti; ha generato 93 falsi positivi e 19 falsi negativi per polipi di dimensioni minori o uguali a 6 mm, e 70 falsi positivi e 6 falsi negativi per polipi di dimensioni maggiori. La sensibilità era quindi 83% per polipi clinicamente non significativi e 93% per quelli con diametro superiore a 6mm; la specificità rispettivamente di 45% e 59%.ConclusioniIn una popolazione di screening con SOF+, la CV senza fecal tagging e senza l’adozione di un cut off dimensionale nella indicazione alla colonscopia tradizionale, ha evidenziato una bassa specificità, a fronte Pickdi una elevata sensibilità nel rilievo di tutte le lesioni.

Diagnostic accuracy of CT colonography in patients with positive faecal occult blood test: results of the Italian project

PurposeIn the framework of the 3-year project of the Italian Legatumori (2003–2006), we evaluated the diagnostic accuracy of computed tomography (CT) colonography in detecting colorectal lesions in a screening population with positive faecal occult blood test (FOBT).Materials and methodsTwo hundred and thirty asymptomatic subjects (age range 45–80 years) were enrolled in the study. CT colonography was performed with standard patient preparation (no faecal tagging) and a 4-detector-row CT scanner. Image analysis was carried out with primary 2D analysis and the use of 3D endoluminal views to solve difficult cases. Patients were referred for conventional colonoscopy in the following situations: detection of three or more suspected lesions with maximum diameter ≤6 mm; evidence of one or more lesions with maximum diameter >6 mm; presence of colonic masses (maximum diameter >3 cm).ResultsCT colonography detected colonic masses in 12 out of 135 subjects (8%). It generated 93 false positives and 19 false negatives in the identification of diminutive lesions (≤6 mm), and 70 false positives and six false negatives in lesions >6 mm. Sensitivity was 83% in smaller lesions and 93% in lesions >6 mm; specificity was 45% and 59%, respectively.ConclusionsIn a screening population with positive FOBT, CT colonography without faecal tagging and no definite size threshold for the reporting of polyps showed very low specificity but high sensitivity in the detection of all colorectal lesions.RiassuntoObiettiviNell’ambito di un progetto triennale finanziato dalla Legatumori (2003–2006) è stata valutata l’accuratezza diagnostica della CV nel rilievo di lesioni colorettali in una popolazione di screening risultata positiva al test per il SOF.Materiali e metodiSono stati inclusi nello studio 230 soggetti asintomatici. La CV era eseguita con preparazione standard (senza fecal tagging) e apparecchiatura TC a 4 strati. L’analisi delle immagini era effettuata con valutazione primaria 2D e uso delle ricostruzioni 3D nei casi dubbi. L’esame di CC veniva indicato in presenza di: almeno 3 lesioni sospette per polipi con diametro inferiore o uguale a 6 mm, almeno 1 lesione con diametro superiore a 6 mm, o masse coliche (diametro massimo >3 cm).RisultatiLa CV ha consentito la diagnosi di masse coliche in 12/135 (8%) pazienti; ha generato 93 falsi positivi e 19 falsi negativi per polipi di dimensioni minori o uguali a 6 mm, e 70 falsi positivi e 6 falsi negativi per polipi di dimensioni maggiori. La sensibilità era quindi 83% per polipi clinicamente non significativi e 93% per quelli con diametro superiore a 6mm; la specificità rispettivamente di 45% e 59%.ConclusioniIn una popolazione di screening con SOF+, la CV senza fecal tagging e senza l’adozione di un cut off dimensionale nella indicazione alla colonscopia tradizionale, ha evidenziato una bassa specificità, a fronte Pickdi una elevata sensibilità nel rilievo di tutte le lesioni.

MRA in Liver and in Orthotopic Liver Transplants

MR imaging provides the necessary information about variations in the vascular and biliary anatomy and allows evaluation of the hepatic parenchyma for diffuse or focal abnormalities.

CT colonography: Project of High National Interest No. 2005062137 of the Italian Ministry of Education, University and Research (MIUR).

PurposeThe aim of this paper is to describe the Web site of the Italian Project on CT Colonography (Research Project of High National Interest, PRIN No. 2005062137) and present the prototype of the online database.Materials and methodsThe Web site was created with Microsoft Office Publisher 2003 software, which allows the realisation of multiple Web pages linked through a main menu located on the home page. The Web site contains a database of computed tomography (CT) colonography studies in the Digital Imaging and Communications in Medicine (DICOM) standard, all acquired with multidetector-row CT according to the parameters defined by the European Society of Abdominal and Gastrointestinal Radiology (ESGAR). The cases present different bowel-cleansing and tagging methods, and each case has been anonymised and classified according to the Colonography Reporting and Data System (C-RADS).ResultsThe Web site is available at http address www.ctcolonography.org and is composed of eight pages. Download times for a 294-Mbyte file were 33 min from a residential ADSL (6 Mbit/s) network, 200 s from a local university network (100 Mbit/s) and 2 h and 50 min from a remote academic site in the USA. The Web site received 256 accesses in the 22 days since it went online.ConclusionsThe Web site is an immediate and up-to-date tool for publicising the activity of the research project and a valuable learning resource for CT colonography.RiassuntoObiettivoDescrivere il sito web del Progetto Italiano sulla Colonscopia Virtuale (CV), PRIN 2005062137 e, presentare il prototipo del database online.Materiali e metodiIl sito web è stato realizzato con il software Microsoft Office Publisher 2003 che consente la realizzazione di pagine web multiple, tra loro collegate attraverso un menu principale localizzato nella home page. Nel suo interno sono archiviati studi DICOM di CV, acquisiti con apparecchiature multistrato seguendo i parametri di qualità definiti dall’ESGAR; i casi presentano differenti metodi di pulizia intestinale. Tutti sono stati anonimizzati e classificati secondo il sistema C-RADS.RisultatiIl sito è disponibile all’indirizzo www.ctcolonography.org ed è costituito da 8 pagine web. Nelle prove di scaricamento dei dati TC da tecnologia ADSL (6 Mbit/s), un file di 294 Mbytes è stato scaricato in 33 minuti, da rete universitaria (100 Mbit/s) in 200 secondi, da sito remoto accademico negli USA in 2 ore e 50 minuti. Il monitoraggio del numero di accessi in 22 giorni, dal giorno di pubblicazione, ha evidenziato 220 accessi.ConclusioniIl sito web è uno strumento immediato e aggiornato per la divulgazione dell’attività di ricerca progettuale e una risorsa didattica di CV.

Abdominal Aorta and Renal Arteries

The recent advent of newer multidetector computer tomography (MDCT) scanners has dramatically changed the role of magnetic resonance imaging (MRI) in the evaluation of the abdominal aorta and its peripheral branches, due to its faster acquisition times, higher spatial resolution allowing to obtain submillimetric sections with voxel isotropy, greater technical simplicity, wider availability, and lower overall cost. However, lack of ionizing radiation and of intravenous administration of iodinated contrast material remain substantial advantages of MRI over MDCT, that make it the technique of choice for young patients and individuals with high serum creatinine values. Moreover, for the assessment of renal arteries MRI offers not only adequate anatomical detail but, and more importantly, is also able to provide quantitative data relative to renal blood flow, as well as to yield functional information about the parenchymal effect of a vascular stenosis by means of phase contrast and perfusion techniques, respectively. In this particular concern, MRI may be successfully proposed as a novel noninvasive tool for functional evaluation of the kidneys.

Colonscopia virtuale: progetto PRIN (Progetto di Rilevante Interesse Nazionale) del MIUR (Ministero dell'Università e della Ricerca), numero 2005062137

PurposeThe aim of this paper is to describe the Web site of the Italian Project on CT Colonography (Research Project of High National Interest, PRIN No. 2005062137) and present the prototype of the online database.Materials and methodsThe Web site was created with Microsoft Office Publisher 2003 software, which allows the realisation of multiple Web pages linked through a main menu located on the home page. The Web site contains a database of computed tomography (CT) colonography studies in the Digital Imaging and Communications in Medicine (DICOM) standard, all acquired with multidetector-row CT according to the parameters defined by the European Society of Abdominal and Gastrointestinal Radiology (ESGAR). The cases present different bowel-cleansing and tagging methods, and each case has been anonymised and classified according to the Colonography Reporting and Data System (C-RADS).ResultsThe Web site is available at http address www.ctcolonography.org and is composed of eight pages. Download times for a 294-Mbyte file were 33 min from a residential ADSL (6 Mbit/s) network, 200 s from a local university network (100 Mbit/s) and 2 h and 50 min from a remote academic site in the USA. The Web site received 256 accesses in the 22 days since it went online.ConclusionsThe Web site is an immediate and up-to-date tool for publicising the activity of the research project and a valuable learning resource for CT colonography.RiassuntoObiettivoDescrivere il sito web del Progetto Italiano sulla Colonscopia Virtuale (CV), PRIN 2005062137 e, presentare il prototipo del database online.Materiali e metodiIl sito web è stato realizzato con il software Microsoft Office Publisher 2003 che consente la realizzazione di pagine web multiple, tra loro collegate attraverso un menu principale localizzato nella home page. Nel suo interno sono archiviati studi DICOM di CV, acquisiti con apparecchiature multistrato seguendo i parametri di qualità definiti dall’ESGAR; i casi presentano differenti metodi di pulizia intestinale. Tutti sono stati anonimizzati e classificati secondo il sistema C-RADS.RisultatiIl sito è disponibile all’indirizzo www.ctcolonography.org ed è costituito da 8 pagine web. Nelle prove di scaricamento dei dati TC da tecnologia ADSL (6 Mbit/s), un file di 294 Mbytes è stato scaricato in 33 minuti, da rete universitaria (100 Mbit/s) in 200 secondi, da sito remoto accademico negli USA in 2 ore e 50 minuti. Il monitoraggio del numero di accessi in 22 giorni, dal giorno di pubblicazione, ha evidenziato 220 accessi.ConclusioniIl sito web è uno strumento immediato e aggiornato per la divulgazione dell’attività di ricerca progettuale e una risorsa didattica di CV.

CT colonography: Project of High National Interest No. 2005062137 of the Italian Ministry of Education, University and Research (MIUR) RID A-2343-2011

PurposeThe aim of this paper is to describe the Web site of the Italian Project on CT Colonography (Research Project of High National Interest, PRIN No. 2005062137) and present the prototype of the online database.Materials and methodsThe Web site was created with Microsoft Office Publisher 2003 software, which allows the realisation of multiple Web pages linked through a main menu located on the home page. The Web site contains a database of computed tomography (CT) colonography studies in the Digital Imaging and Communications in Medicine (DICOM) standard, all acquired with multidetector-row CT according to the parameters defined by the European Society of Abdominal and Gastrointestinal Radiology (ESGAR). The cases present different bowel-cleansing and tagging methods, and each case has been anonymised and classified according to the Colonography Reporting and Data System (C-RADS).ResultsThe Web site is available at http address www.ctcolonography.org and is composed of eight pages. Download times for a 294-Mbyte file were 33 min from a residential ADSL (6 Mbit/s) network, 200 s from a local university network (100 Mbit/s) and 2 h and 50 min from a remote academic site in the USA. The Web site received 256 accesses in the 22 days since it went online.ConclusionsThe Web site is an immediate and up-to-date tool for publicising the activity of the research project and a valuable learning resource for CT colonography.RiassuntoObiettivoDescrivere il sito web del Progetto Italiano sulla Colonscopia Virtuale (CV), PRIN 2005062137 e, presentare il prototipo del database online.Materiali e metodiIl sito web è stato realizzato con il software Microsoft Office Publisher 2003 che consente la realizzazione di pagine web multiple, tra loro collegate attraverso un menu principale localizzato nella home page. Nel suo interno sono archiviati studi DICOM di CV, acquisiti con apparecchiature multistrato seguendo i parametri di qualità definiti dall’ESGAR; i casi presentano differenti metodi di pulizia intestinale. Tutti sono stati anonimizzati e classificati secondo il sistema C-RADS.RisultatiIl sito è disponibile all’indirizzo www.ctcolonography.org ed è costituito da 8 pagine web. Nelle prove di scaricamento dei dati TC da tecnologia ADSL (6 Mbit/s), un file di 294 Mbytes è stato scaricato in 33 minuti, da rete universitaria (100 Mbit/s) in 200 secondi, da sito remoto accademico negli USA in 2 ore e 50 minuti. Il monitoraggio del numero di accessi in 22 giorni, dal giorno di pubblicazione, ha evidenziato 220 accessi.ConclusioniIl sito web è uno strumento immediato e aggiornato per la divulgazione dell’attività di ricerca progettuale e una risorsa didattica di CV.