Fabrizio Urraro

Value of diffusion-weighted magnetic resonance imaging in the characterization of complex adnexal masses

AIMS AND BACKGROUND The aim of the study was to define the role of diffusion-weighted imaging in the characterization of adnexal complex masses, with particular regard to the distinction between benign and malignant lesions. Conflicting results on this topic have emerged from studies in the last decade, with a consequent substantial limitation to the use of this relatively novel technique in clinical practice. METHODS AND STUDY DESIGN Magnetic resonance imaging examinations performed on 91 patients with ovarian masses (56 benign, 35 malignant) were retrospectively evaluated by two observers unaware of the final histopathological diagnosis. Diffusion-weighted sequences with b values of 0, 500 and 1000 were performed in all cases, and apparent diffusion coefficient maps were automatically generated. The signals of both the cystic and solid components of the ovarian masses were evaluated on T2-weighted and diffusion-weighted images acquired with a b value of 1000. Apparent diffusion coefficient values were measured in all cases. RESULTS With regard to the solid components, hypointensity on both the T2-weighted and diffusion-weighted images has proved to be a reliable indicator of benignancy. In contrast, hyperintensity on both sequences was suggestive of malignancy. Signal intensity of the cystic components and apparent diffusion coefficient values of both components have not proven useful in characterization of the masses. CONCLUSIONS Only the definition of the signal intensities on diffusion-weighted images obtained with the use of high b values on the solid component of a complex adnexal mass is useful to characterize an ovarian mass as benign or malignant.

Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches

Aim of our study was to evaluate the prevalence of aberrant origin of the branches of the external carotid artery (ECA) in 97 patients by computed tomography (CTA) and magnetic resonance angiography (MRA) and to compare the accuracy of these two techniques in the visualization of the ECA system. All patients underwent CTA and MRA examination of the head and neck. Multiplanar and volumetric reformations were obtained in all cases. For each set of images, the presence of aberrant origin of the branches of the external carotid artery was investigated. MRA and CTA images of each patient were compared to define their information content. Anatomical anomalies were found in 88 heminecks, with a prevalence of 53.3%. In the 61 patients in whom the CTA was performed before the MRA, the latter method showed only 92% of abnormalities detected at the first examination; in the 36 patients in whom MRA was performed first, CTA identified all of the anomalies highlighted by the former, adding 12 new. Knowledge of the anomalies of origin of the ECA branches is essential for the head and neck surgeon; the high prevalence of anomalies found in our series as in the previous studies indicates the opportunity to perform a CTA or a MRA of the head and neck before any surgical or interventional procedure. CTA is the method of choice in the evaluation of anomalies of origin of the branches of the ECA and in the definition of their course.

[Evaluation with multislice CT of the hilar pulmonary nodules for probable infiltration of vascular-bronchial structures].

Tumor stage is an important prognostic factor for patients suffering from lung cancer, because it affects the type of therapeutic treatment to be implemented. Computed tomography is the imaging method of choice for the staging of lung cancer, and for central neoplasm, it is essential to assess any possible involvement of bronchovascular structures that may affect operability. We report our experience based on the use of reconstruction algorithms for the study of the relationship between tumor, bronchi and adjacent vessels.

Vascular microinvasion from hepatocellular carcinoma: CT findings and pathologic correlation for the best therapeutic strategies

Recurrence of HCC reduces survival rates in patients treated with surgery, and one of the most relevant risk factors for tumour recurrence is microvascular invasion (mVI). The identification of mVI on preoperative examinations could improve surgical planning’s and techniques so as to reduce the risk of tumour recurrence. During our study, we have revised 101 CT examinations of the liver performed on patients diagnosed with solitary HCC who had surgical treatment and pathological analysis of the specimens for mVI in order to detect CT signs which could be reliable in mVI prediction. On CT examinations, the tumours were evaluated for margins, capsule, size, contrast enhancement, halo sign and Thad. From our statistical analysis, we found out that irregularity in tumour margins and defects in peritumoural capsule are the most significant characteristics predicting mVI in HCC. Every report on CT examinations performed on surgical candidate patients should include suggestions about mVI probability in order to tailor procedures, reduce tumour recurrence risk and improve survival rates.

Assessing Response to Radiation Therapy Treatment of Bone Metastases: Short-Term Followup of Radiation Therapy Treatment of Bone Metastases with Diffusion-Weighted Magnetic Resonance Imaging

This study examined the usefulness of diffusion-weighted (DW) Magnetic Resonance Imaging (MRI) in monitoring bone metastases response to radiation therapy in 15 oligometastatic patients. For each metastasis, both mean apparent diffusion coefficient (ADC) changes and high b-value DW metastasis/muscle signal intensity ratio (SIR) variations were evaluated at 30 ± 5 days and 60 ± 7 days after the end of treatment. On baseline DW-MRI, all bone metastases were hyperintense and had signal intensities higher than normal bone marrow on calculated ADC maps. At follow-up evaluations, 4 patterns of response were identified: (I) decreased high b-value DW SIR associated with increased mean ADC (83.3% of cases); (II) increased mean ADC with no change of high b-value DW SIR (10% of cases); (III) decreased both high b-value DW SIR and mean ADC (3.3% of cases); (IV) a reduction in mean ADC associated with an increase in high b-value DW SIR compared to pretreatment values (3.3% of cases). Patterns (I) and (II) suggested a good response to therapy; pattern (III) was classified as indeterminate, while pattern (IV) was suggestive of disease progression. This pattern approach may represent a useful tool in the differentiation between treatment-induced necrosis and highly cellular residual tumor.

Multi-detector computed tomography in the evaluation of variants and anomalies of aortic arch and its branching pattern

OBJECTIVE Evaluate the prevalence of aortic arch anatomy and branching pattern variants and anomalies in 1359 patients by Multi-Detector Computed Tomography Angiography. METHODS Retrospective multi-centric study including exams performed for various clinical issues with the same acquisition and injection protocols on 64-slices scanners. Multi-Planar reformations and Volume Rendering Images were available in all cases. RESULTS A total of 965 patients (71%) had normal aortic arch anatomy and branching pattern. Anatomical variations and anomalies were present in the remaining 394 patients (29%). The most common variation was the common origin of the brachiocephalic and the left common carotid arteries (302/1359 cases, about 22%). The most common anomaly were aberrant right subclavian artery (4/1359, about 0.5%) and right aortic arch (4/1359 cases, about 0.5%). CONCLUSIONS Our multicentric series is, as far as we know, the largest reported to date for the definition of the prevalence of variation and anomalies of aortic arch anatomy and branching pattern. Knowledge of such findings may avoid both in the immediate and in the long term an injury to the patient, decreasing the rate of complications during surgery and interventional radiology procedures in the head and neck district.

Ruolo della diagnostica per immagini nella diagnosi di appendicite acuta: confronto tra ecografia e tomografia computerizzata

Acute appendicitis is the most common cause of acute abdomen requiring emergency surgery. In particular, it affects patients older than 20 years and diagnosis is challenging in this patient subset. The radiologic methods (ultrasound and computed tomography) play a key role in the identification, characterization and staging of the disease as well as optimal timing of surgery. The aim of our study is to assess the usefulness of ultrasound imaging in the diagnosis of acute appendicitis and in a retrospective analysis of 54 ultrasound and computed tomography exams performed in the emergency department.Riassunto. Le appendiciti acute rappresentano la causa piu comune di dolore addominale acuto in pronto soccorso. L’eta media dei pazienti e 20 anni. In alcuni casi la diagnosi puo essere non immediata e la diagnostica per immagini, avvalendosi dell’esame ecografico e della tomografia com puterizzata, gioca un ruolo fondamentale nell’identificazio ne, caratterizzazione e stadiazione della patologia, renden dosi indispensabile soprattutto in casi dubbi. Lo scopo del nostro lavoro e di convalidare l’efficacia dell’ecografia nella diagnosi di appendicite acuta attraverso un’analisi retro spettiva di esami consecutivi ecografici e di tomografia computerizzata, effettuati in 54 pazienti giunti in pronto soccorso.

Sphenoidal pneumosinus dilatans due to anterior skull base meningiomas - CT and MRI aspects: Report of two new cases and literature review.

We report on two patients disclosing a pneumosinus dilatans (PSD) and an anterior skull base meningioma. Our findings, together with those from the pertinent literature, support the thought that this infrequent anomaly of paranasal sinuses is a useful clue to suspect a concomitant meningioma. Moreover, hypotheses concerning the pathophysiology of PSD are discussed.

Imaging of Gastrointestinal Tract Perforation in the Elderly Patient

There are multiple etiologies of gastrointestinal perforation in children. It occurs most frequently in the newborn. The most common causes of perforation include necrotizing enterocolitis (NEC), gastric perforation, Hirschsprung’s disease, meconium ileus, imperforate anus, and neonatal small left colon syndrome. Other causes of intestinal perforation are intussusception, volvulus/malrotation, appendicitis, inflammatory bowel disease, and foreign object.