Ferdinando D'Ambrosio

Strain US elastography for the characterization of thyroid nodules: Advantages and limitation

Thyroid nodules, with their high prevalence in the general population, represent a diagnostic challenge for clinicians. Ultrasound (US), although absolutely reliable in detecting thyroid nodules, is still not accurate enough to differentiate them into benign and malignant. A promising novel modality, US elastography, has been introduced in order to further increase US accuracy. The purpose of this review article is to assess the thyroid application of US strain elastography, also known as real-time elastography or quasistatic elastography. We provide a presentation of the technique, and of up-to-date literature, analyzing the most prominent results reported for thyroid nodules differentiation. The practical advantages and limitations of strain elastography are extensively discussed herein.

Present and future in the use of micro-CT scanner 3D analysis for the study of dental and root canal morphology

The goal of the present article is to illustrate and analyze the applications and the potential of microcomputed tomography (micro-CT) in the analysis of tooth anatomy and root canal morphology. The authors performed a micro-CT analysis of the following different teeth: maxillary first molars with a second canal in the mesiobuccal (MB) root, mandibular first molars with complex anatomy in the mesial root, premolars with single and double roots and with complicated apical anatomy. The hardware device used in this study was a desktop X-ray microfocus CT scanner (SkyScan 1072, SkyScan bvba, Aartselaar, Belgium). A specific software ResolveRT Amira (Visage Imaging) was used for the 3D analysis and imaging. The authors obtained three-dimensional images from 15 teeth. It was possible to precisely visualize and analyze external and internal anatomy of teeth, showing the finest details. Among the 5 upper molars analyzed, in three cases, the MB canals joined into one canal, while in the other two molars the two mesial canals were separate. Among the lower molars two of the five samples exhibited a single canal in the mesial root, which had a broad, flat appearance in a mesiodistal dimension. In the five premolar teeth, the canals were independent; however, the apical delta and ramifications of the root canals were quite complex. Micro-CT offers a simple and reproducible technique for 3D noninvasive assessment of the anatomy of root canal systems.

Contrast enhanced ultrasound in the evaluation and percutaneous treatment of hepatic and renal tumors

Image-guided percutaneous ablation techniques are increasingly being used for the treatment of malignant tumors of the liver and kidney. Contrast enhanced ultrasound (CEUS) is a real-time dynamic imaging technique that plays an important role in the pre-, intra-, and post-procedural management of these patients. This review will focus on the role of CEUS in the evaluation of patients undergoing treatment with percutaneous ablation for hepatic or renal tumors.

Craniometaphyseal dysplasia: A case report

Craniometaphyseal dysplasia (CMD) is a rare genetically transmitted bone dysplasia characterized by alterations in the development of the craniofacial bones with abnormal remodeling of the metaphyses. Sclerosis of the skull bones can lead to cranial nerve compression that finally may result in hearing loss and facial palsy. CMD occurs in an autosomal dominant (AD) (MIM 123000) and an autosomal recessive (AR) form (MIM 218400). Sclerosis of cranial bones is usually much more severe in the AR form. We present a 36-year-old male with a previous diagnosis of Paget disease. The examination reveals prognathism, ocular hypertelorism, mixed bilateral hypoacusia, nasal bossing, a class III malocclusion and a narrow palatal vault. The patient necessitated several dental extractions, surgical procedures were conducted, and a biopsy of the alveolus was performed and the sample underwent histological examination. The histological report led to an exclusion of the previous diagnosis of Paget disease. The final diagnosis of autosomal dominant CMD was confirmed by the molecular testing of the CMD gene (ANKH).

Accuracy of cone-beam computed tomography in defining spatial relationships between third molar roots and inferior alveolar nerve

Objective: Cone-beam computed tomography (CBCT) has been proposed in surgical planning of lower third molar extraction. The aim of the present study was to assess the reliability of CBCT in defining third molar root morphology and its spatial relationships with the inferior alveolar nerve (IAN). Materials and Methods: Intraoperative and radiographic variables of 74 lower third molars were retrospectively analyzed. Intraoperative variables included IAN exposure, number of roots, root morphology of extracted third molars, and presence/absence of IAN impression on the root surface. Radiographic variables included presence/absence of the cortex separating IAN from the third molar roots on CBCT examination, number of roots and root morphology on both orthopantomography (OPG) and CBCT. The statistical association between variables was evaluated using the Fishers exact test. Results: In all cases of intraoperative IAN exposure, the cortex appeared discontinuous on CBCT images. All cases, in which the cortical bone was continuous on CBCT images, showed no association with nerve exposure. In all cases in which nerve impression was identified on the root surface, the IAN cortex showed interruptions on CBCT images. No nerve impression was identified in any of the cases, in which the cortex appeared continuous on CBCT images. CBCT also highlighted accessory roots and apical anomalies/curvatures, not visible on the OPG. Conclusions: CBCT seems to provide reliable and accurate information about the third molar root morphology and its relationship with the IAN.

Audiological and radiological characteristics of a family with T961G mitochondrial mutation.

Abstract Objective: The aim of this study was to describe audiological and radiological characteristics, and other secondary aspects, in a family carrying a T961G mutation in the 12S rRNA mitochondrial gene. Design: Case report. Study sample: Six members of a family participated in an audiological evaluation that included pure-tone audiometry, immittance tests, auditory brainstem responses (ABR), and otoacoustic emissions (OAE). The radiological evaluation was conducted through temporal bone CT scans using a Toshiba 16 channels Aquilon Spirale. Neuropsychiatric evaluation was also administered. Results: Three participants were diagnosed with severe sensorineural hearing loss of cochlear origin and cochlear malformations visible in CT scans. One participant had a mild mixed-hearing loss and no cochlear malformations. Two participants had normal audiological and radiological findings. Conclusions: We believe our study can provide helpful insight on the clinical findings of a rare mutation, of which few data have been presented in literature.

Elastography: A Practical Approach

The first two chapters cover basic fundamental principles of elastography, with subsequent chapters exploring pathology-specific utilization. The authors cover the extensively validated and implemented use of elastography for diffuse liver disease, and diseases of the breast andthyroid gland. They also discuss the potential benefits and limitations for the prostate, spleen, pancreas, kidneys, musculoskeletal system, salivary glands, lymph nodes, and testes. The book concludes with a chapter on potential future applications of this ever-evolving technology.

Orofacial pain and stylohyoid complex syndrome.

Dear Editor, In the introduction of the manuscript entitled ‘nigrostriatal dopaminergic depletion produces orofacial static mechanical allodynia’ (W. Dieb et al. Eur J Pain. 2015 April 21) the authors suggest that nigrostriatal dopamine depletion could cause atypical facial pain. The purpose of this letter is to underline that the stylohyoid complex syndrome (SHCS) induces a part of orofacial pain that should not be confused, as often is the case, with the atypical idiopathic orofacial pain and Dopamine depletion. The term orofacial pain refers to pain that originates from hard and soft tissues of the head and neck. It may also originate from the central nervous system or it can express a psychological disorder. A classification of orofacial pain considers the origin and the onset of pain: dental, oropharyngeal–laryngeal mucosal, neurovascular and atypical idiopathic. SHCS is a rare disease which is not well known. Unfortunately, it is underestimated and is misdiagnosed as atypical idiopathic orofacial pain. Eagle described two clinical groups: (1) Classical syndrome, which occurs after trauma or tonsillectomy and presents chronic neck pain, odynophagia, otalgia, dysphagia and foreign body sensation; (2) Carotid artery Syndrome, which occurs without trauma or tonsillectomy as well as in cases in which the Stylohyoid process (SP) compresses the carotid artery segments and perivascular sympathetic fibres (Eagle, 1949). To make this clear, the SHCS can be represented as follows:

Cone beam computed tomography after round window vibroplasty: do the radiological findings match the auditory outcome?

Abstract Conclusion: The cone beam computed tomography (CBCT) imaging technique has proved to be reliable for assessing the appropriate positioning of the floating mass transducer (FMT) in the round window (RW) niche, although some parameters do not seem to be essential for achieving a satisfactory functional outcome. Objectives: To evaluate the role that specific imaging parameters derived from CBCT of the temporal bone have for predicting the functional outcome after RW vibroplasty (RW-VP). Methods: CBCT imaging was carried out in a homogeneous group of patients who presented with a mixed type of hearing loss after open tympanoplasty. Three arbitrary radiological parameters were taken into account: the FMT/RW membrane contact, bony contacts of the FMT margins, and the inferior FMT tissue support. The audiological assessment took into consideration the PTA4 (500–4000 Hz), the PTA2 (125–250 Hz), and the word recognition score (WRS) in quiet and in noise. Results: One subject presented with all positive CBCT parameters and showed a good, but not the best auditory performance among the study group. In the majority of the subjects, with a satisfactory postoperative hearing improvement, at least two of the three radiological parameters were present. In comparison with the unaided condition, an improvement in both the PTA4 and PTA2 was found in all the subjects.