Francesco Alessandrino

Muscle injuries: ultrasound evaluation in the acute phase.

Muscle injuries can be classified as extrinsic or intrinsic injuries as well as contusions and lacerations, and clinical assessment is composed of the history and physical examination. Diagnostic imaging, particularly ultrasound (US) examination, is essential to a correct assessment of the severity of the injury and to exclude important complications as these two elements influence treatment decisions, prognosis and time to return to unrestricted physical activity. This paper presents the main clinical and US features of acute muscle injuries.RiassuntoI traumi muscolari possono essere classificati in estrinseci, contusioni e lacerazioni, e intrinseci. Il riconoscimento avviene attraverso l’anamnesi e l’esame clinico. L’imaging, in particolare l’ecografia, é di fondamentale importanza per valutare correttamente la gravità del trauma e per escludere le principali complicanze, i due elementi che incideranno di più sul tipo di trattamento a cui sarà sottoposto il paziente, sulla prognosi e sulla tempistica del ritorno all’attività fisica. In questo articolo vengono presentate le principali caratteristiche cliniche ed ecografiche dei traumi muscolari acuti.

Uterine arteriovenous malformation

Uterine arteriovenous vascular malformations (UAVM) are uncommon vascular diseases, occurring during reproductive age. Patients affected by UAMVs usually present with recurrent pregnancy loss or menorrhagia. Initial evaluation of UAVMs is made with ultrasonography (US) and US-Doppler. Magnetic resonance is used when a UAMV is suspected at US. Treatment can be surgical (hysterectomy or surgical removal of AVM), or with selective uterine arterial embolization. We report a case of UAMV, from its clinical signs to diagnostic confirmation and subsequent treatment.RiassuntoLe malformazioni arterovenose dell’utero (MAVU) sono disordini vascolari poco comuni, che spesso si presentano in donne in età fertile; si manifestano come aborti ricorrenti o con menorragia. La valutazione iniziale viene eseguita con l’ecografia e eco colour-Doppler. La risonanza magnetica è utilizzata in caso di sospetto ecografico di MAVU. Il trattamento può essere chirurgico o mediante embolizzazione delle arterie uterine. In questo articolo è riportato un caso di MAVU, dal sospetto clinico alla conferma diagnostica e al trattamento effettivo.

Complications of muscle injuries

Muscle injuries can be classified into strain injuries and contusions. Depending on the type of injury, different complications may occur, which in turn can be divided into early, intermediate and delayed complications. A prompt diagnosis of complications allows early treatment and permits to avoid harmful sequelae. Imaging studies, ultrasonography in particular, allow (recognizing) the assessment of complications whenever clinically suspected. In this article the most frequent complications of muscle injuries are presented.RiassuntoLe lesioni muscolari possono essere classificate in lesioni contusive e lesioni distrattive. A seconda del tipo di lesione, possono insorgere complicanze differenti, che a loro volta possono essere suddivise in complicanze precoci, intermedie e tardive. Un rapido e preciso riconoscimento delle complicanze consente di intervenire precocemente e permette di evitare conseguenze dannose. L’imaging, in particolar modo l’ecografia, permette il riconoscimento di complicanze ogni qualvolta esse siano sospettate clinicamente. In questo articolo vengono presentate le complicanze più frequenti delle lesioni muscolari.

Do MRI Structured Reports for Multiple Sclerosis Contain Adequate Information for Clinical Decision Making

OBJECTIVE Few data are available on how often MRI reports provide sufficient information for clinical decision making in patients with multiple sclerosis (MS). The aim of this study is to evaluate if structured reporting of MRI in MS contain adequate information for clinical decision making compared with nonstructured reporting. MATERIALS AND METHODS Brain and spinal cord MRI reports of patients with suspected or known MS before and after implementation of a structured reporting template were included. Brain and spinal cord MRI reports were assessed for presence of 11 and three key features relevant for management of MS, respectively. Three neurologists evaluated reports and images to assess lesion load, presence of sufficient information for clinical decision making, and necessity to review MR images for clinical decision making. Statistical analysis included t tests and chi-square tests. RESULTS Thirty-two structured and 37 nonstructured reports were reviewed. Brain MRI nonstructured reports contained a mean ± SD of 3.59 ± 0.76 key features, and structured reports contained a mean of 10.25 ± 1.32 key features (p < 0.001). No significant difference was observed in the number of key features in nonstructured and structured spinal cord MRI reports. All neurologists could understand lesion load significantly more often when reading structured versus nonstructured reports (p < 0.001). For two of the three neurologists, structured reports contained adequate information for clinical decision making more often than did nonstructured reports (p < 0.001 and p = 0.006). When reading nonstructured reports, two of the three neurologists needed to evaluate images significantly more often (p < 0.001). CONCLUSION Structured reports of MRI in patients with MS provided more adequate information for clinical decision making than nonstructured reports.

Correlation of the controlled attenuation parameter with indices of liver steatosis in overweight or obese individuals: A pilot study

Objective The aim of this study was to assess the clinical relevance of the controlled attenuation parameter (CAP) by analyzing the correlations between CAP and indirect indices of liver steatosis in obese or overweight individuals. Methods Consecutive participants were prospectively enrolled. BMI, waist circumference, hepatic steatosis index, fatty liver index, percent fat mass and regional fat masses as assessed by dual-energy X-ray absorptiometry (DXA), fat signal fraction as assessed by MRI, and CAP were obtained. Pearson’s r coefficient was used to test the correlation between two study variables. Results A total of 88 individuals were studied. They included 31 men [age, 50.4 years (12.9 years); BMI, 30.7 kg/m2 (4.8 kg/m2)] and 57 women [age, 49.0 years (12.6 years); BMI, 31.4 kg/m2 (5.6 kg/m2)]. DXA, anthropometric parameters, and fatty liver index were moderately correlated with CAP in men. In women, there was a moderate correlation of CAP with the hepatic steatosis index and anthropometric parameters and only a slight or fair correlation of CAP with DXA parameters. CAP and fat signal fraction showed a good correlation (r=0.65 in men, P=0.002; r=0.68 in women, P=0.0009). Conclusion Measurement of CAP is a reliable method for noninvasive assessment of liver steatosis, showing a correlation with other indirect markers of central obesity and a good correlation with MRI results.

Peliosis hepatis associated with hereditary haemorrhagic telangiectasia

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal, predominantly inherited disease characterized by diffuse telangiectases involving the skin, mucous membranes, lung, brain, gastrointestinal tract and liver. Peliosis hepatis is a rare, benign disorder causing sinusoidal dilatation and the presence of multiple blood-filled lacunar spaces within the liver. We report a case of an HHT patient with incidental magnetic resonance findings of focal hepatic peliosis.

Imaging of hepatic toxicity of systemic therapy in a tertiary cancer centre: chemotherapy, haematopoietic stem cell transplantation, molecular targeted therapies, and immune checkpoint inhibitors

The purpose of this review is to familiarise radiologists with the spectrum of hepatic toxicity seen in the oncology setting, in view of the different systemic therapies used in cancer patients. Drug-induced liver injury can manifest in various forms, and anti-neoplastic agents are associated with different types of hepatotoxicity. Although chemotherapy-induced liver injury can present as hepatitis, steatosis, sinusoidal obstruction syndrome, and chronic parenchymal damages, molecular targeted therapy-associated liver toxicity ranges from mild liver function test elevation to fulminant life-threatening acute liver failure. The recent arrival of immune checkpoint inhibitors in oncology has introduced a new range of immune-related adverse events, with differing mechanisms of liver toxicity and varied imaging presentation of liver injury. High-dose chemotherapy regimens for haematopoietic stem cell transplantation are associated with sinusoidal obstruction syndrome. Management of hepatic toxicity depends on the clinical scenario, the drug in use, and the severity of the findings. In this article, we will (1) present the most common types of oncological drugs associated with hepatic toxicity and associated liver injuries; (2) illustrate imaging findings of hepatic toxicities and the possible differential diagnosis; and (3) provide a guide for management of these conditions.

Update on Radiogenomics of Clear Cell Renal Cell Carcinoma

The goal of radiogenomics is to associate imaging features with gene expression pattern and correlate these features with clinical outcomes. Radiogenomics, by overcoming the histologic heterogeneity of clear cell renal cell carcinoma, has the potential to reflect tumor biology and predict prognosis.

MDCT and MRI of the ampulla of Vater (part II): non-epithelial neoplasms, benign ampullary disorders, and pitfalls

AbstractThe purpose of this two-part article is to review the cross-sectional imaging features of benign and malignant ampullary conditions with endoscopic and histopathologic correlation and to present the most common pitfalls in the evaluation of the ampulla. In this part, we will review the mesenchymal and secondary neoplasms of the ampulla, a vast array of benign ampullary conditions, causes of bulging papilla, and pitfalls. Familiarity with ampullary pathologic conditions and pitfalls, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.

MDCT and MRI of the ampulla of Vater (part I): technique optimization, normal anatomy, and epithelial neoplasms

Abstract The purpose of this two-part article is to review the cross-sectional anatomy of the ampulla and periampullary region, to propose novel and optimized MDCT and MRI techniques that allow accurate evaluation of the ampulla of Vater, and to summarize the cross-sectional imaging features of benign and malignant ampullary conditions. In this first part, we will review the normal anatomy of the ampullary region, provide suggestions on how to optimize evaluation of the ampullary region by MDCT and MRI, and review the imaging features of select epithelial neoplasms of the ampulla. Familiarity with the normal ampullary anatomy and the pathologic conditions involving the ampulla, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.