Luca Pio Stoppino

Assessment of osteoporotic vertebral fractures using specialized workflow software for 6-point morphometry

PURPOSE To evaluate the time required, the accuracy and the precision of a model-based image analysis software tool for the diagnosis of osteoporotic fractures using a 6-point morphometry protocol. MATERIALS AND METHODS Lateral dorsal and lumbar radiographs were performed on 92 elderly women (mean age 69.2+/-5.7 years). Institutional review board approval and patient informed consent were obtained for all subjects. The semi-automated and the manual correct annotations of 6-point placement were compared to calculate the time consumed and the accuracy of the software. Twenty test images were randomly selected and the data obtained by multiple perturbed initialisation points on the same image were compared to assess the precision of the system. RESULTS The time requirement data of the semi-automated system (420+/-67 s) were statistically different (p<0.05) from that of manual placement (900+/-77 s). In the accuracy test, the mean reproducibility error for semi-automatic 6-point placement was 2.50+/-0.72% [95% CI] for the anterior-posterior reference and 2.16+/-0.5% [95% CI] for the superior-inferior reference. In the precision test the mean error resulted averaged over all vertebrae was 2.6+/-1.3% in terms of vertebral width. CONCLUSIONS The technique is time effective, accurate and precise and can, therefore, be recommended in large epidemiological studies and pharmaceutical trials for reporting of osteoporotic vertebral fractures.

Rotator cable at MR imaging: considerations on morphological aspects and biomechanical role.

PurposeThe rotator cable (RC) is a thickening of the coracohumeral ligament. It extends from the coracohumeral ligament to the inferior border of the infraspinatus tendon, with fibres running perpendicularly to the rotator cuff fibres. According to some authors, the RC tends to thicken with age, thus allowing some individuals with a cuff lesion to preserve normal shoulder function. We evaluated the RC with magnetic resonance (MR) imaging and investigated its possible role in the biomechanics of the shoulder affected by cuff lesions.Materials and methodsBetween November 2007 and May 2008, we performed shoulder MR examinations for shoulder pain or disability on 94 patients (46 males, 48 females; age range 16–79 years; mean age 54.09±15.09 years) for a total of 104 shoulders (62 right, 42 left).ResultsRC was more easily detectable in oblique coronal scans where it appeared as a crescent-shaped, regularly marginated structure adjacent to the articular surface of the supraspinatus tendon and medial to the insertion point of this tendon on the greater tuberosity. Its thickness was 2.8±0.3 mm. The structure was identified in 62% of cases (mean patient age 55.3±14.9 years). No statistically significant difference in age was found between patients with and without evidence of RC (Student’s t test=0.05; p=0.82). Among patients with partial- or full-thickness supraspinatus tendon lesions at MR imaging, no statistically significant difference was found between the presence or absence of RC and disability on Jobe’s test (χ2=1.17; p>0.05).ConclusionsRC can be observed at MR imaging in >60% cases. In our sample it did not seem to influence shoulder function in patients with cuff lesions.RiassuntoObiettivoIl rotator cable (RC) è un ispessimento del legamento coraco-omerale. Esso si estende dal legamento coraco-omerale fino al margine inferiore del tendine dell’infraspinato con fibre che decorrono perpendicolarmente a quelle dei tendini della cuffia dei rotatori. Secondo alcuni autori, il RC tenderebbe ad ispessirsi con l’età consentendo ad alcuni pazienti con lesioni di cuffia di conservare la normale funzionalità della spalla. Scopo del nostro lavoro è stato valutare il RC attraverso la risonanza magnetica (RM) e definire il suo possibile ruolo nella biomeccanica della spalla in soggetti con lesione di cuffia.Materiali e metodiDa novembre 2007 a maggio 2008 abbiamo reclutato 94 pazienti (46 maschi e 48 femmine), per un totale di 104 spalle (62 destre e 42 sinistre), di età compresa tra i 16 ed i 79 anni (età media 54,09±15,09 anni), che effettuavano l’esame di RM della spalla per dolore o limitazione funzionale.RisultatiIl RC è più agevolmente individuabile nelle scansioni coronali-oblique ove appare come una struttura a forma di semiluna, con margini regolari, adiacente alla superficie articolare del tendine sopraspinato, medialmente al punto d’inserzione di questo tendine sulla grande tuberosità. Il suo spessore è 2,8±0,3 mm. La struttura è stata identificata nel 62% dei casi (età media dei pazienti 55,3±14,9 anni). Non è stata riscontrata alcuna differenza statisticamente significativa per quanto riguardava l’età tra pazienti con o senza evidenza di RC (test t di Student=0,05; p=0,82). Nel gruppo di pazienti che presentavano lesioni parziali o complete del tendine sovraspinoso non è stata osservata alcuna differenza statisticamente significativa tra presenza o assenza del RC e limitazione funzionale al test di Jobe (χ2=1,17; p>0,05).ConclusioniIl RC può essere osservato in RM in più del 60% dei casi. Nel nostro campione di studio esso non sembra influenzare la funzionalità della spalla in pazienti con lesioni di cuffia.

Diffusion-weighted MRI with parallel imaging technique: apparent diffusion coefficient determination in normal kidneys and in nonmalignant renal diseases

The purpose of the study was to assess the capability and the reliability of apparent diffusion coefficient (ADC) measurements in the evaluation of different benign renal abnormalities. Twenty-five healthy volunteers and 31 patients, divided into seven different groups (A-G) according to pathology, underwent diffusion-weighted magnetic resonance imaging (DW MRI) of the kidneys using 1.5-T system. DW images were obtained in the axial plane with a spin-echo echo planar imaging single-shot sequence with three b values (0, 300, and 600 s/mm²). Before acquisition of DW sequences, we performed in each patient a morphological study of the kidneys. ADC was 2.40±0.20×10⁻³ mm² s⁻¹ in volunteers. A significant difference was found between Groups A (cysts=3.39±0.51×10⁻³ mm² s⁻¹) and B (acute/chronic renal failure=1.38±0.40×10⁻³ mm² s⁻¹) and between Groups A and C (chronic pyelonephritis=1.53±0.21×10⁻³ mm² s⁻¹) (P<.05). An important difference was also observed among Group D (hydronephrosis=4.82±0.35×10⁻³ mm² s⁻¹) and Groups A, B, and C (P<.05), whereas no differences were found between Groups B and C (P>.05). A considerable correlation between glomerular filtration rate and ADC was found (P=.04). In conclusion, significant differences were detected among different patient groups, and this suggests that ADC measurements can be useful in differentiating normal renal parenchyma from most commonly encountered nonmalignant renal lesions.

MR characterisation of dysplastic nodules and hepatocarcinoma in the cirrhotic liver with hepatospecific superparamagnetic contrast agents: pathological correlation in explanted livers

PurposeThe authors sought to evaluate the potential of magnetic resonance (MR) imaging with superparamagnetic iron oxide (SPIO) contrast material for identifying, characterising and differentiating dysplastic nodules (DN) and hepatocellular carcinoma (HCC) in the cirrhotic liver by correlating the results with pathological findings on the explanted liver.Material and methodsMR imaging was used to study the liver of 400 cirrhotic patients awaiting liver transplantation, 31 of whom were selected to receive a liver. Of these 31 patients, we included in the study 22 patients (mean age 53 years; range 46–57 years) who underwent liver transplantation within 12–24 h after MR examination. Patients were studied with a 1.5-T device, and scans were acquired before and after the administration of paramagnetic contrast material. For every lesion, we recorded signal intensity on unenhanced baseline T1- and T2-weighted images and enhancement pattern after SPIO administration. Histological examination of the entire liver provided the definitive diagnosis of the lesions.ResultsHistological examination identified 59 lesions: 14 HCC, 4 HCC-DN, 39 DN, and 2 cystoadenomas. Among the 14 HCC, three were well differentiated, eight were moderately differentiated and three were poorly differentiated. Of the 39 DN, 28 were low-grade and 11 high-grade lesions. Unenhanced baseline MR imaging correctly identified and characterised 20 lesions, equal to 33.90% of all lesions: 6 HCC, 12 DN and 2 DN with a subfocus of HCC. SPIO-enhanced MR imaging showed greater sensitivity detecting and characterising 45 lesions, equal to 76.27% of all lesions identified at histology: 14 HCC, 27 DN and 4 DN with subfocus of HCC. SPIO administration improved the sensitivity of MR imaging in lesion detection and characterisation by 42.37%. False negative results with SPIO-enhanced MR imaging occurred in 12 DN (31%), which histological examination revealed to be low-grade DN with a diameter <1 cm.ConclusionsSPIO-enhanced MR imaging proved to be of value in detecting and characterising lesions in the cirrhotic liver, allowing differentiation of DN from HCC and providing an early diagnosis of neoplastic degeneration of DN.RiassuntoObiettivoObiettivo di questo studio è stato valutare le potenzialità della risonanza magnetica (RM) eseguita con mezzo di contrasto (MdC) superparamagnetico (superparamagnetic iron oxide particles, SPIO) nell’identificazione, caratterizzazione e diagnosi differenziale tra noduli displasici (ND) ed epatocarcinoma (HCC) nel fegato cirrotico, confrontando i risultati della RM con quelli dell’esame anatomo-patologico eseguito su fegato espiantato.Materiali e metodiAbbiamo studiato con RM il fegato di 400 pazienti cirrotici in attesa di trapianto, 31 dei quali selezionati per reperimento d’organo da trapiantare. Dei 31 pazienti selezionati per il trapianto d’organo, sono stati inclusi nello studio 22 pazienti, di età media di 53 anni (range 46–57 anni), sottoposti a trapianto di fegato a distanza di circa 12–24 ore dall’esecuzione dell’esame RM. I pazienti inclusi nello studio sono stati sottoposti ad esame RM con un apparecchio da 1,5 T. Sono state eseguite scansioni prima e dopo somministrazione endovenosa di MdC SPIO. Per ogni lesione identificata è stata indicata l’intensità di segnale nelle sequenze di base pesate in T1 e in T2 ed il comportamento dopo iniezione di MdC SPIO. La diagnosi definitiva delle lesioni è stata effettuata con l’esame istologico di tutto il fegato espiantato.RisultatiCon l’esame istologico sono state identificate 59 lesioni: 14 HCC, 4 HCC-ND, 39 ND, 2 cistoadenomi. Dei 14 HCC, 3 sono risultati ben differenziati, 8 moderatamente differenziati, 3 scarsamente differenziati. Dei 39 ND, 28 erano a basso grado di malignità e 11 ad alto grado di malignità. Con l’esame RM di base abbiamo identificato e caratterizzato correttamente 20 lesioni, pari al 33,90% delle lesioni complessivamente individuate, di cui 6 HCC, 12 ND e 2 ND con foci di HCC. L’esame RM, eseguito dopo somministrazione di MdC SPIO, ha mostrato una maggiore sensibilità identificando e caratterizzando complessivamente 45 lesioni, pari al 76,27% delle lesioni totali individuate con l’esame istologico: 14 HCC, 27 ND e 4 ND con foci di HCC. Dopo la somministrazione di MdC SPIO la sensibilità della RM nella identificazione e caratterizzazione delle lesioni è aumentata rispetto alle immagini di base del 42,37%. I falsi negativi con la RM-SPIO sono stati 12 noduli displasici, pari al 31%, che all’esame istologico sono risultati essere ND a basso grado di malignità e con diametro inferiore al cm.ConclusioniLa RM con utilizzo di MdC SPIO, nella nostra esperienza è risultata utile nella identificazione e caratterizzazione delle lesioni epatiche nel fegato cirrotico mostrandosi in grado di differenziare i noduli displasici dagli HCC e ha consentito una diagnosi precoce della trasformazione carcinomatosa dei noduli displasici.

Rapid long-lasting biochemical and radiological response to sorafenib in a case of advanced hepatocellular carcinoma

The multikinase inhibitor sorafenib has demonstrated an overall survival benefit in phase III hepatocellular carcinoma (HCC) trials and has become the new standard of care for advanced stages of this disease. However, in clinical practice, the vast majority of patients obtain disease stabilization and occasionally tumor shrinkage. Furthermore, the appropriate timing of sorafenib therapy initiation, in order to maximize its clinical activity, remains under debate. We report a case of 4-year sorafenib treatment in a patient with an advanced hepatitis C virus (HCV)-related HCC with extensive infiltration of the inferior vena cava. Sorafenib treatment induced a rapid complete biochemical response and a long-term favorable outcome. Additionally, no major toxicities or detrimental effects on quality of life were observed. Thus, it is likely that a subgroup of human HCC may be highly sensitive to sorafenib; new molecular determinants are required to select those patients who may benefit from this therapy. Furthermore, a prompt initiation of treatment when the hepatic function is not compromised is a prerequisite for maximizing the clinical activity of sorafenib.

Mechanism of traumatic knee injuries and MRI findings

Bone bruises are focal abnormalities in subchondral bone marrow due to trabecular microfractures as a result of traumatic force. These trauma-induced lesions are better detected with magnetic resonance (MR) imaging using water-sensitive sequences. Moreover, the pattern of bone bruise is distinctive and allows us to understand the dynamics of trauma and to predict associated soft injuries. This article discusses the mechanism of traumatic injury and MR findings.

Multiple Skeletal Muscle Metastases from Colon Carcinoma Preceded by Paraneoplastic Dermatomyositis

Skeletal muscle metastases are very rare events in colorectal carcinoma. By contrast, dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous manifestations and a well-recognized association with several human malignancies and, among others, colorectal cancer. Here, we report the case of a 71-year-old woman with paraneoplastic dermatomyositis followed by the development of a metastatic colon cancer. Interestingly, this patient developed multiple skeletal metastases which were preceded by the worsening of systemic symptoms of dermatomyositis. This observation suggests that, while muscle tissue is usually resistant to the development of tumor metastases, the inflammatory and immune response which characterizes and boosts paraneoplastic myopathy may represent a favorable soil for tumor cell invasion and metastasization to skeletal muscles.

Case report: Multimodality imaging of van Neck-Odelberg disease.

Synchondrosis ischiopubic syndrome (SIS), also known as van Neck–Odelberg disease, is a syndrome characterized by an atypical ossification pattern of the ischiopubic synchondrosis. Its radiological features may mimic stress fracture, neoplasm, osteomyelitis, or posttraumatic osteolysis, causing problems in diagnosis, sometimes leading to unnecessary workup. We report two cases in which the correlation between the clinical and multimodality imaging data enabled the correct diagnosis of SIS.

Radiologic Assessment of Liver Fibrosis – Present and Future

Liver fibrosis results from chronic damage to the liver in conjunction with the accumulation of extracellular matrix (ECM) proteins including collagen, which is a characteristic of most types of chronic liver diseases (CLD) [1]. Hepatic fibrosis was historically thought to be a passive and irreversible process due to the collapse of the hepatic parenchyma and its substitution with a collagen-rich tissue [2, 3]. Currently, is recognised to be a dynamic process that can progress or regress over periods as short as months [4].

Spontaneous Disappearance of a Pericardial Cyst: Case Report and Literature Review

Pericardial cysts are rare benign anomalies generally discovered as incidental findings on radiographic images. Rarely, pericardial cysts cause symptoms and may lead to complications. A 56-year-old woman presented to the emergency department for mild chest pain. A cardiovascular and respiratory examination revealed no abnormalities, while a chest X-ray and subsequent thoracic computed tomography (CT) showed a pericardial cyst. The patient refused both percutaneous treatment and thoracic surgery. Three years later, a thoracic CT scan showed that the pericardial cyst had disappeared. Although the spontaneous resolution of these lesions is rare, this article highlights the possibility of conservative management in select cases.