Marcello Petrini

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management

BackgroundBowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair.Material and methodsBetween March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as “minor CT findings.” The presence of abdominal guarding and/or abdominal pain was considered as “clinical signs.” Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI).ResultsThirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2–53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively).ConclusionIn patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more “minor CT findings” is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

Novel cardiac magnetic resonance biomarkers: native T1 and extracellular volume myocardial mapping

Cardiac magnetic resonance (CMR) is a non-invasive diagnostic tool playing a key role in the assessment of cardiac morphology and function as well as in tissue characterization. Late gadolinium enhancement is a fundamental CMR technique for detecting focal or regional abnormalities such as scar tissue, replacement fibrosis, or inflammation using qualitative, semi-quantitative, or quantitative methods, but not allowing for evaluating the whole myocardium in the presence of diffuse disease. The novel T1 mapping approach permits a quantitative assessment of the entire myocardium providing a voxel-by-voxel map of native T1 relaxation time, obtained before the intravenous administration of gadolinium-based contrast material. Combining T1 data obtained before and after contrast injection, it is also possible to calculate the voxel-by-voxel extracellular volume (ECV), resulting in another myocardial parametric map. This article describes technical challenges and clinical perspectives of these two novel CMR biomarkers: myocardial native T1 and ECV mapping.

Noncardiac findings in clinical cardiac magnetic resonance: Prevalence in 300 examinations after blind reassessment

Purpose To assess the prevalence of noncardiac findings (NCFs) in a consecutive series of 300 cardiac magnetic resonance (CMR) studies. Methods We retrospectively evaluated CMRs of 192 males and 108 females (42 ± 22 years), comparing findings included in reports to those detected after focused reassessment of CMR images. Noncardiac findings were classified as relevant if additional workup was required. Results We found 19 NCFs, 14 (4.7%) tagged as nonrelevant and 5 (1.7%) as relevant. Images’ reassessment presented 45 NCFs, 26 (8.7%) nonrelevant and 16 (5.3%) relevant (P < 0.003). Conclusions Cardiac magnetic resonance involves the study of areas larger than the heart alone, and NCFs are found in 1 of 7 patients; more than a half of them are not included in the initial CMR report. A small part is relevant, but detection can be unnecessarily stressful and harmful for patients and could increase costs. Risks of overdiagnosis or underreporting are to be taken into account.

Thoracic Aortic Aneurysms, Fistula, and Thrombus

Thoracic aortic aneurysms (TAAs) are abnormal dilatation occurring in the thoracic aorta. They can be classified according to location, morphology, and etiology. TAAs can be divided into true aneurysms and false aneurysms (also called pseudoaneurysms). True aneurysms are usually associated with fusiform dilatation of the aorta and most commonly due to atherosclerosis. False aneurysms are typically saccular with a narrow neck and most commonly due to trauma, penetrating atherosclerotic ulcers, or infections (mycotic aneurysm). Atherosclerosis, genetic causes, aortitis, trauma, and dissection can be the causes of TAAs. MDCT allows the evaluation of TAAs in terms of morphologic features, extent, and signs of instability or impending rupture. Acute aortic thrombosis and aortic fistula with esophagus or bronchi are rare but life-threatening complications of aortic disease. Imaging findings may be subtle.

Epicardial adipose tissue evaluated with cardiac magnetic resonance in normal subject and in patients with ischemic and dilated cardiomyopathies

Methods We retrospectively evaluated 150 patients who underwent CMR (1.5 T, Siemens) in a time span of 22 months: 50 negative (mean age ± standard deviation 47 ± 12.2 years), 50 with CAD (65 ± 9.7 years) and 50 with DCM (56 ± 12.8 years). For each patient we segmented manually the EAT in short-axis cine images at end-diastolic phase with Syngo-Argus software. Volume of EAT was converted into g (g=0.9196*volume). Intra and inter-reader reproducibility in a sub-group of 30 randomly selected patients (10 negative, 10 with CAD, 10 with DCM) was tested. Mann Whitney U and Bland-Altman test were used.

Prognostic value of late enhancement in cardiac magnetic resonance in patients with dilated cardiomyopathy: a meta-analysis

Methods A literature search was performed on Medline and Embase for original articles estimating the LGE prognostic value in patients with DCM. Original articles had to assess mortality for cardiac and non-cardiac causes, sudden cardiac death, sudden death avoided, and hospitalization for cardiac failure. Heterogeneity (I) was evaluated using the Cochrane Q statistics: P-value <0.100 were considered significant. Pooled odd ratio (OR) and 95% confidence interval (CI: 95%) were calculated using Comprehensive Meta-Analysis.