Marco Di Maurizio

Potential role of fetal cardiac evaluation with magnetic resonance imaging: preliminary experience

To report our experience with magnetic resonance imaging (MRI) in fetal heart evaluation.

Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience.

To assess if a correlation is present between apparent diffusion coefficient (ADC) values and normal lung maturation during gestation to define potential reference values as indicators of the lung development.

Features and perspectives of MR enterography for pediatric Crohn disease assessment.

The aim of this paper is to provide indications for performing magnetic resonance enterography (MRE) in Crohn’s disease (CD), the essential technical elements of MRE techniques and typical findings in patients with CD. Patients suffering from CD frequently require cross-sectional imaging. By performing MRE, it is possible to obtain results comparable to those obtained with endoscopy in terms of identifying and assessing disease activity and better than other cross-sectional imaging techniques, such as CT, in the evaluation of the fibrosis and complications of disease. The MR imaging of diffusion MR is a technique which enables medical staff to add important additional information and which may replace the use of intravenous contrast agents in the near future. Magnetic resonance enterography is an accurate tool for assessing bowel disease and the various complications associated with CD. The lack of exposure to non-ionizing radiation is an important advantage of this imaging technique, especially in the case of pediatric patients. Familiarity with common and pathognomonic imaging features of CD is essential for every clinician involved in the treatment of inflammatory bowel disease and the care of patients.

4D Fetal Echocardiography

Congenital heart defects (CHD) are the most frequent malformation in the human fetus and are the leading cause of mortality due to malformations in the first year of life. Despite its clinical importance screening performed by ultrasonographic examination during the second trimester of pregnancy has shown disappointingly low detection rates mainly due to the difficulties in obtaining an adequate examination of the fetal heart. Four-dimensional (4D) ultrasound of the fetal heart has been recently suggested as a tool to improve the detection rate of CHD by decreasing the dependency on operator skills required in two-dimensional ultrasound scans but up to now no practical manuals are available in describing its application in clinical practice for the study of fetal heart. The objective of this Ebook is to explain the role of 4D during second trimester examination and in fetuses with CHD. The technique of obtaining 4D volume of the fetal heart, how to navigate in the volume to obtain diagnostic planes and how to use semiautomatic and automatic software of analysis are described. We believe that after reading this book the standard fetal cardiac anatomy survey can be performed in the second trimester fetus by 4D in both normal and abnormal hearts. This approach may reduce the operator dependency in diagnosis CHD. This Ebook should prove to be a valuable resource for obstetricians, sonographers and pediatric cardiologists.

Cuore e vasi

Lo studio del distretto cardiovascolare e delle patologie cardiache congenite in utero con Risonanza Magnetica (RM), stando anche a recenti studi pubblicati in letteratura, e ancora pioneristico anche se possibile, in relazione alle numerose limitazioni di ordine tecnico solo parzialmente superabili [1, 2]. Tuttavia, la RM potrebbe offrire, rispetto all’ecocardiografia, una migliore finestra di studio nelle fasi piu avanzate della gravidanza in virtu dei progressivi processi di riduzione del liquido amniotico (oligoidramnios fisiologico) e di calcificazione delle coste fetali che riducono la propagazione degli ultrasuoni (US) [3]. Coesistono inoltre, in particolare nelle cardio- patie complesse, limitazioni di carattere intrinseco legate ad anomalie di rotazione o a ipertrofie ventricolari, che alterano la normale geometria del cuore con perdita dei classici piani. Non si puo inoltre dimenticare che allo stato dell’arte non e possibile fornire valutazioni flussimetriche nelle patologie su base valvolare e vascolare (ad esempio, incontinenza, reflusso, atresia, stenosi ecc), anomalie che possono essere solamente ipotizzate se determinanti un’alterazione anatomica. Inoltre, le patologie con alterazioni del ritmo cardiaco non sono allo stato attuale di pertinenza RM. La contrattilita cardiaca e la funzionalita valvolare non sono valutabili con la RM: infatti l’impossibilita tecnica di sincronizzare l’acquisizione con il battito cardiaco fetale e 1’ancora limitata risoluzione temporale delle attuali sequenze cine RM (2–3 frame al secondo) non permettono di seguire la funzionalita cardiaca in real time, ma acquisiscono il movimento cardiaco in maniera artificiale, con velocita dipendente dalla rapidita di acquisizione delle fette e non dalla reale velocita di contrazione atrioventricolare [4].

Patologia malformativa dell’addome fetale

Le malformazioni congenite dell’addome e del tratto gastrointestinale fetali sono piuttosto frequenti e multiformi: comprendono sia difetti di parete (difetti diaframmatici, difetti della parete addominale anteriore) che anomalie intraddominali degli organi contenuti in sede peritoneale e retroperitoneale (fegato, colecisti, stomaco, intestino, pancreas, surreni, reni, vasi, vescica, ureteri, genitali, vasi del cordone ombelicale).