Maria Francesca Rinaldi

Prevalence of thoracolumbar vertebral fractures on multidetector CT: Underreporting by radiologists

OBJECTIVE To evaluate the prevalence of osteoporotic vertebral fractures in patients undergoing multidetector computed tomography (MDCT) of the chest and/or abdomen. MATERIALS AND METHODS 323 consecutive patients (196 males, 127 females) with a mean age of 62.6 years (range 20-88) who had undergone chest and/or abdominal MDCT were evaluated. Sagittal reformats of the spine obtained from thin section datasets were reviewed by two radiologists and assessed for vertebral fractures. Morphometric analysis using electronic calipers was performed on vertebral bodies which appeared abnormal upon visual inspection. A vertebral body height loss of 15% or more was considered a fracture and graded as mild (15-24%), moderate (25-49%) or severe (more than 50%). Official radiology reports were reviewed and whether the vertebral fractures had been reported or not was noted. RESULTS 31 out of 323 patients (9.5%) had at least 1 vertebral fracture and 7 of those patients had multiple fractures for a total of 41 fractures. Morphometric grading revealed 10 mild, 16 moderate and 15 severe fractures. Prevalence was higher in women (14.1%) than men (6.6%) and increased with patients age with a 17.1% prevalence in post-menopausal women. Only 6 out 41 vertebral fractures (14.6%) had been noted in the radiology final report while the remaining 35 (85.45) had not. CONCLUSION although vertebral fractures represent frequent incidental findings on multidetector CT studies and may be easily identified on sagittal reformats, they are often underreported by radiologists, most likely because of unawareness of their clinical importance.

Lung perfusion in patients with pulmonary hypertension: comparison between MDCT pulmonary angiography with minIP reconstructions and 99mTc-MAA perfusion scan.

Objectives:Alterations in lung perfusion are a well-known feature of pulmonary hypertension (PH) seen on nuclear medicine studies. Abnormal radiotracer distribution in patients with PH may be caused by arterial thromboembolic occlusion, like in chronic thromboembolic pulmonary hypertension, by parenchymal destruction as in interstitial lung disease and pulmonary emphysema or by distal arteriopathy, like in idiopathic pulmonary arterial hypertension and other nonembolic forms. The different imaging pattern on radionuclide perfusion studies represents an important element for differential diagnosis. The aim of this study was to evaluate minimum intensity projection (minIP) images as an alternative to perfusion scintigraphy. We compared lung parenchyma attenuation patterns as depicted in minIP reconstructions with scintigraphic findings of lung perfusion in patients affected by pulmonary hypertension from various etiologies. Methods:One hundred and seven consecutive patients affected by PH of different etiology (37 of those had chronic thromboembolic pulmonary hypertension) who had undergone both multidetector computed tomography pulmonary angiography and 99mTc-MAA perfusion scan were included. Five-millimeter thickness contiguous axial, coronal, and sagittal minIP images were reconstructed from the contrast enhanced computed tomography datasets. Two radiologists evaluated the images and qualitatively graded pulmonary attenuation as homogeneous, inhomogeneous with nonsegmental patchy defects, or inhomogeneous with segmental defects. The presence of parenchymal and pleural alterations was recorded. MinIP perfusion grading results were then compared with those of perfusion scintigraphy. Results:In 87 of 107 patients (81.3%), the attenuation pattern seen on minIP images (39 homogeneous patterns, 13 with nonsegmental patchy defects, and 39 with segmental defects) correlated with the nuclear medicine scans. In the remaining 20 patients (18.7%), the imaging pattern was discordant because of 7 false-positive and 2 false-negative thromboembolic patterns at minIP and 11 false-positive thromboembolic patterns at perfusion scan. Air-trapping and parenchymal disease caused false-positive findings at minIP and perfusion scans, respectively. The sensitivity and specificity of minIP in detection of a chronic thromboembolic perfusion pattern were 94.5% and 90%, whereas perfusion scan had 100% sensitivity and 84% specificity. Conclusion:MinIP reconstructions can identify different patterns of pulmonary parenchymal attenuation, which show high concordance with perfusion patterns seen on radionuclide studies in patients with pulmonary hypertension. MinIP is a promising technique to evaluate lung perfusion in PH and may be used as an alternative to scintigraphy in the diagnostic work-up of these patients.

Incidental vertebral compression fractures in imaging studies: Lessons not learned by radiologists

AIM To assess radiologists reporting rates of incidental vertebral compression fractures in imaging studies. METHODS We performed a review of the current literature on the prevalence and reporting rates of incidental vertebral compression fractures in radiologic examinations. RESULTS The bibliographic search revealed 12 studies: 7 studies using conventional radiology and 5 using multidetector computed tomography (MDCT). The loss of height cut-off to define a vertebral fracture varied from 15% to 25%. Fracture prevalence was high (mean 21.1%; range 9.5%-35%) in both radiographic and MDCT studies (mean 21.6% and 20.2%, respectively). Reporting rates were low with a mean value of 27.4% (range 0%-66.3%) and were significantly lower in MDCT than in radiographic studies (mean 8.1% vs 41.1%). Notably, recent studies showed lower reporting rates than older studies. CONCLUSION Many scientific studies have confirmed a high prevalence of vertebral compression fractures as incidental findings on imaging studies. However, the underreporting of these fractures, as determined in our study, may negatively affect patient care.

Incidental lung nodules on CT examinations of the abdomen: prevalence and reporting rates in the PACS era.

OBJECTIVES To retrospectively evaluate prevalence, reporting rates and clinical implications of incidental pulmonary nodules detected in multidetector computed tomography (MDCT) abdominal studies. MATERIALS AND METHODS Abdominal MDCT studies of 243 consecutive patients, 94 of whom had a history of cancer, were evaluated. Lung bases included in the scan were reviewed on a PACS workstation with different window settings and post-processing techniques. Nodules were classified according to their density (calcified, solid noncalcified, non-solid, part-solid) and size (<4mm; 4-6mm; 6-8mm; >8mm). The study findings were compared with the corresponding radiologic reports. Previous of following CT studies, when available from the PACS, were also reviewed to evaluate changes in number and size of the detected nodules. RESULTS An average of 8.2 cm of lung parenchyma was imaged in each patient. 213 noncalcified nodules (NCNs) were identified in 95 patients (39.1%) but only 8 patients (8.4%) had it mentioned in the final report. Comparison CT studies were available for 44 out of the 95 positive patients showing disappearance of the nodules in 2 cases, no interval change in 26 and progression in size and/or number in 16 patients, in whom a final diagnosis of metastasis or primary lung cancers was achieved. CONCLUSION Radiologists tend to overlook lung portions on abdominal CT studies. Underreporting may affect patient care and have medico-legal implications since images are permanently stored in digital format on PACS and CD-ROMs. Management of the discovered nodules should be tailored to the clinical situation of the patient, and particular care should be reserved to patients with oncologic history.

Three-dimensional analysis of pulmonary nodules: variability of semiautomated volume measurements between different versions of the same software

PurposeThis study was done to evaluate the variability of semiautomated volume measurements of solid pulmonary nodules between two different versions of the same volumetric software.Materials and methodsThe volumes of 100 solid intraparenchymal nodules (mean volume 88.10 mm3; range 7.36–595.25 mm3) studied with the same multidetector computed tomography (MDCT) protocol were determined using two different versions of the same volumetric software (LungCARE 2006G and LungCARE 2007S). The 2006G version is based on a single-segmentation algorithm, whereas the newer version features two algorithms: SmallSizeNodule and AllSizeNodule. The results obtained with the 2006G version were compared with those of the 2007S version with the SmallSizeNodule algorithm, as recommended by the user manual. In addition, we compared the volumetric measurements obtained by the two different algorithms of the 2007S version.ResultsThe 2006G version and the 2007S version with the SmallSizeNodule algorithm agreed in only two of 100 cases and showed a mean variability of 1.66% (range 0%–8.78%). A more significant volumetric discrepancy was observed between the two different algorithms of the 2007S version, with the AllSizeNodule algorithm providing on average larger volumes (mean variability 71.08%; range 6.02%–218.80%) than SmallSizeNodule. Volume discrepancies were more pronounced in the subgroups of smaller nodules in all comparisons.ConclusionsThere is variability also in the results provided by different versions of the same volumetric software, and this may affect the calculation of the nodule-doubling time. Computer-aided assessment of the growth of lung nodules should always be performed using the same version of volumetric software and the same segmentation algorithm.RiassuntoObiettivoScopo del nostro studio è stato valutare la variabilità delle misurazioni volumetriche di noduli polmonari solidi dovuta all’utilizzo di diverse versioni dello stesso software di volumetria.Materiali e metodiI volumi di 100 noduli polmonari solidi intraparenchimali (volume medio di 88,10 mm3; range 7,36–595,25 mm3) sottoposti a tomografia computerizzata (TC) multidetettore con lo stesso protocollo d’esame sono stati misurati con 2 versioni diverse dello stesso software di volumetria (LungCARE 2006G e LungCARE 2007S). La versione 2006G presenta un unico algoritmo di segmentazione mentre la versione 2007S è dotata di 2 algoritmi chiamati SmallSizeNodule e AllSizeNodule. I risultati della versione 2006G sono stati confrontati con quelli della versione 2007S ottenuti con l’algoritmo SmallSizeNodule come consigliato dal manuale del software. Sono stati inoltre confrontati tra loro i risultati delle volumetrie ottenute con i diversi algoritmi della versione 2007S.RisultatiLa versione 2006G e la versione 2007S con algoritmo SmallSizeNodule hanno dato un risultato sovrapponibile solo in 2 casi su 100 ed hanno esibito una variabilità volumetrica media dell’1.66% (range 0%–8,78%). Una discrepanza volumetrica assai maggiore è stata osservata tra i 2 diversi algoritmi di segmentazione della versione 2007S in cui l’algoritmo AllSizeNodule ha fornito volumi mediamente superiori del 71,08% (range 6,02%–218,80%) rispetto all’algoritmo SmallSizeNodule. L’entità delle discrepanze volumetriche è risultata maggiore nei sottogruppi di noduli di minori dimensioni in tutte le comparazioni eseguite.ConclusioniAnche tra diverse versioni dello stesso software di analisi volumetrica esiste una variabilità di risultati che può influenzare il calcolo del tempo di raddoppiamento dei noduli. La valutazione computerizzata del tasso di crescita di un nodulo polmonare andrebbe eseguita utilizzando nei vari controlli sempre la stessa versione del software di volumetria ed il medesimo algoritmo di segmentazione.

DISH of the cervical spine causing epiglottis impingement

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by calcification and ossification of ligaments and entheses; it mainly affects the vertebral column. We report the case of a patient with pharyngeal dysphagia and episodic aspiration secondary to DISH involvement of the cervical spine, which had caused alteration in the epiglottic tilt mechanism during deglutition.

Hyperdense spleen after prolonged gold therapy

A 60-year-old woman underwent computed tomography imaging of her chest because of a recent episode of hemoptysis. The scan did not show any abnormalities in the thorax. However, unenhanced scans showed a strikingly hyperdense spleen (mean attenuation value 174 [normal 56–65] Hounsfield units) ([

Tract metastasis from previously unknown malignant pleural mesothelioma: a case report

A case of malignant pleural mesothelioma discovered because of a chest wall metastasis which developed over a previous pleural drainage site is presented. Imaging findings at sonography, contrast enhanced computed tomography and fluorodeoxyglucose - positron emission tomography are shown.