Michelangelo Nasuto

Accuracy of radiography, computed tomography and magnetic resonance imaging in diagnosing foreign bodies in the foot

PurposeThe purpose of this study was to determine the accuracy of conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in detecting foreign bodies by using cadaver feet.Materials and methodsOne hundred and sixty foreign bodies consisting of 5×2-mm fresh wood, dry wood, glass, porcelain and plastic fragments were randomly placed in the plantar soft tissue of the forefoot and sole. An additional 160 incisions were made without the insertion of foreign bodies. Radiographs, CT and MRI scans were assessed in a blinded fashion for the presence of a foreign body.ResultsOverall sensitivity and specificity for foreign body detection was 29% and 100% for radiographs, 63% and 98% for CT and 58% and 100% for MRI. The sensitivity of radiography was lower in the forefoot. CT and MRI detection rates depended on the attenuation values of the foreign bodies and on the susceptibility artefact, respectively. CT was superior to MRI in identifying waterrich fresh wood.ConclusionsRadiography, CT and MRI are highly specific in detecting foreign bodies but sensitivity is poor. The detection rate depends on the type of foreign body for all techniques and on location for radiography. To identify foreign bodies with MRI, pulse sequences should be used to enhance the susceptibility artefact. In water-rich wood, as in chronically retained wood, CT is more accurate than MRI.RiassuntoObiettivoLo scopo di questo studio è determinare l’accuratezza della radiografia tradizionale, della tomografia computerizzata (TC) e della risonanza magnetica nucleare (RMN) nell’identificazione dei corpi estranei inseriti nei piedi di cadaveri.Materiali e metodiNei tessuti molli plantari dell’avampiede e del meso-retropiede sono stati posizionati, in maniera casuale, centosessanta corpi estranei di legno fresco, legno secco, vetro, porcellana e plastica dalle dimensioni di 5×2 mm. Sono state inoltre praticate centosessanta incisioni senza inserire alcun corpo estraneo. Le radiografie, TC e RMN alla ricerca dei corpi estranei sono state interpretate in cieco.RisultatiLa sensibilità e la specificità complessive sono risultate rispettivamente del 29% e 100% usando le radiografie, del 63% e 98% usando la TC e del 58% e 100% usando la RMN. La sensibilità della radiologia tradizionale è risultata minore nell’avampiede. Le percentuali di identificazione di TC e RMN sono dipese rispettivamente dai valori di attenuazione dei corpi estranei e dagli artefatti da suscettibilità. La TC si è rivelata migliore rispetto alla RMN nell’individuazione del legno fresco, ricco di acqua.ConclusioniRadiologia tradizionale, TC e RMN sono altamente specifiche nella rilevazione dei corpi estranei ma presentano una bassa sensibilità. Le percentuali di identificazione dipendono, per tutte le metodiche, dal tipo di corpo estraneo e, per quanto riguarda la radiologia tradizionale, anche dalla posizione. In RMN andrebbero usate sequenze pulsate per esaltare gli artefatti da suscettibilità dei corpi estranei. La TC è superiore alla RMN nel legno fresco ricco di acqua e in quello ritenuto a lungo nei tessuti.

Quantitative Assessment of Abdominal Aortic Calcifications Using Lateral Lumbar Radiograph, Dual-Energy X-ray Absorptiometry, and Quantitative Computed Tomography of the Spine

Abdominal aortic calcifications (AACs) represent an independent determinant of cardiovascular events and are strongly associated with cardiovascular disease. To our knowledge, a comparison between lateral lumbar radiography, lateral spine dual-energy x-ray absorptiometry (DXA), and quantitative computed tomography (QCT) in the assessment of AAC has not been performed. Our objective was to compare those methods in the detection and quantification of AAC using a simplified 8-point score system (AAC-8). Three hundred twenty-three postmenopausal women underwent lateral lumbar radiography, lateral spine DXA, and QCT for osteoporosis screening and were scored for AAC using the AAC-8. Lateral lumbar radiographs, lateral spine DXA, and QCT detected AAC in 58%, 55%, and 60% of the subjects, respectively. The nonparametric intraclass correlation coefficient between lateral lumbar radiograph and lateral spine DXA and lateral lumbar radiograph and QCT were 0.699 (95% confidence interval [CI]: 0.638-0.752) and 0.829 (95% CI: 0.783-0.865). Area under operating curve (receiver operating characteristic [ROC]) for lateral spine DXA was 0.826 (95% CI: 0.764-0.888), whereas for QCT was 0.948 (95% CI: 0.922-0.974) considering lateral lumbar radiograph as gold standard. AAC has been shown to be a significant predictive marker of overall cardiovascular disease. DXA may be a screening tool among asymptomatic patients with low radiation exposure to identify an important cardiovascular disease risk factor. QCT represents a reliable technique that may be applied as a future standard to facilitate the detection of abdominal aortic calcification as well as to provide more accurate measurement of bone densitometry.

Forensic and medico-legal radiology: challenges, issues and new perspectives

off-label devices or contrast agents and issues with physician–patient relationship [3]. As a consequence, radiologists have to be aware of the most common errors in observation, interpretation and communication [4]. Even the increasing use of contrast media requires extensive knowledge in terms of use appropriateness, choice of the right contrast agent, management of the emergency scenarios and providing proper informed consent to the patient. An adequate understanding of these main medico-legal issues could positively influence the radiologist’s clinical routine and the behaviour of patients and referring physicians, leading towards a significant reduction of errors and malpractice legal claims. On the other side, forensic radiology has arisen from two disciplines both based on the interpretation of anatomical–pathological findings. Before the advent of multi detector computed tomography (MDCT), the “forensic role” of radiology remained substantially circumscribed to the identification of foreign bodies (bullets above all) by conventional radiology [5]. Nowadays the improvements in cross-sectional imaging and post-processing techniques have ensured that MDCT plays a key-role in the emergency assessment of hemodynamically stable patients with penetrating wounds. The identification of wound track, its extension and its relationships with the surrounding organs are crucial for the therapeutic choice and can be very challenging for the forensic radiologist, who is supposed to know the different patterns of injuries and even the related legal aspects. Besides the “in vivo” setting, the true revolution in forensic radiology has come for post-mortem imaging, which for decades constituted a marginal, ancillary technique of autopsy [6]. In addition to the identification of foreign bodies, a comparison of ante-mortem with post-mortem radiographs was adopted since the 1930s for the crosscheck of During the last decades the radiologist’s world has been significantly influenced by the waves of technological progress. Higher anatomical detail and multi-parametric analysis of pathological changes have widened the imaging spectrum and set new health quality standards demanding a more complex professional figure. Medico-legal radiology has thus reflected this evolution through a dichotomous path: one bridging radiology with forensic medicine, and the other focusing on issues and malpractice lawsuits. Both sides of this evolution rely in this special feature, which encloses the contributions of international experts in the fields of forensic radiology and legal medicine with the aim to provide a comprehensive overview on “the state of the art” and new perspectives on future developments. The radiologist’s deeper involvement in the diagnostic and clinical management of the patient revealed a duality of new, attractive challenges versus growing duties, liabilities, higher risks, and more sources of diagnostic errors. Moreover, the evolution of case law [1] and the growing awareness of healthcare safety have dramatically raised the legal claims and, as a consequence, the phenomenon of the “defensive medicine” [2]. Malpractice lawsuits against radiologists are commonly related to diagnostic errors, improper use of

Spectrum of Signs of Pneumoperitoneum

Pneumoperitoneum is caused by rupture of a hollow viscus that includes the stomach, small bowel, and large bowel, with the exception of those portions that are retroperitoneal in the duodenum and colon. The causes of pneumoperitoneum are numerous, ranging from iatrogenic and benign causes to more life-threatening conditions. In the absence of a benign cause of pneumoperitoneum, the identification of free intraperitoneal gas usually indicates the need for emergency surgery to repair a perforated bowel. The plain film is the primary diagnostic tool for detecting pneumoperitoneum: multiple signs of free intraperitoneal air can be found especially on supine abdominal radiographs. Computed tomography (CT) examination has been shown to be more sensitive than abdominal radiographs for the detection of free intraperitoneal air. It is important that the radiologist become familiar with the signs of pneumoperitoneum that can be discerned on abdominal radiographs, on CT scout view, and on CT scan.

Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals

This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.

Computed Tomography and MR Imaging in Spondyloarthritis

This article provides an overview of the computed tomography (CT) and MR imaging appearances suggestive of spondyloarthritis, with a specific emphasis on the MR imaging findings of vertebral and sacroiliac involvement, and presents relevant clinical features that assist early diagnosis. CT is a sensitive imaging modality for the assessment of structural bone changes, but its clinical utility is limited. MR imaging is the modality of choice for early diagnosis, because of its ability to depict inflammation long before structural bone damage occurs, for monitoring of disease activity, and for evaluating therapeutic response.

Quantitative Ultrasound and Fracture Risk Assessment

Quantitative ultrasound (QUS) is a non-invasive technique for the investigation of bone tissue used in several pathologies and clinical conditions, especially for the identification of bone changes connected with menopause, osteoporosis and bone fragility. The versatility of the method, its low cost and lack of ionising radiation have led to a worldwide diffusion with an increasing interest among clinicians. In the last years several studies have been conducted to investigate the potential of QUS in various pathologies of bone metabolism, in secondary osteoporosis, paediatrics, neonatology, genetics and other fields. The results have confirmed the ability of the technique in the prediction of fracture risk; studies in paediatrics led to the establishment of reference curves for some QUS devices and other promising results have been reported in several conditions involving metabolic bone disorders.

Analysis of size and shape differences between ancient and present-day Italian crania using metrics and geometric morphometrics based on multislice computed tomography

ABSTRACT The Museum of Human Anatomy in Naples houses a collection of ancient Graeco-Roman crania. The aim of this study was to use multislice computed tomography (MSCT) to evaluate and objectively quantify potential differences in cranial dimensions and shapes between ancient Graeco-Roman crania (n = 36) and modern-day southern Italian crania (n = 35) and then to characterize the cranial changes occurring over more than 2000 years, known as secular change. The authors used traditional metric criteria and morphometric geometry to compare shape differences between the sets of crania. Statistically significant differences in size between the ancient and modern crania included shorter facial length, narrower external palate, smaller minimum cranial breadth, shorter right and left mastoid processes, and wider maximum occipital and nasal breadth. The shape changes from the ancient to modern crania included a global coronal enlargement of the face and cranial diameters, with more anterior projection of the face at the anterior nasal spine, but also posterior projection at the glabella and the nasion. It is not possible to determine whether these differences result exclusively from secular changes in the cranium or from other factors, including a mix of secular change and other unknown factors. To the best of our knowledge, this is the first MSCT-based study to compare ancient Graeco-Roman and modern-day southern Italian crania and to characterize shape and size differences.

Herniated Cervical Disk Anterior Diskectomy

Patient with bilateral cervical pain in C5–C6 herniated disk treated by anterior diskectomy and intervertebral prosthesis positioning