Sergio Salerno

Static magnetic fields generated by a 0.5 T MRI unit affects in vitro expression of activation markers and interleukin release in human peripheral blood mononuclear cells (PBMC).

PURPOSE To investigate the effects of the static magnetic field (SMF) generated by a 0.5 T superconducting MRI unit on in vitro activation marker expression and interleukin release in human peripheral blood mononuclear cell (PBMC) samples from healthy volunteers. MATERIALS AND METHODS PBMC samples were split into two groups: exposed and sham-exposed under isothermal conditions. PBMC were exposed for 2 h at 24 degrees C to the SMF of a 0.5 T superconducting MRI unit. Immediately after exposure, both samples were cultured for 24 h at 37 degrees C with or without mitogenic stimulation by phytohaemagglutinin (PHA). PBMC were examined for expression of CD25, CD69 and CD71 by immunofluorescence analysis and supernatants were assayed to quantify IFN-gamma, TNF-alpha and IL-4 by ELISA. RESULTS The 0.5 T SMF produced, after 24 h of culture, a reduced expression of CD69 from PBMC in vitro, that was enhanced after PHA stimulation. An increased release of IFN-gamma and IL-4 was also found, which was reduced after PHA stimulation. The release of TNF-alpha, IL-6 and IL-10 was not modified. CONCLUSIONS The SMF generated by a 0.5 T superconducting MRI unit modified in vitro activation marker expression and interleukin release from human PBMC.

CT exposure in adult and paediatric patients: a review of the mechanisms of damage, relative dose and consequent possible risks

An increase has been observed not only in the absolute number of CT examinations but also in the length of coverage and number of scanning phases, with the result that exposure to ionising radiation from CT is becoming an increasingly serious problem. The extent of the problem is not entirely known and cannot be adequately addressed without proper knowledge of all the phases that leads to the effective dose calculation. In light of the growing awareness of the issue of ionising radiation dose and the possible risk for the individual and the population, there is a need for radiologists, medical physicists and radiographers to play an active role in dose management. In this review, the authors try to delineate the problem in a consequential and multifaceted way: radiation–patient interaction, possible mechanisms of damage, main CT dose units, risk and its quantification in the population, with the aim of optimising the acquisition dose without diagnostic drawbacks. For an “up-to-date” use of CT, radiologists must know the dose concerns for the single patient and population, and use the CT apparatus with the best dose care; substitute CT with other diagnostic techniques when possible, especially in children; reduce the number/extension of scans and phases, and the dose in single scans and single examinations.

Role of virtopsy in the post-mortem diagnosis of drowning

PurposeDue to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning.Materials and methodsWe retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy.ResultsAll the cadavers showed fluid in the airways and patchy ground-glass opacities in the lung. Only one patient had no fluid in the digestive tract; this patient had a left parietal bone fracture with a large gap and other multiple bone fractures (nose, clavicle, first rib and patella). One of the three patients who had fluid in the digestive tract had no fluid in the paranasal sinuses. This latter patient showed cerebral oedema with subarachnoid and intraventricular haemorrhage, multiple bone fractures (orbital floor, ribs, sacrum and acetabular edge) and air in the heart, in the aorta and in bowel loops.ConclusionTo date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in that it allows us to understand if the victim was alive or dead when he entered the water and if the cause of death was drowning.

Imaging evaluation of facial complex strut fractures.

High-resolution multidetector computed tomography with multiplanar reformations and 3-D postprocessing often provides the detail necessary for preoperative assessment of facial injuries. Maxillofacial fractures are classified in the following manner: upper face fractures, midface fractures (the most frequent), Le Fort fractures, and lower face or mandible fractures. The facial skeleton is a framework of vertical and horizontal buttresses that ensures a better resistance to trauma, but serves also as reference for maxillofacial surgery to restore facial size and shape. Radiologists should know how to diagnose and report the main types of facial fracture.

Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients

Background Preoperative lymphoscintigraphy is without doubt a valid method for the detection of the sentinel lymph node (SLN). There has been considerable debate regarding the optimal site for the introduction of the tracer; various sites include peritumoral (PT), periareolar (PA), subdermal, and intradermal injection. Purpose To evaluate retrospectively the lymphoscintigraphic identification rate of peritumoral (PT) injection versus subdermal periareolar (PA) injection in the detection of SLNs in breast cancer. Material and Methods Between October 2002 and December 2011, a cohort of 906 consecutive patients with biopsy proven breast cancer underwent 914 SLN biopsy procedures. A total of 339 procedures (Group A) were performed using a PT deep injection of radiotracer while 575 procedures (Group B) adopted a subdermal PA injection of radiotracer towards the upper outer quadrant, regardless of the site of the carcinoma. All the patients underwent synchronous excision of the breast cancer and SLN biopsy. Results SLNs were identified in the lymphoscintigram in 308/339 cases (90.85%) of Group A (PT injection) and in 537/575 cases (93.39%) of Group B (PA injection). Furthermore, in 2/339 patients (0.58%) of Group A, internal mammary lymph nodes were found at lymphoscintigraphy, whereas no internal mammary sentinel nodes were found in the Group B patients. The intraoperative identification rate of axillary SLNs was 99.41% (337 of 339) in the Group A patients and 99.65% (573 of 575) in the Group B patients. There was no significant difference in the two groups between the incidence of the number of SLNs detected and the incidence of identification of positive SLNs. Conclusion PT versus PA injection of radiotracer showed comparable success rates for axillary SLN identification, and can be considered a rapid and reliable method.

Multifocal biliary cystadenocarcinoma of the liver : CT and pathological findings

Biliary cystadenocarcinoma is a rare tumor that originates from the hepatobiliary epithelium. Although this tumor can affect any portion of the biliary tree, intrahepatic location is more common. It is usually a slow growing tumor and often asymptomatic until it reaches a considerable size. The lesion is most often solitary and large when discovered; multiple lesions or metastases within the liver are very rare. A 63-year-old man was referred to our institute for weight loss, abdominal discomfort, worsening bulky symptoms in the right upper abdominal quadrant, and an increase in serum aminotransferases that had been present for several months. Spiral CT of the abdomen demonstrated two lesions, a larger one and a distant intrahepatic lesion, with a multiloculated cystic aspect, a thin peripheral capsule, multiple solid peripheral portions, and irregular septa enhancing in the portal phase after intravenous administration of iodinated contrast medium. The diagnosis of multifocal cystadenocarcinoma of the liver was confirmed by surgical laparoscopy and biopsy of the lesion. The patient was treated with chemotherapy.

Radiation risks knowledge in resident and fellow in paediatrics: a questionnaire survey

BackgroundAnalyse through a multi-choice anonymous questionnaire the knowledge’s level in paediatric residents and fellows in two different main Italian hospital, looking mainly to the information to patients and relatives related to risks of ionizing radiation used in common radiological investigations in children.Methods65 multi choice questionnaires were distributed to paediatric residents and fellows of two different hospitals, an University Hospital (A.O.U.P. “P. Giaccone”- University of Palermo) and a national reference centre for paediatrics (Ospedale Pediatrico Bambino Gesù - Rome). The questionnaire included twelve multiple-choice questions with the aim of analyzing the knowledge about ionizing radiation related risks in infants and children who undergo common diagnostic radiology investigations. The data obtained were processed using software Stata/MP version 11.2. In order to measure the level of expertise of each interviewee a binary indicator was built. The value 1 was assigned if the percentage of correct answers exceeds the median of the distribution and 0 for values not exceeding the median. The association between the level of competence and demographic characteristics (gender, age) and training experience was measured by means of α2 test.Results51/65 questionnaires were completed, returned and analysed (87.7%). Only 18 surveyed (35%), (95% IC = [22%-48%]) can be defined as competent in radiation risk knowledge for common radiological investigations, considering the percentage of correct answers at least of 50% (sufficient knowledge was given with a minimum score of 8 correct answers out of 12).ConclusionsThe study demonstrates an urgent need to implement the radiation protection knowledge in the training programme of paediatricians, that improve if just a short targeted training is performed.

Semi-automatic volumetric segmentation of the upper airways in patients with pierre robin sequence.

Pierre Robin malformation is a rare craniofacial dysmorphism whose pathogenesis is multifactorial. Although there is some agreement in non-invasive treatment in less severe cases, the dispute is still open on cases with severe respiratory impairment. We present a semi-automatic novel diagnostic tool for calculating upper airway volume, in order to eventually address surgery in patients with Pierre Robin Sequence (PRS). Multidetector CT datasets of two patients and two controls were tested to assess the proposed method for ROI segmentation, upper airway volume computation and three-dimensional reconstructions. The experimental results show an irregular pattern and a severely reduced cross-sectional area (CSA) with a mean value of 8.3808 mm2 in patients with PRS and a mean CSA value of 33.7692 mm2 in controls (a ΔCSA of about −75%). Moreover, the similarity indexes and sensitivity/specificity values obtained showed a good segmentation performance. In particular, mean values of Jaccard and Dice similarity indexes were 91.69% and 94.07%, respectively, while the mean values of specificity and sensitivity were 96.69% and 98.03%, respectively. The proposed tool represents an easy way to perform a quantitative analysis of airway volume and useful 3D reconstructions.

Reversible effect of MR and ELF magnetic fields (0.5 T and 0.5 mT) on human lymphocyte activation patterns

Purpose: The aim of this study was to investigate the effects of magnetic fields (MF) of different intensity generated by a magnetic resonance (MR) unit (0.5 Tesla) and a double cylindrical coil (0.5 mTesla) on human CD4+ T cell lines. Materials and methods: CD4+ T cells were exposed for two hours under isothermal conditions (37 ± 0.5°C) to the above mentioned MF; a control group was provided for each exposed sample. After exposure, the samples were analysed in the laboratory for the following endpoints: Release of cytokines, expression of surface markers, cell proliferation and levels of cytosolic free-calcium. Results: Exposure to MF for 2 h and subsequent in vitro stimulation in the presence of the appropriate mitogen, caused a decrease of interferon-γ production, a decrease of cell proliferation, a decrease of expression of CD25 and a decrease of cytosolic free calcium concentration in exposed CD4+ T cell lines. Data obtained, were statistically significant when evaluated after 24 h of in vitro culture, but were not significant, for both types of MF, when the experimental groups were analysed after prolonged in vitro culture. Conclusion: These results indicate that static magnetic fields (SMF) can give rise to transient biological effects on T lymphocytes and the present system is a sensitive model for understanding the effects of MF on the immune system.

Sialodochoplasty in the treatment of salivary-duct stricture in chronic sialoadenitis: technique and results

Purpose.This study was undertaken to investigate peroral balloon angioplasty of salivary-duct strictures (sialodochoplasty) in chronic sialadenitis, analysing the technique, results and limitations.Materials and methods.Nine patients underwent sialodochoplasty: seven for Stensens-duct strictures and two for Whartons-duct strictures. One patient had a double stricture of Stensens duct and another a salivary stone associated with a Whartons-duct stricture. All patients were subjected to preliminary sialography to evaluate stricture site, length and grade. Sialodochoplasty was performed after local anaesthesia and progressive dilation of the salivary-duct orifice.Results.The stricture was successfully dilated in 7/9 patients. The stricture was unchanged after dilatation in one patient, and in another, it recurred after 13 months. In the patient with a double stricture of Stensens duct, one was resolved and the other was only partially dilated, with significant symptom improvement. One patient developed a new episode of sialadenitis after 3 months, which resolved with medical therapy. Five out of seven patients were asymptomatic at follow-up.Conclusions.Sialodochoplasty is an effective procedure in the treatment of salivary-duct strictures, improving symptoms in the majority of patients. The procedure is repeatable and can be proposed as a first-line treatment for symptomatic salivary-duct stricture.