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Perianal fistulas represent one of the most critical complications of Crohn’s disease (CD). Management and treatment need a multidisciplinary approach with an accurate description of imaging findings. Aim. This study aspires to assess the significative role of Magnetic Resonance Imaging (MRI) in the study of perianal fistulas, secondary extensions, and abscess in patients with CD. Therefore it is essential to standard-ize an appropriate protocol of sequences that allow the correct evaluation of disease activity and complica-tions. Methods: We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about pelvic MRI imaging and features in CD. We excluded studies that weren’t in the English language. Conclusions: MRI has a crucial role in the evaluation and detection of CD perianal fistulas because, thanks to its panoramic and multiplanar view, it gives excellent anatomic detail of the anal sphincters. To-day MRI is the gold standard imaging technique for the evaluation of perianal fistulas, mainly because this technique shows higher concordance with surgical findings than does any other imaging evaluation. Surgical treatment is often required in the management of perianal fistula in patients with CD, which often have complex perineal findings. (www.actabiomedica.it).

Objective: Evaluate the prevalence of aortic arch anatomy and branching pattern variants and anomalies in 1359 patients by Multi-Detector Computed Tomography Angiography. Methods: Retrospective multi-centric study including exams performed for various clinical issues with the same acquisition and injection protocols on 64-slices scanners. Multi-Planar reformations and Volume Rendering Images were available in all cases. Results: A total of 965 patients (71%) had normal aortic arch anatomy and branching pattern. Anatomical variations and anomalies were present in the remaining 394 patients (29%). The most common variation was the common origin of the brachiocephalic and the left common carotid arteries (302/1359 cases, about 22%). The most common anomaly were aberrant right subclavian artery (4/1359, about 0.5%) and right aortic arch (4/1359 cases, about 0.5%). Conclusions: Our multicentric series is, as far as we know, the largest reported to date for the definition of the prevalence of variation and anomalies of aortic arch anatomy and branching pattern. Knowledge of such findings may avoid both in the immediate and in the long term an injury to the patient, decreasing the rate of complications during surgery and interventional radiology procedures in the head and neck district., Italian Journal of Anatomy and Embryology, Vol 119, No 3 (2014)

The abdominal aortic aneurysm (AAA) is a potentially fatal asymptomatic disease. They progress silently with clinical complications that, when they occur, constitute a very serious event, frequently resulting in the patient's exitus. As a result, early detection and treatment are critical, because the right therapeutic strategy can halt the disease's natural progression. AAA is frequently discovered as an incidental finding during an abdominal ultrasound or a plain X-ray of the abdomen, which is required for other pathologies. The primary diagnostic tool for AAA identification is abdominal B-mode ultrasound. It is cheap, widely available, non-invasive, and has a high diagnostic sensitivity. However, this diagnostic tool may fail in rare cases due to misleading anatomical findings. We present an unusual flaw in echographic AAA evaluation that should be considered during the diagnostic work-up.

Aim: Regorafenib induces radiological changes in liver metastasis among patients with metastatic colorectal cancer (mCRC). The standard criteria used to evaluate solid tumor response (Response Evaluation Criteria in Solid Tumors) may be limited in assessing response to biologic agents with anti-angiogenic action. Patients & methods: A total of 67 hepatic lesions in 32 selected patients were analyzed to evaluate tumor attenuation as measured by Hounsfield unit (HU) and size changes. Results: Following two cycles of regorafenib, tumor HU values decreased in the in 73.1% (49/67) of lesions (average HU changes -25.6%) while tumor size increased in 64.2% (43/67) of them (average size changes +25.4%). Conclusion: The computed tomography density changes evaluation may be an additional tool, in combination with tumor sizing, to evaluate tumor response in patients treated with regorafenib.

Maxillofacial region is an anatomically complex area, representing a crossroads of different systems and apparatus. It is defined as the anatomical region lying on the facial skeleton from the inferior outline of maxilla up to an ideal plane passing through the skull base and the inion point, posteriorly. In this area, the digestive and respiratory systems connect to themselves and open in the mouth and sino-nasal cavities. Even the orbits with the ocular globes and their surrounding tissues lie in the same area. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body due to the "pivotal role" of the face in human relations. Moreover, the external openings of respiratory and digestive systems and the orbital cavities represent an easy way in for foreign bodies (FBs). Based on the access paths, it is possible to distinguish ingested, inhaled, penetrating, and iatrogenic (owing to surgery) FBs. FB may stop in oral and ocular cavities, or proceed deeply, reaching the surrounding soft tissues, the facial bones, or other cavities such as sino-nasal region, mouth, orbits, and further spaces of the head and neck region, like infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FBs accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection.