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Background: Cardiac CT with late iodine enhancement (LIE-CT) may characterize the scarred myocardium, but the role of readers’ experience and scar pattern on LIE-CT diagnostic performance is unknown. Aim was to assess the diagnostic performance of LIE-CT according to readers’ experience, scar pattern and contrast-to-noise ratio (CNR) using late gadolinium enhancement MRI (LGE-MRI) as reference. Methods: LIE-CT and LGE-MRI images of 40 consecutive patients were analyzed. Two readers with different experience (8 and 2years) independently analyzed LIE-CT images defining the presence/absence of scar and scar CNR, segmental involvement, transmural pattern and scar etiology. The same parameters were extracted from LGE-MRI by two expert readers in consensus, blinded to the LIE-CT results. Results: Scars were identified at LGE-MRI in 29/40 patients and 141/680 segments. Scar burden at LIE-CT versus LGE-MRI correlated better for the most experienced reader than for the least experienced one (ρ = 0.954 and ρ = 0.797, p < 0.001). The most experienced reader missed scars in 2 patients and in 21/141 segments; the least experienced in 5 patients and 53/141 segments. The most experienced reader showed higher accuracy and sensitivity compared to the least experienced in per-patient (accuracy: 95% vs. 88%; sensitivity: 93% vs. 83%) and per-segment analysis (accuracy: 96% vs. 92%; sensitivity: 85% vs. 62%). Specificity was excellent (100% per-patient, 99% per-segment,) regardless of readers’ experience. Missed scars had non-ischemic pattern, low scar burden (< 6%) and lower CNR compared to ischemic scars (2.33 vs. 3.54, p = 0.005). Conclusion: LIE-CT represents an alternative to LGE-MRI, although the impact of readers’ experience on sensitivity for small non-ischemic scars should be considered.

To investigate the role of the apparent diffusion coefficient (ADC) as a potential prognostic biomarker in the evaluation of the aggressiveness of oesophageal cancer.Between November 2009 and December 2013, 43 patients with evidence of oesophageal or oesophago-gastric junction cancer were referred to our institution and prospectively entered in our database. The final study population consisted of 23 patients (18 men; 5 women; mean age, 64.62 ± 10.91 years) who underwent diffusion-weighted Magnetic Resonance before surgical intervention. Specifically, 14 were directly treated with surgery and 9 were addressed to chemo/radiotherapy beforehand. Two radiologists independently measured mean tumour ADC and inter-observer agreement (Spearman's and intraclass correlation coefficient [ICC]) was assessed. In the univariate analysis, overall survival curves related to pathological ADC, pT, pN, tumour location and histotype were fitted using the Kaplan-Meier method. Survival curves were then compared using the log-rank test.Inter-observer reproducibility was very good (Spearman's rho = 0.95; ICC = 0.94). At a total median follow-up of 19 months (2-49 months), 4 patients had died. The median follow-up was 18.50 months (5-49 months) for the surgery-only group (1/4 events, 25 %) and 24 months (2-34 months) for the chemo/radiotherapy group (3/4 events, 75 %). Survival time at 48 months for the overall population was 59 % (±0.11), while for the surgery-only group and the chemo/radiotherapy group was 90 % (±0.09) and 61 % (±0.34), respectively. In the univariate analysis, ADC values below or equal to 1.4 × 10(-3) mm(2)/s were associated with a negative prognosis both in the total population (P = 0.016) and in the surgery-only group (P 0.001).Despite the biggest limitation of our study (i.e. the small study population), we were able to show that pathological ADC could be considered a prognostic factor for oesophageal cancer. DWI might be introduced into clinical practice as a promising and reliable technique in the diagnostic pathway of this tumour.

This study evaluated the methods, technical aspects and impact of preoperative radiological guidance in radioguided occult lesion localisation (ROLL) for single nonpalpable breast lesions.A total of 288 patients underwent ROLL before surgery. Human serum albumin macroaggregates labelled with 3.7-7.4 MBq of technetium(99) were injected into the lesion. In the case of ultrasonographic guidance (221/288 patients), inoculum positioning resulted in a change of echogenicity at the lesion site. In the case of mammographic guidance (67/288 patients), iodinated contrast medium was injected following the radiotracer for subsequent mammographic evaluation. Patients underwent surgery within 24 h from ROLL. A gamma-detecting probe was used to locate the lesion during surgery and guide its removal. After excision, the specimen was examined by either ultrasonography or mammography to verify complete lesion removal before histological evaluation.The lesion was correctly localised in 281/288 patients (97.5%). One ROLL procedure failed because surgery could not be performed within 24 h and the radioactivity decayed. Of the six incorrect localisations, 2 were due to the radiological guidance and 4 to technetium(99) dispersion.Radiological guidance in ROLL ensured the outcome of the procedure of localisation and removal of single, nonpalpable breast lesions in the majority of cases.

The aim of this study was to assess whether the pancreatic phase may replace the arterial phase in the evaluation of endocrine pancreatic tumours.Twenty-nine endocrine pancreatic lesions with definitive morphological and immunohistochemical characterisation after surgical treatment (n=24) or fine-needle-aspiration cytology under endoscopic ultrasonography guidance (n=5) were retrospectively evaluated. All lesions were studied with triple-phase 16-row multidetector computed tomography (MDCT). Images obtained during each phase were separately interpreted by two senior radiologists experienced in pancreatic pathology and who were blinded to surgical results. Endocrine tumour and normal pancreas attenuation and the mean absolute tumour-to-gland attenuation difference were measured in each phase, and data were analysed with Student's t test. Visualisation of arterial vascular abnormalities and hypervascular liver metastases in the arterial and pancreatic phases and the diagnostic contribution of the two phases were compared.For both radiologists, the mean absolute tumour-to-gland attenuation difference was significantly higher (p0.05) in the pancreatic phase (40+/-53 HU and 34+/-56 HU) than in the arterial phase (31+/-38 HU and 26+/-43 HU). There were no differences in the detection of arterial vascular abnormalities or hypervascular liver metastases in the two phases. The diagnostic contribution was higher in the pancreatic phase.In our experience, the pancreatic phase can replace the arterial phase in the evaluation of pancreatic endocrine tumours.

This study was aimed at assessing the Magnetic Resonance (MR) features of persistent hip pain in children. Twenty-six patients aged 1.6 to 15.2 years (mean: 6.5 years) were clinically selected for the study; at clinics, all patients had persistent hip pain after 10 days' therapy. All patients were examined with radiography, US and MRI at 0.5 T. SE T1-weighted sequences, with and without fat suppression (FS), SE T2-weighted and gradient echo (GE) T1-weighted-like (T1*) sequences were acquired on the coronal plane. Slices were 5 and 3 mm thick on SE and GE T1* sequences, respectively. Morphology and signal intensity of epiphysis, growth plate and metaphysis were prospectively studied with MRI. Clinical and/or imaging follow-up (3 months) was the reference standard in our study. Final diagnoses were: no evidence of alteration (n = 3), transient synovitis (n = 6), rheumatic fever (n = 3), Perthes' disease (n = 7), Meyer's dysplasia (dysplasia epiphysealis capitis femoris, DECF) (n = 2), early slipped capital femoral epiphysis (n = 2), incomplete fracture (n = 1), extraarticular cause of pain (muscular abscess, osteomyelitis) (n = 2). In 23 of 26 patients MRI confirmed clinical, radiographic and US findings. MRI was particularly helpful in making an unquestionable diagnosis in the other 3 cases; in a patient with suspected slipped capital femoral epiphysis MRI revealed an incomplete fracture, in a patient with suspected Meyer's dysplasia MRI revealed early Perthes' disease and finally in a patient with suspected transient synovitis MRI revealed Perthes' disease. To conclude, MRI allows the condition causing persistent hip pain to be assessed and accurately depicted, integrating clinical, radiographic and US findings and in some cases also changing diagnosis and therapy.

This study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle.MRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle.Of the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26 ± 19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant.MRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.

We studied the main ocular and retrobulbar vessels with color-Doppler US and report on examination technique, detectability of the vessels and their flow characteristics to define the normal ranges of Doppler spectra for each artery and vein. We comparatively examined both eyes of 20 healthy subjects. Of each eye we studied the ophthalmic artery, the central retinal artery, the ciliary artery, the central retinal vein and the superior ophthalmic vein. The following flow parameters were considered: peak systolic velocity, end-diastolic velocity and resistive index for arteries; maximum and minimum velocity for veins. The examination lasted about 10 minutes per eye--20 minutes for each subject. In all subjects the five investigated vessels were identified in both eyes, and adequate Doppler spectra were obtained. The average peak systolic velocities of ophthalmic, central retinal and ciliary arteries were respectively about 35, 12 and 10 cm/s, with low resistance patterns (resistive index: 0.75, 0.72 and 0.68, respectively). The venous flow, which is usually continuous, may be sometimes influenced by cardiac and respiratory activities: the maximum velocities of superior ophthalmic and central retinal veins were about 6 and 5 cm/s, respectively. Color-Doppler US noninvasively visualizes both ocular and retrobulbar vessels, providing major hemodynamic information from different flow parameters; the knowledge of these parameters in normal conditions can be the basis of hemodynamic studies in many abnormal orbital conditions.

The aim of our study was to review CT findings concerning secondary aorto-enteric fistulae (AEF). In particular, we aimed to evaluate signs of contrast medium extravasation from the aortic graft into the bowel (active bleeding), in correlation with clinical and surgical reports.Clinical and CT findings were retrospectively evaluated in 13 surgically proven cases of AEF. All patients underwent spiral CT examination with biphasic contrast technique, before and 30 and 80 seconds after intravenous injection of 120-150 ml of contrast medium (Ultravist 370; flow rate 2.5-3 ml/sec). Late scans (240 seconds) were also acquired on surgical anastomoses. We used 3 mm (arterial phase) and 5 mm (venous phase) slices.At surgery, all 13 patients presented a communication between the bowel and the aortic graft. At CT examination, all 13 patients presented one or more CT signs indicating AEF (perigraft soft tissue, perigraft fluid, ectopic air or bowel wall thickening). Moreover, in 6 out of 13 patients, contrast medium extravasation from the aortic graft into the small bowel (active bleeding) was detected with CT. Detection of active bleeding was possible because CT examinations were performed without oral administration of contrast medium.CT is easily and readily available and provides an accurate evaluation of the aorta and surrounding retroperitoneal tissues. In our study we were able to identify the CT sign of active bleeding in more than a half of the patients with acute gastrointestinal bleeding (66%). Hence, we suggest that patients undergo CT examination without oral contrast medium administration in order to better appreciate the presence of active bleeding.

This work was aimed at assessing Magnetic Resonance (MR) accuracy in the preoperative investigation of abdominal aortic aneurysms, with a view to suggesting MRI as the method of choice for surgical planning, replacing other relatively invasive investigation techniques like angiography and enhanced CT. In the last 3 years 80 patients with abdominal aortic aneurysms identified with US or CT were examined with 0.5-T MRI and underwent surgical repair within 15 days. Spin-echo (SE) T1-weighted axial, sagittal and coronal sequences were always performed. In 18 patients gradient-echo (GE) flow sequences were also acquired; SE T2-weighted sequences were used to study parietal thrombi in 10 patients and finally Gd-DTPA T1-weighted sequences were obtained in inflammatory aneurysms (3 patients). MR images were blindly evaluated by 2 radiologists. The following variables which are useful for surgical planning were considered for each patient: aneurysm extent, characteristics of parietal thrombi, dissections, fixurations, inflammation signs, involvement of renal arteries, vena cava, ureters, duodenum, the presence of retroaortic renal vein or of other anomalies or associated conditions. MR images were always compared with intraoperative findings, since surgery was considered as the gold standard. MR findings were in agreement with surgical findings in the evaluation of cranio-caudal aneurysm extent (78/80), parietal thrombus features (80/80), dissection (1/1) and fixuration signs (8/9), origin of renal arteries (80/80), inferior vena cava involvement (3/3), other anatomical anomalies or conditions (6/6). Inflammation signs were overestimated (14/8) as well as adhesion between aneurysm and duodenum (17/13). The presence of distal renal polar arteries was underestimated (2/4). In conclusion, MRI proves to be a highly sensitive method to demonstrate abdominal aortic aneurysms and is therefore suggested as the examination of choice before surgery.

To assess the accuracy of magnetic resonance (MR) with Mangafodipir (Mn-DPDP) in the identification of focal solid pancreatic lesions. The possibility of lesion characterisation based on quantification of Mn uptake was also investigated.Thirty-four patients (11 females, 23 males, aged 21-75, mean age 57) selected at sonography (US) and spiral CT (SCT) for clinically suspected focal solid pancreatic lesion, were studied between June 2000 and July 2001. Patients eligible for surgery underwent MR imaging (1.5 T) before and after infusion of 5 micromol/kg of Mn-DPDP (0.5 ml/kg Teslascan, Nycomed Amersham Health, Oslo, Norway). The baseline examination included FSE T2-weighted sequences and fat-saturated and non fat-saturated breath-hold gradient-echo T1-weighted sequences (FMP SPGR). After Teslascan infusion, fat-saturated and non fat-saturated FMP SPGR sequences were repeated. Thirty of the 34 patients had a definitive diagnosis provided by reference standards such as post-operative histology (22 cases), cytology (FNAB) and/or a follow-up period of at least 6 months (8 patients). As regards lesion characterisation, the signal-to-noise ratio (S/N ratio) and contrast-to-noise ratio (C/N ratio) of lesions compared to the pancreatic parenchyma were calculated using ROIs before and after contrast infusion.The definitive diagnosis was pancreatic malignancy in 18 patients, focal pancreatitis in 5 and neuroendocrine tumours in 3. Four patients with suspected lesions at US and/or SCT were free of focal pancreatic disease. Mn-DPDP MR identified 17/18 malignancies, 2/3 endocrine neoplasms 5/5 focal pancreatitis; the 4 patients with no pancreatic lesions were correctly identified. The Mn-DPDP MR accuracy in detecting focal pancreatic solid lesions was 93%. MR missed 1 small adenocarcinoma (the only pT1 in our group) and 1 insulinoma (with Mn uptake similar to the surrounding parenchyma). Due to the small number of inflammatory lesions included in the study, no significant differences were found in signal intensity and Mn-DPDP uptake between focal pancreatitis and neoplasms.MR with Mn-DPDP is very accurate in the identification of focal solid pancreatic lesions. Mangafodi-pir is also very useful for excluding the presence of pancreatic lesions suspected at US or CT. The characterisation of lesions, in particular of inflammatory versus neoplastic lesions, remains problematic and requires further investigation.

To assess the feasibility and accuracy of cytologic and microhistologic breast biopsy using a MR imaging-guided stereotactic system with MR-compatible non-magnetic needles.Between December 2001 and September 2002, cytologic and microhistologic sampling of 14 lesions (12 patients) was performed in our radiology department using a commercially available MR-guided stereotactic device. MR-compatible non-magnetic needles or mixed kit (non-magnetic coaxial needle + conventional ferromagnetic needle) were used. Of the 12 patients examined, 2 were undergoing MR examination because of genetic/familial risk, 4 during post-operative follow-up and the remaining 6 for contradictory mammographic and sonographic findings. Ten of the 14 lesions were visible on MR alone. The mean lesion diameter was 12 mm (range 5-30 mm).The procedure was relatively simple and feasible. The procedure took 45 minutes on average. The cytologic samples were adequate in 4/14 cases (29%). The diagnosis was absence of malignant cells in one case, ductal carcinoma in one case and suspected carcinoma in two cases. The cytologic diagnosis was confirmed by core biopsy, and by post-operative histology in the malignant lesions. The remaining 10/14 (71%) cytologic samples were inadequate for diagnosis. All the microhistologic samples (100%) were considered sufficient for diagnosis and yielded diagnosis of benignity in 9/14 (60%) lesions and malignancy in 5/14 (40%). Two patients with benign diagnosis underwent surgery, which confirmed the diagnosis. The remaining seven patients were evaluated by follow-up MRI; the first follow-up at 3 months showed no significant changes. Post-operative histology of the 5 lesions with malignant microhistologic diagnosis confirmed the nature of the lesions.MR-guided stereotactic biopsy is a simple, fast and safe procedure comparable to the interventional breast procedures performed under mammography and ultrasound guidance. The stereotactic device used ensures correct positioning of the needle into the lesion. The new dedicated non-magnetic needles and the mixed kit provide quantitatively and qualitatively adequate tissue for the histologic analysis. On the basis of our initial experience, we conclude that the procedure is feasible and accurate and can therefore be recommended for routine clinical use.

The aim of this work is to describe the characteristics of Magnetic Resonance contrast media available or experimental in evaluation of focal liver diseases: non specific extracellular contrast media, reticoloendothelial and hepatobiliary-specific contrast media. A rational use of these different categories is suggested by analysis of their molecular and pharmacokinetic features.

The methods to measure intraabdominal fat amount and to distinguish visceral from subcutaneous fat are useful and needed because visceral obese people are at risk of developing cardiovascular disorders. We investigated US capabilities in measuring intraabdominal fat thickness and distribution distinguishing visceral from subcutaneous fat. The results were compared with those obtained with CT, the gold standard, and with the waist-hip ratio (W/H).Thirty obese women admitted to the Internal Medicine I Department, Ospedale S. Raffaele (Milan, Italy) were examined. The patients, aged 18-60 years and with BMI ranging 29.0-47.3, were submitted to consecutive double blind measurements with US and CT. The following anthropometric values were compared for every patient: W/H, US visceral/subcutaneous thickness, CT visceral/subcutaneous thickness, CT visceral area, CT subcutaneous adipose area and CT visceral/subcutaneous adipose area.The classification of visceral obesity by W/H (.85) was confirmed by CT visceral/subcutaneous adipose area (.491). The W/H correlated significantly with CT visceral/subcutaneous adipose thickness and CT visceral/subcutaneous adipose area (r = .52, p.004; r = .51, p.004), but not with US visceral/subcutaneous adipose thickness (r = .42, p.06). Significant correlations were found between Ct visceral/subcutaneous adipose area and with both US and CT visceral/subcutaneous adipose thickness (r = .59, p.006; = .71, p.0001). A high correlation was found between US visceral/subcutaneous adipose thickness and CT visceral/subcutaneous adipose thickness (r = .96, p.0001).Analyzing the results of the different methods, we conclude that US can always be used to study abdominal fat amount and distribution in obese women because this method exhibits significant correlations with CT, the gold standard. The W/H is not sufficient to distinguish visceral from subcutaneous intraabdominal fat.

We report the results of a comparative study of digital and conventional chest radiographs to detect normal anatomical structures of the thorax. A digital Toshiba unit (TCR 201) was used to examine 100 selected patients who were diagnosed with no chest pathologic conditions. The images in both modes were submitted for interpretation to five radiologists. The depiction of nine normal anatomical structures was more accurate on digital than on conventional radiographs. The mean confidence levels achieved in viewing digital images were higher than those obtained with conventional radiographs. This difference was statistically significant (p = 0.002).

After a group of autoptic kidneys, taken from new-born babies, had been injected via the ureter with micronised barium at various pressures, they were examined micro-radiographically and histologically in order to observe the appearance of intra-renal reflux and the anatomical structures involved. The radiological patterns, clinically observed during cysto-uretrography, were also considered. The intra-renal reflux is tubular, when injection is carried out at a low pressure, whereas at higher pressures one can observe the erosion of the fornices of the calyces and the following sino-lymphatic and/or venous drainage.

Thirty-three patients with histological diagnosis of endometrial carcinoma were studied with MR imaging at 1.5 T. All patients were clinically diagnosed as having stage I or II disease (FIGO) and underwent abdominal hysterectomy. MR tissue characteristics and morphological features were compared with morphological features were compared with microscopic pathological findings, in all patients. The following initials were adopted for statistical comparison: M0 = tumor confined to endometrium; M1 = infiltration of the inner third of myometrium; M2 = invasion of the central third of myometrium; M3 = infiltration of the outer third of myometrium. T1-weighted (SE 600/30) and T2-weighted (SE 2000/35.90) (SE 1500/28.60) images were obtained in sagittal plane (section thickness = mm 4). Overall MR accuracy in determining the extent of myometrial invasion was 78%. Correct evaluation of myometrial invasion is essential in patients with stage I or II endometrial carcinoma who are to undergo transvaginal hysterectomy without lymphadenectomy (M0, M1).