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Purpose No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses. Methods Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton’s neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes. Results Median VAS and FFI before treatment were 8[5–8.5] and 45.85[32.4–59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0–5] and 0 [0–2.75], respectively) and median FFI (7.9 [3.95–20] and 0 [0–3.95], respectively) showed a significant reduction in pain and disability (p p Conclusion Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.

Purpose: Tendon transfers have become a common surgical procedure around the ankle. In this study, we sought to evaluate the existence of a correlation between specific anthropometric parameters and the size of some ankle tendons measured on MRI, in particular those mostly used as graft in ankle surgery. Methods: We recorded gender, height, weight, and body mass index (BMI) of 113 patients (57 females; mean age: 42 ± 18) who underwent ankle MRI. MRI measurements performed by a radiologist were: axial shortest diameter of Achilles (AT), posterior tibialis (PTT), flexor digitorum longus (FDLT), flexor hallucis longus (FHLT), peroneus longus (PLT), and anterior tibialis (ATT) tendons, intermalleolar distance (ID) and talus width (TW). Mann–Whitney U test and Pearson’s correlation coefficient were used. After applying the Bonferroni correction for multiple comparisons, statistical significance was set at p < 0.002. Results: The mean patient height, weight and BMI were 169 ± 9.8cm (range: 140–193), 72.4 ± 16.4kg (range: 44–142), and 25 ± 5.7 (range: 16–50), respectively. The mean ankle measurements were: AT = 5.3 ± 1.4mm, PTT = 3.3 ± 0.6mm, FDLT = 2.6 ± 0.4mm, FHLT = 2.7 ± 0.4mm, PLT = 2.9 ± 0.5mm, ATT = 3±0.6mm, ID = 62.9 ± 4.5mm, and TW = 28.8 ± 2.5mm. A statistical difference between male and female patients was observed regarding ID (z = −6.955, p

Purpose: To perform a survey among all members of the Italian Society of Medical and Interventional Radiology (SIRM) to assess how whole-body MRI (WB-MRI) is performed in oncologic patients in Italy. Methods: On March 2019, we administered an online poll to all SIRM members about their use of WB-MRI in 2018 asking 15 questions regarding oncologic indications, imaging protocol, use of contrast media, experience in WB-MRI, duration of scan time and reporting time. Results: Forty-eight members participated to the survey. WB-MRIs/total MRIs ratio was 1%. Lymphoma was the most common indication (17/48, 35%), followed by myeloma and prostate cancer, with these three tumors representing the most common indication in 39/48 of cases (81%). WB-MRI acquisition time and reporting time were 46–60min in 22/48 centers (46%) and 20–30min in 19/48 (40%), respectively. WB-MRIs were mostly performed in 1.5T scanners (43/48, 90%), with surface coils (22/48, 46%) being preferred to Q-body (15/48, 31%) and integrated coils (11/48, 23%). Contrast media were injected in 22/48 of the centers (46%), mainly used for breast cancer (13/22, 59%). DWI was the most used sequence (45/48, 94%), mostly with b800 (27/48, 56%), b0 (24/48, 50%) and b1000 (20/48, 42%) values. In about half of cases, radiologists started evaluating WB-MRI non-contrast morphologic sequences, then checking DWI and post-contrast images. Conclusion: WB-MRI was mainly performed at 1.5T unit, with lymphoma, myeloma and prostate cancer having been the most common indications. The extreme variability in the choice of imaging protocols and use of contrast agents demonstrates the need of a standardization of WB-MRI application in clinical practice.

To produce an informed consent for CT colonography (CTC), to be diffused by the Italian Society of Radiology, aimed to make patients and referring physicians aware of CTC examination protocol, advantages and disadvantages, limits and potential related risks.Delphi method was used to create a consensus among experts on an informed consent for CTC. The overall agreement among different consulted specialists was evaluated and ranked using the Cronbach's correlation coefficient (α) at two time points: after the first and the second 'round' of consultation.The Cronbach index was 0.84 at the end of the first round and 0.93 at the end of the second round. The number of disagreements dropped from an overall of 11-5, from the first to the second round.The experts were able to produce an informed consent for CTC, hoping that this may be the beginning of a process focused on implementation of quality standards in CTC.

Few studies have correlated computed tomography enterography (CTE) findings with Crohn’s disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity. The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and complications related to the disease (fistulas, strictures, abscesses). Activity was assessed using the Crohn’s Disease Activity Index (CDAI) and some biochemical markers (C-reactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correlations between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression. CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03). The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clinically active and that these patients may require more aggressive treatment than patients without these findings.

To assess the incidence of collateral findings detected on whole-body magnetic resonance (WB-MRI) scans performed on patients with lymphoma. 114 patients (65 male; median age 45.2 years, range 15–86) with histologically confirmed lymphoma (47 Hodgkin, 67 Non-Hodgkin) underwent WB-MRI. The collateral findings were classified into three classes, according to their clinical significance, as follows: not or low significant (class 1), moderately or potentially significant (class 2), and significant (class 3). A Chi-square (χ 2) test was performed to assess the statistical significance of differences in the incidence of collateral findings based on age (≤50 and >50 years old), gender and histology (Hodgkin and Non-Hodgkin Lymphoma). Ninety-one of 114 patients (79.8 %) had one or more incidental findings on WB-MRI. Collateral findings were more frequent in class 1 (43 %); abnormalities found in 35 patients (30.7 %) were considered potentially significant, whereas seven patients (6.1 %) demonstrated significant collateral findings requiring immediate treatment or further diagnostic evaluation. Collateral findings were more frequent in subjects over 50 years old compared to those of 50 years old or younger; differences were statistical significant (χ 2 = 8.42, p 0.05) and histology (χ 2 = 0.24, p > 0.05). WB-MRI is an attractive procedure that allows to detect incidental abnormalities of organs not involved by disease offering the opportunity to obtain an early diagnosis of asymptomatic life-threatening diseases.

Purpose. This study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis. Materials and methods. A total of 277 patients (mean age 60 1 1 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments. Results. Myocardial bridging was present in 82 patients (30%, mean age 59 +/- 12). Bridges were of variable length (2 cm 10%) and depth (superficial 69%. intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), 50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p

Objective. The aim of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) enteroclysis after oral hyperhydration with isotonic solution in detecting bowel wall alterations in patients with Crohn’s disease. Materials and methods. Twenty-eight patients with a diagnosis of Crohn’s disease established by ileocolonoscopy and histology were enrolled in the study; 15 patients with negative ileocolonoscopy served as controls. In all cases, MDCT enteroclysis was performed after oral administration of 2,000 ml of isotonic solution and intravenous administration of N-butylscopolamine. Axial, isotropic multiplanar and volume-rendered reconstructions were used to evaluate bowel wall thickness, ulceration, contrast enhancement, extraparietal involvement and possible complications. Results. MDCT enteroclysis identified the typical signs of Crohn’s disease in 26 patients (92.8%), with sensitivity of 92.8%, specificity of 100%, positive predictive value 100% and negative predictive value 75%. Conclusions. MDCT enteroclysis after oral hyperhydration with isotonic solution showed a high level of accuracy in detecting small bowel changes in patients with Crohn’s disease. It can be considered a safe and effective alternative to conventional radiography and small-bowel spiral computed tomography enema, especially in patients who refuse nasojejunal intubation.

The purpose of this study was to describe the findings and evaluate the role of multidetector (40–slice) computed tomography (MDCT) in the preoperative assessment of gastrointestinal stromal tumours (GISTs). Thirteen patients with histologically proven GIST (size: 4–30 cm; mean: 9 cm) underwent 40–slice MDCT after the ingestion of 1,000 ml of water. Images were obtained before and 70 s after intravenous injection of 120 ml of iodinated contrast agent. Two experienced radiologists reviewed the CT findings to evaluate lesion site, size, margins, attenuation, growth pattern, enhancement pattern, ascites, lymphadenopathy, direct invasion to adjacent organs and distant metastasis. Multiplanar maximum intensity projection and three–dimensional (3D) reconstructions were also obtained. Seven out of 13 GISTs were located in the jejunumileum, 3/13 in the stomach, 2/13 in the rectum and in one case, the origin remained unknown. Eleven out of 13 were exophytic, and ten had well–defined borders. Two out of 13 showed calcifications. Thirteen out of 13 exhibited inhomogeneous enhancement due to areas of necrosis and cystic degeneration. Direct invasion to adjacent organs (n=3), ascites (n=3), and liver (n=1) and peritoneal (n=1) metastases were also detected. Bowel obstruction, vascular invasion and lymphadenopathy were never seen. MDCT allowed reliable preoperative assessment of GIST, providing useful clues for lesion characterisation.

To investigate the diagnostic accuracy of two different protocols for image evaluation used in multislice computed tomography coronary angiography (MSCT-CA).Sixty patients with suspected coronary artery disease undergoing conventional coronary angiography (CA) were enrolled for MSCT-CA. All patients underwent 16-row MSCT (Sensation 16, Siemens, Germany) with the following parameters: detector rows 16, collimation 0.75 mm, gantry rotation time 375 ms. Two independent observers assessed the images for significant stenosis using a a protocol with standard projections and a three-dimensional protocol. The diagnostic accuracy for both methods was calculated using quantitative CA as a reference standard.The sensitivity, specificity, negative predictive value and positive predictive value obtained with the conventional projection protocol and with three-dimensional protocol were: 54% and 93%, 97% and 97%, 76% and 86%, 92% and 99%, respectively.Conventional projections in the assessment of MSCT-CA provide insufficient diagnostic accuracy compared with three-dimensional processing.

To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy.Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy.The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed.The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.

To assess the diagnostic potential of ultrasound as compared to conventional radiography in quantifying the anatomic and structural damage and determining the grade of acute traumatic lesions of the acromioclavicular (AC) joint.From September 2001 to September 2002, 18 patients (16 men, 2 women; age range: 17-78 years) who came to our Emergency Service with clinically suspected acute traumatic AC joint lesion were examined by ultrasonography with a variable frequency linear-array transducer (7.5-12 Mhz). The morphology of the AC joint peri-articular ligaments and soft tissues, distance between the edge of the acromion and the lateral margin of the clavicle, distance between the superior edge of the coracoid and the inferior margin of the clavicle were evaluated. Conventional radiography was performed prior to ultrasound using routine antero-posterior (A-P), single-film stress and "outlet" projections. All patients subsequently underwent clinical follow-up for a mean period of six months.On US examination, all patients presented AC ligament lesion associated with consistent intra- and extra-articular sero-haemorrhagic effusion. Six of the 18 patients had suffered indirect trauma. Diastasis of the AC joint with ligament lesion not associated with involvement of coracoclavicular (CC) joint and with ligament integrity was observed. Twelve of the 18 patients had direct trauma. Changes to AC and CC ligaments with consequent diastasis of both joints were observed. Measurements of AC and CC distance obtained on US examination corresponded to those obtained at conventional radiography in the A-P projection. At clinical follow-up, no variation in the previously established diagnosis was recorded in any patient.If appropriate methodology and adequate transducers are used, ultrasound is an accurate and reliable technique for the evaluation of acute AC joint injuries, complementing and correlating well with conventional radiography.

The aim of the present study is to report our experience using digital cineradiography to assess morphological and functional disorders of the pharynx in patients with prior partial or total laryngectomy.From March 2000 to October 2002, 21 patients (18 males and 3 females) with prior total laryngectomy (12 patients), total laryngopharyngectomy (2 patients) and partial laryngectomy (7 patients) were examined. A digital cineradiography with 12 frames/second acquisition was performed in all patients. In four patients the procedure was interrupted for massive barium aspiration, without cough (silent aspiration). In 17 patients standing in the left posterior oblique position and prone in the right posterior oblique position the oesophagus and oesophagogastric junction were also examined. The water siphon test was performed at the end of the procedure. Small boluses (10 ml) of liquid (60% w/v) and high-density (250% w/v) barium, barium paste (110% w/v), and solid meal (obtained spreading a dry biscuit with barium paste) were used.All patients with prior total laryngectomy and total laryngopharyngectomy showed morphological and functional disorders of the neopharynx: parapharyngeal diverticulum (2 cases), submandibular pouch (6 cases), fistulas (2 cases), lumen narrowing and post-surgical stenoses (2 cases), tumour recurrence (1 case), prominent cricopharynx (5 cases) and rhinopharyngeal reflux (4 cases). All patients with prior partial laryngectomy (7 cases) presented silent aspiration. Eleven patients had an oesophageal motility disorder, which was very serious in three of them with decrease in oesophageal clearing and barium retention in the oesophagus. Oesophagogastric junction evaluation showed hiatus hernia in six cases, two of them with associated gastro-oesophageal reflux.Digital cineradiography appears able to identify the organic and functional postoperative complications of patient treated with partial or total laryngectomy. A special swallowing study can suggest to the speech therapist the best compensatory mechanism for improving patient swallowing and therefore quality of life.

To describe the enhancement patterns of atypical hepatic haemangiomas with Pulse Inversion Harmonic Imaging (PIHI) using SH U 508A (Levovist).Twenty-five patients (15 women, 10 men; age range: 29-65 years, mean: 48.2 years) with 28 hepatic haemangiomas (size: 1.5 - 11.5 cm; mean: 4.6 cm) underwent PIHI before and after i.v. administration of Levovist. Selected images obtained at baseline and 25-30s, 55-60s and 240s after Levovist injection were sequentially reviewed to determine the changes in echogenicity of haemangiomas in comparison to surrounding liver parenchyma.At the baseline US study, 22/28 (79%) haemangiomas revealed highly inhomogeneous echotexture; 5/28 (18%) were homogeneously hypoechoic and 1/28 (3%) was isoechoic with respect to hepatic parenchyma. After Levovist administration, 16/28 (57%) haemangiomas showed peripheral hyperechoic nodules in the arterial phase with progressive centripetal fill-in in portal and late phases; such fill-in was complete in 14/16 cases and incomplete in 2/16. Four of twenty-eight (14%) haemangiomas revealed a rapid and complete homogeneous fill-in on arterial phase that lasted throughout the portal and late phases. Finally, 8/28 (29%) showed a rim-like enhancement with progressive and complete centripetal fill-in on portal and late phases.According to our results, PIHI with Levovist allows demonstration of typical enhancement patterns in most of atypical haemangiomas, thus providing useful diagnostic information for their characterization.

To evaluate the role of preoperative virtual colonoscopy to study the proximal colon in patients with distal occlusive carcinomas, diagnosed by conventional colonoscopy.We examined 19 patients aged 46 to 83 years (13 men and 6 women) with distal occlusive colorectal carcinomas diagnosed by conventional colonoscopy, who were preoperatively studied with virtual colonoscopy. Patients with acute bowel obstruction were excluded. Results were compared with the findings of preoperative conventional colonoscopy and barium enema examination, intraoperative colon palpation, histopathologic outcome, postoperative conventional colonoscopy and barium enema examination.Virtual colonoscopy identified all 19 distal occlusive colon carcinomas and 22 synchronous lesions, 2 cancers (prevalence 10,6%) and 20 polyps (prevalence 68,4%). Both synchronous cancers were confirmed intraoperatively by direct palpation. Postoperative conventional colonoscopy, which was performed in 18 patients, confirmed the presence of 15 polyps in 12 patients. Three subcentimeter polyps were removed during conventional colonoscopy and were missed at virtual colonoscopy. Two polyps shown by virtual colonoscopy were not found at conventional colonoscopy. Postoperative barium enema was performed in three patients and confirmed three polyps identified at virtual colonoscopy. Preoperative barium enema was performed in five patients and failed to adequately demonstrate the proximal colon. Virtual colonoscopy showed a sensitivity of 87% and a specificity of 75%.Virtual CT colonoscopy can be considered an important diagnostic technique to evaluate preoperatively the proximal colon in patients with distal occlusive carcinomas,as it gives better results than barium enema or conventional colonoscopy, as well as being well tolerated and less invasive.

To assess the yield of superparamagnetic iron oxide (SPIO)-enhanced MR images in the detection and characterization of benign hepatic tumors and to evaluate the potential role and safety of SPIO administration in the diagnosis of these tumors.Eighteen patients underwent MRI before and after administration of SPIO particles. Spin echo (SE) T1, DP, T2 and Gradient echo (GE) T2* images were acquired with a.5 T superconductive unit. MR diagnosis was bioptically proved in 12 patients. In the remaining six patients, who had hemangiomas only, diagnosis was confirmed by at least two imaging techniques-such as MR, CT, ultrasonography, radio-labeled red cells scintigraphy-and by both clinical and imaging follow-up.Thirthy-four tumors were detected on the MR images: 29/34 (85,3%) before and 33/34 (97%) after SPIO administration - 6 focal nodular hyperplasias (FNH), 6 adenomas and 22 hemangiomas. One small tumor (adenoma) was detected on the unenhanced MR images only, while 4 lesions (3 adenomas, 1 FNH) were detected after SPIO administration only.SPIO-enhanced MRI increased the detection rate of benign hepatic tumors compared to non-enhanced MRI. Iron oxide was also useful in the characterization of such lesions as it was able to demonstrate any heterogeneity resulting from the presence of central scars or septa. Nevertheless, in our experience it was useful to compare baseline with SPIO-enhanced MRI, even if time consuming. Indeed the uptake of iron oxide particles by well-differentiated lesions and normal hepatic parenchyma, is comparable, so that well-differentiated lesions appear isointense and therefore undetectable.In our experience, although numerically limited, SPIO-enhanced MRI was clinically safe and more effective than non-enhanced MRI in both the detection and characterization of benign hepatic tumors, providing useful clues for diagnosis.