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Background Patients undergoing cardiac surgery are subject to severe alterations of the coagulation system. The four cardiac surgery centers in Tuscany (Italy) structured and shared an algorithm (Granducato Patient Blood Management algorithm, G-PBMa) with predefined interventions for patient blood management. The aim of the study is to analyze the impact of that algorithm on the transfusion needs and bleeding-related outcomes in a large patient population. Methods Multicenter retrospective observational study on 3839 patients undergoing cardiac surgery at the four cardiac centers in Tuscany. The G-PBMa was released at the end of 2015 and it was structured in three parts: pre-, intra-, and post-operative. The year 2014, before the G-PBMa (1955 patients) and the year 2016 (1884 patients) after the G-PBMa in place were compared. Logistic regression analyses were used. Results The main changes introduced were the routine application of viscoelastic tests in bleeding patients (+72%) and the use of fibrinogen and prothrombin complex concentrate (+67%). The G-PBMa resulted in a significant reduction in the overall transfusion rate and in the transfusion rate of the separate blood products (relative risk for transfusions: 0.75, 95% confidence interval 0.65–0.85, P = 0.001). For preoperative hemoglobin values of between 8 and 10 g/dL, the absolute difference in RBC transfusion rate before and after the G-PBMa introduction ranged around 15%–17%. The G-PBMa introduction determined lower ( P = 0.02) chest drain blood loss, lower ( P = 0.001) postoperative acute kidney injury and shorter ( P = 0.001) hospital stay. Conclusions The G-PBMa was effective in reducing blood loss, transfusion requirements, and resulted in a better outcome.

Objectives: To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. Methods: The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach’s statistics were used to rate levels of agreement and internal reliability of the consensus. Results: Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. Conclusions: The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. Key points: • Liver-specific contrast agents are recommended in MRI of the liver. • The hepatobiliary phase improves the detection and characterization of hepatocellular lesions. • Liver-specific contrast agents can improve the detection of HCC., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is still associated with a dismal outcome. Combination therapy with everolimus (EVL) and vascular endothelial growth factor inhibitor sorafenib (SORA) is based on the role of both b-Raf and mammalian target of rapamycin/protein kinase B pathways in the pathogenesis of HCC and is being investigated in clinical practice. Methods This was a single-center retrospective analysis on LT recipients with unresectable HCC recurrence and undergoing combination therapy with EVL and SORA. Patients were included if they were switched to EVL+SORA at any time after surgery. Primary endpoint was overall survival (OS) after both LT and recurrence, and response to treatment based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) in the intention-to-treat (ITT) population. Secondary analysis was safety of combination therapy with EVL and SORA in the population of patients who received ≥1 dose of the study drug. Results Seven patients (100% male; median age 53 years [interquartile range (IQR) 9 years]) were considered for analysis. HCC recurrence was diagnosed at a median (IQR) interval since LT of 9 (126) months, and patients were administered EVL+SORA at a median interval since LT of 11 (126) months. Baseline immunosuppression was with tacrolimus (TAC) in 2 patients (28.6%), cyclosporine (CsA) in 2 (28.6%), and EVL monotherapy in 3 (42.8%). At a median (IQR) follow-up of 6.5 (14) months, 5 patients (71.4%) were alive, 4 of them (57.1%) with tumor progression according to the mRECIST criteria. Median (IQR) time to progression was 3.5 (12) months. Two patients died at a median (IQR) follow-up of 5 (1) months owing to tumor progression in 1 patient (14.3%) and sepsis in the other (14.3%). EVL monotherapy was achieved in 6 patients (85.7%), whereas 1patient (14.3%) could not withdraw from calcineurin inhibitor owing to acute rejection. Treatment complications were: hand-foot syndrome in 5 patients (71.4%), hypertension in 1 (14.3%), alopecia in 1 (14.3%), hypothyroidism in 1 (14.3%), diarrhea in 2 (28.6%), pruritus in 1 (14.3%), abdominal pain in 1 (14.3%), rash in 1 (14.3%), asthenia in 3 (42.8%), anorexia in 3 (42.8%), and hoarseness in 2 (28.6%). Adverse events led to temporary SORA discontinuation in 2 patients (28.6%) and to SORA dose reduction in 3 (42.8%). Conclusions Treatment of HCC recurrence after LT with a combination regimen of EVL+ SORA is challenging because of SORA-related complications. Longer follow-up periods and larger series are needed to better capture the impact of such combination treatment on tumor progression and patient survival.

Objectives: Early assessment of hepatocellular carcinoma (HCC) response during sorafenib (SO) treatment is challenging, since tumor necrosis, extension and radiological appearance can be inhomogeneous. We evaluated the predictive value of different imaging criteria - such as Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor density and volume variations - in the early follow-up of SO treatment. Methods: The study included 22 patients. CT images from baseline and 2 months were reviewed to assess response according to RECIST 1.1, mRECIST, EASL, Choi's criteria (decreased tumor density by ≥15%) and arterial-enhancing tumor volume ratio; α-fetoprotein (AFP) variations were expressed as AFP ratio. Results: The response criteria and volume measurements were reproducible (k > 0.80). The overall disease control rate was 40.9% by EASL and mRECIST, and 27.3% by RECIST 1.1; a ≥15% decrease in tumor density was observed in 9 patients (40.9%). The mean volume ratio was 1.73 ± 2.12, the mean AFP ratio 14 ± 37. The 1-year survival rate was 65.9%. Volume ratio was the only predictive factor for survival, with 1-year cumulative survival rates of 90% for volume ratios ≤1.1 and of 45.4% for volume ratios >1.1 (p = 0.04). Conclusions: Tumor volume measurements are reproducible and might provide an early predictive marker of response in HCC patients treated with SO.

Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease of the central nervous system due to JC polyoma virus infection of oligodendrocytes. PML develops in patients with impaired T-cell function as occurs in HIV, malignancy or immunosuppressive drugs users. Until now no imaging methods have been reported to correlate with clinical status. Diffusion-weighted imaging (DWI) is a robust MRI tool in investigating white matter architecture and diseases. The aim of our work was to assess diffusion abnormalities in focal white matter lesions in patients with PML and to correlate the lesion load measured with conventional MRI and DWI to clinical variables. We evaluated eight patients with a biopsy or laboratory-supported diagnosis of PML. All patients underwent MRI including conventional sequences (fluid attenuated inversion recovery-FLAIR) and DWI. Mean diffusivity (MD) maps were used to quantify diffusion on white matter lesions. Global lesion load was calculated by manually tracing lesions on FLAIR images, while total, central core and peripheral lesion loads were calculated by manually tracing lesions on DWI images. Lesion load obtained with the conventional or DWI-based methods were correlated with clinical variables such as disease duration, disease severity and survival. White matter focal lesions are characterized by a central core with low signal on DWI images and high MD (1.853 x 10(-3) mm2/s), surrounded by a rim of high signal intensity on DWI and lower MD (1.1 x 10(-3) mm2/s). The MD value of normal-appearing white matter is higher although not statistically significant (0.783 x 10(-3) mm2/s) with respect to control subjects (0.750 x 10(-3) mm2/s). Inter-rater correlations of global lesion load between FLAIR (3.96%) and DWI (3.43%) was excellent (ICC=0.87). Global lesion load on FLAIR and DWI correlates with disease duration and severity (respectively, p=0.037, p=0.0272 with Karnofsky scale and p=0.0338 with EDSS on FLAIR images; p=0.043, p=0.0296 with Karnofsky scale and p=0.0365 with EDSS on DW images). Central core lesion load on DWI correlates with disease duration and severity (respectively p=0.043, p=0.0103 with Karnofsky scale and p=0.0112 with EDSS), while peripheral lesion load does not correlate with any clinical variable. The global lesion load in PML correlates with disease duration and severity. DWI images, which can distinguish within lesions a central core from a peripheral rim, reveal that a larger central core component correlates to a worsened clinical status and longer disease duration. On the other hand the peripheral rim lesion load visualized on DWI images does not correlate with clinical variables and does not achieve obtaining further prognostic information with respect to conventional imaging.

Transgenic Centre for Research in Neurodegenerative Diseases 8 (TgCRND8) mice expressing a double mutant form of human amyloid precursor protein represent a good model of Alzheimer's disease, and can be useful to clarify the involvement of mitogen-activated protein kinases (MAPK) dysregulation in the pathophysiology of this neurodegenerative disorder. Activation of extracellular regulated kinase (ERK) 1/2, jun kinase (JNK) and p38MAPK was studied in the hippocampus of 7-month-old TgCRND8 mice by immunohistochemistry and Western blot analysis using antibodies selective for the phosphorylated, and thus active, forms of the enzymes. We demonstrated that the three main MAPK pathways were differentially activated in cells of the hippocampus of TgCRND8 mice in comparison to wild type (Wt) littermates, p38MAPK and JNK being more activated, while ERK less activated. p38MAPK was significantly activated in microglia, astrocytes and neurons, around and distant from the plaques. JNK was highly activated in cells closely surrounding the plaques. No difference was observed in the activation of the two major bands of JNK, at a molecular weight of 46 kDa and 54 kDa. These data indicate the possible involvement of p38MAPK and JNK pathways dysregulation in the pathogenesis of Alzheimer's disease. The ERK2 isoform of the ERK pathway was less activated in the hippocampal dentate gyrus of Tg mice in basal conditions. Furthermore activation of the ERK pathway by ex vivo cholinergic stimulation with carbachol caused significantly higher activation of ERK in the hippocampus of Wt mice than in Tg mice. These findings may pose a molecular basis for the memory disruption of Alzheimer's disease, since proper functioning of the basal forebrain cholinergic neurons and of ERK2 is critical for memory formation.

The aim of our study was to describe the visualization, normal anatomy, and variations of the ileocecal valve with computed tomographic (CT) colonography to provide information about its optimal imaging. We analyzed data in two- and three-dimensional rendering mode in 71 consecutive patients who underwent routine CT colonoscopy followed by conventional colonoscopy for confirmation of the radiologic findings. Complete visualization of the ileocecal valve was better achieved in the supine than in the prone position (82% vs. 62%, respectively); the ileocecal valve appeared in 64% of cases in the supine position when it was invisible in prone position (p < 0.0001). Partial visualization of the ileocecal valve was possible in 94% of cases. The ileocecal valve was of labial type in 76%, papillary type in 21%, and lipomatous in 3% of cases. The orifice was identified in 53% of ileocecal valves; in two cases of cecal carcinoma, the normal ileocecal valve morphology was grossly disrupted. The ileocecal valve was at least partly visualized by CT colonoscopy in 94% of cases, more frequently in the supine position. Its most common normal morphology is the labial type. The absence of orifice visualization alone is not a specific sign for neoplasia, but its presence helps distinguish physiologic bulging from neoplasia.

The purpose of this study is to review the role of the percutaneous interventional procedures in the treatment of vascular complications after orthotopic liver transplantations (OLT). Vascular complications, such as arterial stenosis and venous thrombosis, which occur in approximately 1% to 10% of liver transplant patients, are associated with a higher risk of graft dysfunction. Percutaneous interventional procedures, including angioplasty, local thrombolysis, and embolization, are useful to manage these complications. A reduced blood loss and a low incidence of procedural complications allow for rapid recovery. Hepatic arterial and portal vein anastomotic stenosis can be treated effectively by means of balloon dilation; stenting has also been proposed, particularly for venous complications. Infusional local thrombolysis may be useful in venous thrombosis. Arteriovenous fistulas, occurring at the level of the anastomosis or after liver biopsy, require intraarterial embolization using microcoils or gelfoam. Timing of the intervention for the treatment of ischemic complications is of outmost importance to guarantee liver functional recovery and avoid irreversible parenchymal injuries. Other interventional procedures may be extremely useful to manage portal hypertension after OLT; for example, by creation of transjugular portosystemic shunts, or, in the case of associated hypersplenism, transarterial embolization of the splenic artery. Finally, in patients with recurrent hepatitis, the transjugular approach has been shown to be safe and effective for liver biopsy, whereas transarterial chemoembolization may be extremely useful to treat recurrent hepatocarcinoma.

Purpose The purpose of this study was to evaluate the accuracy of Multidetector Computed Tomographic Angiography (MDCTA) to detect hepatic artery (HA) stenosis after orthotopic liver transplantation (OLT) and the efficacy of treatment using percutaneous transluminal angioplasty (PTA). Materials and methods Twenty-two consecutive patients with OLT underwent MDCTA for evaluation of HA, followed by digital subtraction angiography (DSA) (gold standard). Source images (Ax) were processed, obtaining multiplanar reformations (MPRs), maximum intensity projections (MIPs), and volume renderings (VRs). Images were evaluated to identify the following: (1) arterial depiction (celiac axis, anastomosis, and left [LHA] and right [RHA] HA), (2) detection of stenoses, and (3) grading of stenoses. Indications for PTA were set at MDCTA and DSA, and PTA was performed when appropriate. Results MDCTA depicted the celiac axis and anastomoses in all patients; LHA and RHA were visualized in 21 of 22 patients with Ax, MPRs, and MIPs, and in 17 of 22 with VRs. All reconstruction modalities enabled correct diagnosis of celiac (n = 3) and anastomotic stenoses (n = 14). Of 6 LHA and RHA stenoses, 4 (66.7%) were visualized with Ax, MPRs, and VRs, and 5 (83.3%) were visualized with MIPs. Stenosis was overestimated in 9 (39.1%) cases with VRs and in 3 (13%) with the other modalities. PTA was performed in 8 cases, with 1 case of arterial dissection requiring re-OLT. At a median follow-up of 28 months, the primary and secondary patency rates were 71.4% (5 of 7) and 85.7% (6 of 7), respectively. Conclusions MDCTA and accurate postprocessing enable confident depiction of the arterial anatomy and detection of stenosis after OLT. PTA is safe and allows allograft saving, at least until another suitable donor becomes available.

The aim of this study was to evaluate diagnostic accuracy of contrast-enhanced MRA (CEMRA) compared with digital subtraction angiography (DSA) in studying neck vessels of 48 patients. In three groups of patients, we used three MRA protocols differing for voxel size to assess if intravoxel dephasing effects could modify accuracy of CEMRA. Accuracy and correlation with DSA results were calculated in all patients and separately in the three groups. A qualitative analysis of the likeness between morphology of the stenosis in CEMRA and DSA images was also assessed. In all patients accuracy and agreement with DSA were 96% and k=0.85 in subclavian arteries, 96% and k=0.84 in vertebral artery, 97% and k=0.88 in common carotid arteries, and 94% and k=0.86 in internal carotid arteries. In the three groups accuracy and agreement with DSA did not show any significant difference. Qualitative analysis of CEMRA and DSA images revealed a better agreement in depicting the morphology of stenosis using a smaller voxel size. The CEMRA represents a powerful tool for the non-invasive evaluation of neck vessels. Overestimation trend of CEMRA is confirmed and the reduction of voxel size, decreasing the dephasing intravoxel effect, allows to have a better overlapping of stenosis morphology on CEMRA compared with DSA, but it does not yield diagnostic gain in the stenosis grading.

High-resolution MR of the inner ear performed in 3 consecutive pediatric patients affected by distal renal tubular acidosis (dRTA) and progressive sensorineural hearing loss (SNHL) revealed enlarged vestibular aqueducts (LVA) (bilateral in 1 case and unilateral in 2). LVA is associated to sporadic, progressive SNHL, often secondary to minor head trauma and activities involving the Valsalva maneuver. We believe that the presence of LVA may have contributed to the onset of SNHL and its progression in our patients, and therefore want to stress the importance of morphological studies of the inner ear in patients affected by dRTA and SNHL.

Virtual endoscopy enables the creation of endoluminal views of the aorta and its branches by processing spiral computed tomographic (CT) images, thereby allowing the preoperative and postoperative evaluations of abdominal aortic aneurysms, aneurysms of the splenic, celiac, and common iliac arteries, and renal artery stenoses. Moreover, it is helpful for verifying the position of stents and endoprostheses from within the aortic lumen. This method is a promising addition to spiral CT.

With advances in imaging and surgical techniques, the number of patients undergoing partial hepatectomies for primary or secondary liver tumors have significantly increased during the past decade. Improvements in imaging modalities have contributed to early detection, precise localization and characterization of liver lesions (Meun 1998). Refinements in surgical techniques have reduced both the morbidity and the mortality rates from elective hepatectomy and have allowed surgeons to consider more extensive resections. Nevertheless, in most patients with liver tumors, surgery is not an appropriate option. Patients with primary hepatocellular carcinoma (HCC) are often poor surgical candidates, because of the lack of hepatic reserve resulting from coexisting liver cirrhosis or the presence of multiple lesions at the time of the diagnosis (Lencioni and Also, in most patients with hepatic metastases resec-tion is not feasible because the lesion is adjacent to critical vascular structures or too many segments are involved that resection would not leave enough liver tissue for survival (Steele and Ravikumar 1989).

We describe a case of graft-related pseudoaneurysm of the abdominal aorta evaluated with spiral CT and DSA. Spiral CT data sets were processed to obtain surface-rendered internal views (virtual angioscopy, VA) of the graft and the pseudoaneurysm, and to demonstrate from inside the lumen the site of dehiscence. A jet flow phenomenon inside the pseudoaneurysm was observed at DSA. Spiral-CT axial images, multiplanar volume reconstructions with maximum intensity projections, and shaded surface display showed the site of rupture. The VA findings were: (a) from inside the graft lumen, the evidence of a communication canal between the graft and the pseudoaneurysm; and (b) from inside the pseudoaneurysm, the presence of a jet flow. The VA findings showed good correlation with those obtained with the other imaging techniques.

To evaluate the feasibility of magnetic resonance (MR) virtual endoscopy of the pancreaticobiliary tract by using MR cholangiopancreatography (MRCP) data sets as source images, we retrospectively reviewed MRCP data sets of 120 patients with Navigator software (GE/Medical Systems, Milwaukee, WI) that allowed display of inner views by surface rendering the internal wall of the bile ducts with simulated light and shadow.

Minimally invasive percutaneous therapies, such as percutaneous ethanol injection (PEI) or interstitial hyperthermia obtained by radiofrequency (RF) have now been accepted by many groups as first step treatment of hepatocellular carcinoma (HCC) in cirrhosis’, taking into account the surgical risk and the very high recurrence rate, which are characteristic of this tumour.

The purpose of this study was to investigate the accuracy of endorectal coil MRI in the local staging of prostate carcinoma. A total of 73 patients with biopsy-proven prostate carcinoma were examined at 0.5 T prior being submitted to radical prostatectomy. The gold standard was provided in all patients by findings at whole-mount sectioning of the surgical specimens. At pathology 28 patients had stage T2, 30 had stage T3a/b, and 15 had stage T3c lesions. Overall accuracy of endorectal coil MRI in defining local tumor stage was 82% (60 of 73 patients). Of 73 patients, 5 (7%) were underestimated and 8 (11%) overestimated. The sensitivity and the specificity of endorectal coil MRI in diagnosing capsular penetration were 95% and 82%, respectively. Seminal vesicle invasion was detected with 80% sensitivity and 93% specificity. Our data indicate that endorectal coil MRI is an accurate method for local staging of prostate cancer.

Thyroid hypoechogenicity at ultrasound is a characteristic of autoimmune thyroid diseases, with an overlap of this echographic pattern in patients affected by Graves' disease or Hashimoto's thyroiditis. Aim of the present paper was to study the thyroid blood flow (TBF) by color-flow doppler (CFD) and peak systolic velocity (PSV) at the inferior thyroid artery in 37 Graves' and 45 goitrous Hashimoto's thyroiditis patients. CFD pattern was defined as normal (or type 0): TBF limited to peripheral thyroid arteries (PSV = 17.7 +/- 3 cm/sec, mean +/- SD); type I: TBF mildly increased; type II: TBF clearly increased; type III: TBF markedly increased. The CFD was in direct relationship to the PSV. Out of 18 patients with Graves' disease and untreated active hyperthyroidism CFD pattern was type III in 17 and type II in 1. The PSV was 42.1 +/- 15 cm/sec. In 17 patients euthyroid under methimazole, the CFD pattern was type 0 in 3 (17%) type I in 5 (30%), type II in 5 (30%), type III in 4 (23%). In this group of Graves' patients the PSV was 36 +/- 14 cm/sec. In two patients, hypothyroid after radioiodine treatment, the CFD pattern was type 0 in 1 and type I in 1. In the group of Hashimoto's patients TBF was in no relationship with thyroid status or treatment and was type 0 in 22 (49%), type I in 20 (44%), type II in 3 (7%), while none had type III CFD pattern. Thyroid hypoechogenicity at ultrasound was present in 32/37 (86%) Graves' and 41/45 (91%) Hashimoto's patients. All the four patients with Hashimoto's thyroiditis and normal thyroid ultrasound pattern had also a normal CFD pattern, while 4/5 patients with Graves' disease and normal echographic pattern had an increased TBF. In conclusion, a diffusely increased thyroid blood flow is pathognomonic of untreated Graves' disease and an abnormal CFD pattern identifies the majority of Graves' patients with a normal thyroid ultrasound pattern. Thus, CFD sonography may be useful in distinguishing patients with Graves' disease and Hashimoto's thyroiditis having a similar thyroid echographic pattern at ultrasound.

In a retrospective analysis performed on 4167 routine abdominal sonographic (US) examinations (September 1989 to December 1991), 93 US reports strongly suggesting the presence of gastrointestinal (GI) tract disorders were found. Neoplastic GI tract diseases were indicated in 65.6 % of cases and non-neoplastic conditions in 34.4 %. The final diagnoses confirmed all the cases of non-neoplastic disease, while 3 patients sonographically suspected as having a neoplasm proved not to have any GI tract abnormality. In the period January 1992 to December 1992, 62 patients with a suspected GI tract abnormality were enrolled in a prospective double-masked US study after being submitted to conventional radiological studies only in 28 of 62 cases, after conventional studies and CT in 24 of 62 cases, and after CT only in 10 of 62 cases. Sonography furnished additional diagnostic information in 28 of 62 cases when the previous radiological examination did not include CT, but sonography misinterpreted 4 inflammatory disorders as tumours. Our study confirmed the important role of US alone or in association with other imaging modalities in the study of GI tract diseases.

The aim of our work was to implement and validate a system for the acquisition, local management and remote transmission of diagnostic images using two interconnected brrnldbarud Metropolitan Area Networks (MANs). The MAN technoloy is compliant with the IEEE 8()2.6 standard, also known as DiStribrutell Queue Dual Bus (D()1)B). Application domains included tcleradiblogy and teleprocessing of diagnostic incages. Teleradiology was focused on the enhancement of the radiologist to clinician information flow witlcirc the framework of the European Project EurIPACS. An intrainstitutional scenario was taken as a paradigm in the field of staging, nonstrrgical treatment, and follow-up of hepatocellular carcinoma. Remote processing of diagnostic images using the broadband MAN allowed a cooperative work with scientific institutions in an area often limited by the complexity of image transfer acrd the lack of timely feedback concerning tlce. clinical usefulness of processed images. ()ur preliminary experience demonstrated that the DQDB MAN provided a fast and reliable means for transmitting diagnostic images.

The aim of this study was to evaluate the efficacy and safety of sonographically guided percutaneous injection of ethanol for treating autonomous thyroid nodules in order to assess that technique's feasibility as an alternative to traditional ablative (radionuclide and surgical) therapies.Thirty-two patients with autonomous thyroid nodules were included in the study: seven had thyrotoxicosis, and 25 were in the pretoxic clinical phase. Ethanol was injected percutaneously on an outpatient basis once or twice a week for a total of three to 10 injections per nodule, mainly depending on the nodule's size. Scintigrams obtained 3 months after the end of treatment were used to assess response to this therapy. The follow-up period was from 3 to 30 months.Thyroid scintigraphy 3 months after percutaneous injection of ethanol showed complete recovery of function in extranodular tissue in 26 patients (81%), partial recovery in five patients (16%), and no recovery in one patient (3%). In all patients, the volume of the nodules decreased by more than 50% after treatment. In three of five patients in whom scintigraphy showed only partial recovery of function in extranodular tissue, a second percutaneous injection of ethanol was given after 15 months. The therapy was well tolerated, and after a total of 216 injections, no patient had permanent side effects.Our experience shows that percutaneous injection of ethanol is a practical alternative to traditional treatments for autonomous thyroid nodules and that it is an option for treating pretoxic adenoma.

The aim of this study was to investigate the possibility of a precise definition of the volumetric and spatial features of malignant prostatic lesions needing radiation therapy and a later follow-up. The modeling procedure is mainly composed of three sequential phases: a) automatic acquisition of time sequences of 2D echotomograms; b) 3D reconstruction of images; c) generation of a spatial geometrical model. A software system has been specifically designed and implemented for digital image handling and management. The preliminary c1inical applications in the evaluation of patients with prostatic cancer showed promising results.

Poster: "ECR 2010 / B-828 / CT colonography with color coding by means of open source software (OsiriX): A new approach to primary 2D reading " by: " L. Faggioni , E. Neri, F. Cerri, F. Turini, E. Picano, P. Vagli, C. Bartolozzi; Pisa/IT"

Two cases of arteriovenous fistula associated with renal cell carcinoma were studied using multiple techniques, including magnetic resonance imaging (MR). These techniques clearly delineated the vascular abnormalities without the use of a contrast agent; they also demonstrated the extent of the tumors. Data derived from MR were confirmed upon surgical exploration and were useful in planning the approach to the kidney.