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To investigate whether colour Doppler US can demonstrate haemodynamic differences in patients with renal colic after pharmacological treatment with indomethacin and ketorolac.We studied 180 consecutive patients with unilateral acute renal colic with colour Doppler US; 90 were treated with indomethacin, 90 with ketorolac. Furthermore, 37 consecutive patients without obstruction (17 treated with indomethacin and 20 with ketorolac) were also examined and considered normal controls.In the patients with renal colic the average resistive index (RI) was significantly greater on the side of the colic after administration of either indomethacin or ketorolac (p0.001). The average RI in the obstructed kidneys was significantly higher in the patients treated with ketorolac than with indomethacin (p0.005). No statistically significant differences were shown between the average RIs of the non obstructed kidneys of the patients with renal colic and between the kidneys of the control patients treated with either indomethacin or ketorolac.Doppler evaluation of patients with renal colic requires careful interpretation after the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), since values of renal RI depend on the drug that has been used to relieve symptoms.

MRI is a very accurate technique to study the elbow joint, tendon, ligament and chondral structures. In the last years elbow disorders were described by several MR investigators, while we studied MR capabilities in depicting normal elbow anatomy. This investigation might permit the correct differentiation of normal from abnormal MR patterns.Eleven healthy volunteers (6 men and 5 women, mean age: 27.5 years) were examined. All studies were performed on a 1.5 T imager (Magnetom SP 4000) with two types of receiver: the knee coil was used in 7 volunteers examined in the prone position, with the arm above their head, the elbow extended and the forearm supine and the shoulder coil was used in 4 volunteers examined in the prone position, with the arm above their head, the elbow flexed and the forearm prone. We acquired T1-weighted SE sequences (TR/TE = 690/15 ms, FA 90 degrees, MA 256 x 512, NEX 2,20 3-mm sections with .3-mm interslice gap, FOV 20-22 cm) on the axial, coronal and sagittal planes and T2-weighted GE sequences (TR/TE = 450/10 ms, MA 256 x 256, 3 NEX, 18 4-mm sections with .4-mm interslice gap, FOV 13-18 cm) on the coronal plane. Two MR-expert radiologists studied the images and identified the main anatomical structures of the elbow and 12 smaller reference elements (2 anatomical variants, 4 ligaments, 3 nerves and 3 arteries) describing their MR appearance and pointing out the most effective planes for their representation. Finally, the image quality of the knee coil was compared with that of the shoulder coil.All bones were clearly depicted on the coronal and axial planes, while the semilunar groove and its anatomical variants were best seen on the sagittal plane. The joint cartilage was best depicted on the coronal plane with T2-weighted GE sequences. Collateral ligaments were best seen with the elbow extended and the forearm supine (knee coil), on coronal T1-weighted SE images, where the radial and ulnar collateral ligaments were visible in 71.4% and 85.7% of the subjects, respectively. Annular ligaments, muscles and tendons were best demonstrated on the axial plane with the elbow extended and the forearm supine (knee coil), while the triceps tendon was best recognized on the sagittal plane with the elbow flexed and the forearm prone (shoulder coil). Vessels and nerves were also best seen on the axial plane with the elbow extended and the forearm supine; in particular, the median nerve was visible in 71.4% of the subjects.MRI is very effective in representing elbow anatomical structures. Its accuracy depends on elbow (flexed or extended) and forearm (prone or supine) position. The coronal images with the elbow extended and the forearm supine (knee coil) are the most effective to show the ligaments and the joint surfaces between the radial head and the coronoid process of ulna with the capitellum and trochlea of distal humerus, while the axial images best depicted the muscles, vessels and nerves. The coronal and axial planes, with the elbow flexed and the forearm prone (shoulder coil) are poorly effective for anatomical detailing, even though this position is more comfortable for the patient, while the sagittal plane is best suited to depict the triceps tendon. This position may be used when the elbow cannot be fully extended or when the triceps tendon is studied.

Nonostante i continui progressi tecnologici, l’ecografia convenzionale in scala di grigi non presenta elevata specificita nella caratterizzazione delle lesioni focali epatiche [1]. Inoltre, nella pratica clinica, il non infrequente riscontro di alterazioni diffuse del parenchima epatico, come la steatosi, puo rendere ancora piu difficoltosa una corretta diagnosi [2]. In particolare l’infiltrazione adiposa del fegato,dovuta all’accumulo di trigliceridi sotto forma di vacuoli di differenti dimensioni all’interno degli epatociti, la cui incidenza, secondo alcuni studi autoptici, varia dal 6 all’11%, e responsabile di un’ alterazione diffusa dell’ecogenicita del parenchima epatico che assume un aspetto definito “ brillante”, nel contesto del quale le lesioni epatiche presentano, indipendentemente dalla loro natura, un aspetto prevalentemente ipoecogeno [3, 4]. Inoltre la steatosi puo interessare in maniera focale solo alcune aree del parenchima epatico e, per converso, in un fegato diffusamente steatosico possono esistere le cosiddette “aree di risparmio”, con il risultato di creare pseudolesioni che, specialmente nei pazienti oncologici sottoposti a chemioterapia che spesso sviluppano una steatosi epatica, possono porre problemi di diagnosi differenziale con le metastasi.

Introduction Ground-glass nodules may be the expression of benign conditions, pre-invasive lesions or malignancies. The aim of our study was to evaluate the capability of chest digital tomosynthesis (DTS) in detecting pulmonary ground-glass opacities (GGOs). Methods An anthropomorphic chest phantom and synthetic nodules were used to simulate pulmonary ground-glass nodules. The nodules were positioned in 3 different regions (apex, hilum and basal); then the phantom was scanned by multi-detector CT (MDCT) and DTS. For each set (nodule-free phantom, nodule in apical zone, nodule in hilar zone, nodule in basal zone) seven different scans (n = 28) were performed varying the following technical parameters: Cu-filter (0.1–0.3 mm), dose rateo (10–25) and X-ray tube voltage (105–125 kVp). Two radiologists in consensus evaluated the DTS images and provided in agreement a visual score: 1 for unidentifiable nodules, 2 for poorly identifiable nodules, 3 for nodules identifiable with fair certainty, 4 for nodules identifiable with absolute certainty. Results Increasing the dose rateo from 10 to 15, GGOs located in the apex and in the basal zone were better identified (from a score = 2 to a score = 3). GGOs located in the hilar zone were not visible even with a higher dose rate. Intermediate density GGOs had a good visibility score (score = 3) and it did not improve by varying technical parameters. A progressive increase of voltage (from 105 kVp to 125 kVp) did not provide a better nodule visibility. Conclusion DTS with optimized technical parameters can identify GGOs, in particular those with a diameter greater than 10 mm. Implications for practice DTS could have a role in the follow-up of patients with known GGOs identified in lung apex or base region.

Introduction: Despite the constantly growing popularity of radiological imaging in forensic pathology, a systematic review investigating the efficiency and limits of radiological techniques, in comparison to forensic autopsy, was still missing. Aim: The present review aims at providing an overview on the current role of radiology in the forensic investigation of fatal gunshot wounds without any restriction to specific radiological techniques. Material and methods: A systematic literature search on three databases (PubMed, Web of Science, and Science Direct) was performed until December 2017. The Oxford Centre for Evidence Based Medicine (OCEBM) grading system for levels of evidence was applied, in order to weigh published evidence. Results and discussion: Eighty-six papers (1.64% of the records) were included. Despite the quite limited general level of evidence, which contrasts with the abundance of the scientific literature on this topic, several recommendations/statements, coupled to their OCEBM grade, were distilled as for the identification of retained bullets, gunshot wounds detection, diagnosis of entrance and exit wounds, trajectories and internal injury detection and estimation of the firing distance. Conclusions: Imaging radiological technologies represent the present and future of wound ballistics. However,traditional, micro and molecular imaging techniques require further validation through blinded cross-sectional studies with appropriate reference standards (e.g. forensic autopsy).

Renal neoplasm histotypes have been recently reclassified by the World Health Organization. This chapter describes the fundamental imaging features of the most common benign solid renal tumors. The most common benign solid renal tumors are angiomyolipomas and renal oncocytomas. The most typical imaging feature of renal angiomyolipoma is the evidence of macroscopic fat which can be identified by unenhanced CT and by fat-saturation MR sequences. Renal angiomyolipomas with minimal fat component may present the same imaging features of malignant renal masses. The most typical pattern of renal oncocytomas on contrast-enhanced CT consists in a spoke-wheel shape or diffuse enhancement pattern and a sharp, smooth rim. Stellate area of low attenuation may be found in 30–40 % of large oncocytomas.

Chronic renal infections are becoming increasingly rare because of the availability of effective antibiotics and early detection and treatment of both acute renal and urinary tract infections and conditions predisposing a patient to chronic infections. The aim of the present chapter is to illustrate the fundamental imaging features of the different forms of chronic renal infections and the modern imaging of renal tuberculosis with multidetector CT urography. From pathological point of view, the chronic renal infections include two types, interstitial chronic pyelonephritis and granulomatous pyelonephritis, namely, xanthogranulomatous pyelonephritis, malacoplakia, and renal tuberculosis. In this chapter the findings and the role of ultrasonography (US), computed tomography (CT), intravenous excretory urography, and CT urography in the different chronic renal infections are reviewed.

The aims of this chapter are to illustrate the typical imaging findings of the kidney in elderly patients and the typical features of the main renal pathologies in the elderly patient. The kidneys present some important morphologic changes according to the patient’s age, which can be detected first by gray-scale ultrasound (US) and color Doppler US, and second, by all the other imaging modalities. These changes have an impact on patient management, particularly with respect to drug therapy. The landmark is diffuse irregular margins due to nephronangiosclerosis of the intrarenal arteries. The fundamental alterations of renal morphology in elderly patients include size reduction, parenchymal thickness reduction, margin irregularities, and increased cortico-medullary differentiation. The main renal pathologies, including vascular and tumoral diseases, present some peculiar features in the elderly patient.

injection, which requires that microbubbles have a diameter smaller than 8–10 μm. Free air-filled microbubbles exhibited very limited persistence and efficacy, while aqueous solutions, colloidal suspensions, and emulsions did not meet with the required efficacy and safety profile compatible with US. The physical and chemical properties of the more recently introduced microbubble-based contrast agents are superior to those of the initial agents, and stabilized microbubbles offer both excellent stability and safety profiles, as well as acceptable efficacy. Microbubble-based agents are injectable intravenously and pass through the pulmonary capillary bed after peripheral intravenous injection, since their diameter is below that of red blood cells (Fig. 1.1). Microbubble-based agents are isotonic to human plasma and are eliminated through the respiratory system. With the advent of the new-generation of perfluorocarbon or sulphur hexafluoride-filled microbubbles, the duration of contrast enhancement has increased up to several minutes which provides sufficient time for a complete study of the vascular bed using slow bolus injections or infusions.

E. Quaia, MD Assistant Professor of Radiology, Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy frequently observed in renal cell carcinoma, while a homogeneously bright and wedge-shaped appearance, with evidence of posterior acoustic shadowing, is considered typical for renal angiomyolipoma (Yamashita et al. 1992; Helenon et al. 1997, 2001; Jinzaki et al. 1997). Some typical US patterns have also been described for renal oncocytoma, such as the presence of a central scar that appears as a stellate hypoechoic area and the absence of hemorrhage and necrosis (Helenon et al. 2001). Nevertheless, baseline US has low accuracy in the characterization of renal masses, especially if smaller than 4 cm in diameter, since benign and malignant tumors frequently present a similar appearance (Correas et al. 1999). In fact, approximately 30% of small renal cell carcinomas appear as hyperechoic masses (Forman et al. 1993), while atypical isohypoechoic and slightly hyperechoic angiomyolipomas account for 6% and 29% respectively (Helenon et al. 2001). Furthermore, even benign and malignant renal masses >4 cm may present a similar appearance, and large renal cell carcinomas can resemble large angiomyolipomas on baseline US (large renal cell carcinomas usually display a heterogeneous appearance due to intratumoral necrosis, calcifications, and hemorrhage, while large angiomyolipomas may also appear heterogeneous owing to solid, adipose, and hemorrhagic components). Power Doppler and color Doppler US may reveal different vascular patterns in renal tumors. Jinzaki et al. (1998) identified four vascular patterns relevant to lesion characterization. Intratumoral (pattern 1) or penetrating (pattern 2) vessels were described as typical for benign renal tumors, and in particular for angiomyolipoma, while peripheral (patterns 3) or mixed penetrating and peripheral (pattern 4) vessels were considered typical for renal cell carcinomas, even though they could also be observed in 20% of renal angiomyolipomas. Even though the description of these vascular patterns represents a first endeavor to differentiate the different histotypes of renal tumors using color and power Doppler, this technique does not significantly CONTENTS