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Purpose: Evaluate the agreement between bone age assessments conducted by two distinct machine learning system and standard Greulich and Pyle method. Materials and methods: Carpal radiographs of 225 patients (mean age 8 years and 10 months, SD = 3 years and 1 month) were retrospectively analysed at two separate institutions (October 2018 and May 2022) by both expert radiologists and radiologists in training as well as by two distinct AI software programmes, 16-bit AItm and BoneXpert® in a blinded manner. Results: The bone age range estimated by the 16-bit AItm system in our sample varied between 1 year and 1 month and 15 years and 8 months (mean bone age 9 years and 5 months SD = 3 years and 3 months). BoneXpert® estimated bone age ranged between 8 months and 15 years and 7 months (mean bone age 8 years and 11 months SD = 3 years and 3 months). The average bone age estimated by the Greulich and Pyle method was between 11 months and 14 years, 9 months (mean bone age 8 years and 4 months SD = 3 years and 3 months). Radiologists' assessments using the Greulich and Pyle method were significantly correlated (Pearson's r > 0.80, p < 0.001). There was no statistical difference between BoneXpert® and 16-bit AItm (mean difference = − 0.19, 95%CI = (− 0.45; 0.08)), and the agreement between two measurements varies between − 3.45 (95%CI = (− 3.95; − 3.03) and 3.07 (95%CI − 3.03; 3.57). Conclusions: Both AI methods and GP provide correlated results, although the measurements made by AI were closer to each other compared to the GP method. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to evaluate the prevalence of early complications after Transcatheter Aortic Valve Implantation (TAVI) and their correlation with the Calcium Score (CS) of the aortic valve, aorta and ilio-femoral arteries derived from pre-procedural computed tomography (CT). Materials and methods: We retrospectively reviewed 226 patients (100 males, mean age 79.4 ± 6.7 years) undergoing 64-slice CT for pre-TAVI evaluation from January 2018 to April 2021. The population was divided into CS quartiles. Results: Overall, 173 patients underwent TAVI procedure, of whom 61% presented paravalvular leak after the procedure, 28% presented bleeding or vascular complications, 25% presented atrioventricular block, and 8% developed acute kidney injury. The prevalence of paravalvular leak and vascular complications was higher in the upper CS quartiles for aortic valve and ilio-femoral arteries. Conclusions: Aortic valve and vascular CS could help to predict post-TAVI early complications. [ABSTRACT FROM AUTHOR]

In recent years, the widespread diffusion of pervasive sensing devices and the increasing need for reducing energy consumption have encouraged research in the energy-aware management of smart environments. Following this direction, this paper proposes a hybrid intelligent system which exploits a fog-based architecture to achieve energy efficiency in smart buildings. Our proposal combines reactive intelligence, for quick adaptation to the ever-changing environment, and deliberative intelligence, for performing complex learning and optimization. Such hybrid nature allows our system to be adaptive, by reacting in real time to relevant events occurring in the environment and, at the same time, to constantly improve its performance by learning users' needs. The effectiveness of our approach is validated in the application scenario of a smart home by extensive experiments on real sensor traces. Experimental results show that our system achieves substantial energy savings in the management of a smart environment, whilst satisfying users' needs and preferences. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide an up-to-date overview on imaging of paediatric vascular soft tissue masses, including both neoplastic and non-neoplastic lesions. We describe the—often challenging-imaging diagnosis—mainly performed by ultrasound (and secondarily by MRI) and differential diagnosis of vascular soft tissue lesions in children. We underline how important it is to determine whether a vascular anomaly has a regional vascular origin, or if there are other entities, ranging from benign to malignant lesions, which have flow-signal or blood degradation products. Even though clinical examination and patient's history are the first and indispensable steps in the initial diagnosis, the role of imaging is crucial, not only to determine whether a mass represents a true tumour/pseudo-tumour, but also to achieve a more correct diagnosis and determine the extension of the tumour/pseudo-tumour and its relation with the nearby anatomic structures. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to acknowledge errors in patients positioning in CT colonography (CTC) and their effect in radiation exposure. Materials and methods: CTC studies of a total of 199 patients coming from two different referral hospitals were retrospectively reviewed. Two parameters have been considered for the analysis: patient position in relation to gantry isocentre and scan length related to the area of interest. CTDI vol and DLP were extracted for each patient. In order to evaluate the estimated effective total dose and the dose to various organs, we used the CT-EXPO® software version 2.2. This software provides estimates of effective dose and doses to the other various organs. Results: Average value of the patients' position is found to be below the isocentre for 48 ± 25 mm and 29 ± 27 mm in the prone and supine position. It was observed that the increase in CTDI and DLP values for patients in Group 1, due to the inaccurate positioning, was estimated at about 30% and 20% for prone and supine position, respectively, while in Group 2, a decrease in CTDI and DLP values was estimated at about 16% and 18% for prone and supine position, respectively, due to an average position above isocentre. A dose increase ranging from 4 up to 13% was calculated with increasing the over-scanned region below anal orifice. Conclusion: Radiographers and radiologists need to be aware of dose variation and noise effects on vertical positioning and over-scanning. More accurate training need to be achieved even so when examination protocol varies from general practice. [ABSTRACT FROM AUTHOR]

Hyaline fibromatosis syndrome (juvenile hyaline fibromatosis) is a rare, progressive, autosomal recessive disorder whose main hallmark is the deposition of amorphous hyaline material in soft tissues, with an evolutionary course and health impairment. It may present involvement of subcutaneous or periskeletal soft tissue, or may develop as a visceral infiltration entity with poor prognosis. Very few radiological data about this inherited condition have been reported, due to the extreme rarity of disease. We herein present a case of two siblings, affected by different severity of the disease, with different clinical features. They were examined by whole-body MR (WBMR) in order to assess different lesions localization, to rule out any visceral involvement and any other associated anomalies and to define patients' management. [ABSTRACT FROM AUTHOR]

Background: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. Method: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too. Results: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart ( p = 0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa = 0.41, p < 0.001) and after (kappa = 0.37, p < 0.001) the flow-chart administration. Conclusion: The developed flow-chart demonstrated to be useful in increasing residents performance in UVC placement assessment. [ABSTRACT FROM AUTHOR]

Objective: Every patient could feel anxious when he waits in a radiological department to undergo diagnostic exams. The aim of our study is to evaluate the impact of the radiological exams on patient anxiety. Materials and methods: We evaluated 343 patients (mean age 54.83 years) who underwent different types of diagnostic exams in the Department of Diagnostic Imaging at our Hospital from April 2013 to August 2014. We administered to patients the State and Trait Anxiety Inventory Test, which detected with high sensitivity both state anxiety and trait anxiety. A team of clinical psychologists and radiologists evaluated the scores obtained. Results: 83 out of 343 patients were excluded because refused to file the questionnaire. 31 % of the patients were submitted to MR, 18 % to breast imaging, 10 % to X-ray, 22 % Computer Tomography and 19 % to ultrasound, as previously described. 41 % of patients were submitted to the examination because of an oncologic disease, while 59 % because of non-oncological disease. Therefore, it was found that high levels of anxiety were present in most (about 91 %) of the patients and the scores varied according to the imaging examination and to the examination's reason: anxiety level was higher in non-oncological patients (54 %) and in patients waiting to undergo to MRI exams (29 %). Conclusion: Our data suggest that the diagnostic exams are stressful events for the patient, also in non-oncological patients. So, it is important to adequate the radiological staff to receive the patient, to inform him and perform exams with emotive involvement with a targeted education. Also, further studies are needed to evaluate the anxiety level and the quality of the images, because the anxiety can result in a somatic disorder with hyperactivity of the autonomic nervous system which may affect the patient's physical examination, causing problems in the evaluation of radiological images making to non-cooperative patient. MRI imaging is the examination that more of all led to an anxious state of patients but the main stressor is not related to the type of diagnostic examination, but to the uncertainty of the diagnosis, therapy and prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Although some studies proved the role of STIR sequences in the evaluation of perianal fistulas in Crohn's Disease (CD), contrast medium is still injected in many institutions since there is not a validated reference MR protocol. Our purpose was to evaluate the role of the STIR sequence in the detection and characterization of perianal fistulae comparing it to the post-contrast T1 sequence and correlating it with rectal examination under anesthesia. Materials and methods: We retrospectively reviewed all clinical records of 31 CD patients, suspected of having perianal fistulas, who had been submitted to an MR study before and after contrast medium injection and surgical exploration under anesthesia within the same month. Perianal fistulas were classified according to the Parks' criteria. Finally, comparison between STIR and post-contrast T1-weighted fat saturated sequences was done. Results: 29 fistulas were detected in 25 patients who underwent an MR study. There was no significant difference between MR imaging and exploration under anesthesia. For the detection of perianal fistulas of any type, there was a perfect statistical agreement between gadolinium-enhanced and STIR sequences (kappa value = 1). Conclusion: STIR sequences represent a valid alternative to the T1-weighted sequences acquired after the injection of contrast medium, allowing the identification of the primary fistula, any secondary ramification, and complications of the disease. [ABSTRACT FROM AUTHOR]

Multidetector computed tomography (MDCT) represents the main source of radiation exposure in trauma patients. The radiation exposure of young patients is a matter of considerable medical concern due to possible long-term effects. Multiple MDCT studies have been observed in the young trauma population with an increase in radiation exposure. We have identified 249 young adult patients (178 men and 71 women; age range 14-40 years) who had received more than one MDCT study between June 2010 and June 2014. According to the International Commission on Radiological Protection publication, we have calculated the cumulative organ dose tissue-weighting factors by using CT-EXPO software. We have observed a mean cumulative dose of about 27 mSv (range from 3 to 297 mSv). The distribution analysis is characterised by low effective dose, below 20 mSv, in the majority of the patients. However, in 29 patients, the effective dose was found to be higher than 20 mSv. Dose distribution for the various organs analysed (breasts, ovaries, testicles, heart and eye lenses) shows an intense peak for lower doses, but in some cases high doses were recorded. Even though cumulative doses may have long-term effects, which are still under debate, high doses are observed in this specific group of young patients. [ABSTRACT FROM AUTHOR]

Purpose: Due to admitted limits of autopsy-based studies in the diagnosis of drowning, virtopsy is considered the new imaging horizon in these post-mortem studies. The aim of our study was to evaluate the role of virtopsy performed through computed tomography (CT) in the forensic diagnosis of drowning. Materials and methods: We retrospectively examined the CT data of four cadavers recovered from sea water and suspected to have died by drowning. Each patient underwent a full-body post-mortem CT scan, and then a traditional autopsy. Results: All the cadavers showed fluid in the airways and patchy ground-glass opacities in the lung. Only one patient had no fluid in the digestive tract; this patient had a left parietal bone fracture with a large gap and other multiple bone fractures (nose, clavicle, first rib and patella). One of the three patients who had fluid in the digestive tract had no fluid in the paranasal sinuses. This latter patient showed cerebral oedema with subarachnoid and intraventricular haemorrhage, multiple bone fractures (orbital floor, ribs, sacrum and acetabular edge) and air in the heart, in the aorta and in bowel loops. Conclusion: To date, there are no autopsy findings pathognomonic of drowning. This study proves that virtopsy is a useful tool in the diagnosis of drowning in that it allows us to understand if the victim was alive or dead when he entered the water and if the cause of death was drowning. [ABSTRACT FROM AUTHOR]

Purpose: 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. Materials and methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the atherosclerotic pattern of patients with coronary myocardial bridging (MB) by means of CT Coronary Angiography (CT-CA). 254 consecutive patients (166 male, mean age 58.6 ± 10.3) who underwent 64-slice CT-CA according to current clinical indications were reviewed for the presence of MB and concomitant segmental atherosclerotic pattern. Coronary plaques were assessed in all patients enrolled. 73 patients (29%) presented single (90%) or multiple (10%) MB, frequently (93%) localized in the mid-distal left anterior descending artery. The MB segment was always free of atherosclerosis. Segments proximal to the MB presented: no atherosclerotic disease ( n = 37), positive remodeling ( n = 23), <50% ( n = 14), or >50% stenoses ( n = 7). Distal segments presented a different atherosclerosis pattern ( P < 0.0001): absence of disease ( n = 73), no significant lesions ( n = 8). No significant differences were found between segments proximal to MB and proximal coronary segments apart from left main trunk. Pattern of atherosclerotic lesions located in segments 6 and 7 significantly differs between patients with MB and patients without MB ( P < 0.05). CT-CA is a reliable method to non-invasively demonstrate MB and related atherosclerotic pattern. CT-CA provides new insight regarding atherosclerosis distribution in segments close to MB. [ABSTRACT FROM AUTHOR]

The article provides information on the radiological finding of acute epiploic appendicitis, computed tomography images and lesion with fat indicating acute inflammation. Topics include uncommon cause of abdominal pain, appendicitis affecting the sigmoid colon or cecum and causes of acute diverticulitis.

The article focuses on the radiological appearance, known as the starry sky, that is used to describe a liver containing multiple biliary hamartomas (MBH). Topics discussed include the congenital disorders associated with MBH, the differential diagnosis for the imaging appearance of MBH, and the use of magnetic resonance cholangiopancreatography (MRCP) to characterize this condition.

The article focuses on intravenous pyelography (IVP) diagnosis of medullary sponge kidney (MSK) which when imaged radiologically has an appearance like a bouquet of flowers. It states that MSK is characterized by cystic dilation of the terminal collecting ducts in the kidneys which causes the medulla to have a sponge-like appearance. It comments on the diagnostic accuracy of multidetector computed tomography urography and discusses differential diagnosis for MSK imaging appearance.