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Persistent sciatic artery (PSA) is a rare vascular anomaly classified into five types according to the Pillet and Gauffre classification system. Although PSA may be detected as an incidental finding, symptomatic cases account for approximately 80% of all cases and have variable clinical presentations. Due to the frequent ischemic and aneurysmal complications, PSAs can lead to limb-threatening conditions requiring prompt identification and adequate treatment management. In this paper, we present a series of four cases of PSA with extremely different anatomical characteristics, patients’ ages, medical histories and clinical presentations. All cases were diagnosed in our institution and managed after multidisciplinary discussions involving vascular surgeons and interventional radiologists. The series included three women and one man. In two cases, one of which included gluteal and back pain, pulsatile masses were found. Two patients had lower-limb chronic ischemia, one with rest pain and one with IIb claudication. Whereas selective angiography was performed only in endovascular approaches, computed tomography angiography (CTA) was performed on all patients as the decisive diagnostic modality. In our series, treatment strategies were selected on the basis of clinical and anatomical factors, and after the evaluation of the potential risks and benefits of each technique. Treatment was medical in two cases, endovascular in one case and hybrid in one case.

Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney enhancement, ureters distension and opacification, and radiation exposure. The availability of new reconstruction algorithms, such as iterative and deep-learning-based reconstruction has dramatically improved the image quality and reducing radiation exposure at the same time. Dual-Energy Computed Tomography also has an important role in this type of examination, with the possibility of renal stone characterization, the availability of synthetic unenhanced phases to reduce radiation dose, and the availability of iodine maps for a better interpretation of renal masses. We also describe the new artificial intelligence applications for CTU, focusing on radiomics to predict tumor grading and patients’ outcome for a personalized therapeutic approach. In this narrative review, we provide a comprehensive overview of CTU from the traditional to the newest acquisition techniques and reconstruction algorithms, and the possibility of advanced imaging interpretation to provide an up-to-date guide for radiologists who want to better comprehend this technique.

(1) Background: The value of dual-energy CT angiography (DE-CTA) in the detection of peripheral arterial disease (PAD) has been widely recognized. We aim to evaluate the diagnostic accuracy of virtual non-contrast (VNC) imaging of DE-CTA compared to true non-contrast phase (TNC). (2) Methods: Our Internal Review Board (IRB) approved prospective study enrolled 40 patients (28 men, 12 women; median age 69 y, range 41–93 y) who underwent lower extremity DE-CTA for symptomatic PAD. Mean attenuation values of TNC and VNC were obtained by placing circular regions of interest (ROI) at five levels from the aortic to the popliteal arterial lumen, reported in Hounsfield units (HU), and compared using a two-sample t-test. The subjective quality of VNC images was assessed by two independent radiologists with 10 and 4 years of CTA-imaging experience according to a 4-point scale and verified by the intra-class correlation coefficient (ICC). Dose Length Product (DLP) values of each DE-CTA examination were also considered. (3) Results: Except for the external iliac artery, VNC attenuation values were significantly lower than the corresponding TNC values at all levels, with a mean difference ranging from 14.1 and 8.7 HU. At qualitative analysis, VNC images were considered excellent to diagnose in 40%, good in 50%, and sufficient in 10% of cases. No cases of non-diagnostic VNC imaging were reported. Avoiding the TNC phase, a mean reduction in DLP of 54% for each DE-CTA was estimated. (4) Conclusions: TNC and VNC images showed comparable reliability and diagnostic accuracy in the detection of PAD. VNC may be considered a promising substitute for TNC from the perspectives of dose reduction and workflow optimization.

Purpose: While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available in the literature of tuberculous PJIs, aiming to detect factors that may influence patient outcomes. Methods: The ESGIAI and ESGMYC study groups were used to collect information on non-published cases of tuberculous prosthetic joint infections (PJIs). Additionally, a literature review of all published cases of tuberculous PJIs was conducted. All identified cases in the retrospective study and in the literature review were merged and included in the statistical analysis, involving both univariate and multivariate analyses. Results: Fifteen previously unreported cases of tuberculous prosthetic joint infections (PJIs) from four countries were detailed. Among them, ten patients were female, with a median age of 76 years. The hip was affected in 13 cases. Seven patients experienced co-infection with another microorganism. Treatment approaches varied, with 13 patients undergoing implant removal, one treated with DAIR (debridement, antibiotics, and implant retention), and one case was treated with an unknown treatment method. All patients received antibiotic therapy and achieved a cure. The literature review that was conducted detected 155 published cases. Univariate analysis revealed a statistical significance for previous tuberculosis, joint, and no importance of surgery for cure. Conclusions: Tuberculous prosthetic joint infection (PJI) is a rare condition, typically presenting as a localized chronic infection. Antibiotic treatment is essential for the management of these patients, but neither surgical treatment nor duration of treatment seems to have importance in the outcome.