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PURPOSE: Our purpose was to compare 4 different postprocessing techniques (maximum-intensity projection [MIP], multiplanar reconstruction, curved planar reconstruction, and volume rendering [VR]) for the study of hepatic arteries. METHODS: One hundred thirty-seven patients who underwent multi-detector-row computed tomography angiography between August 2009 and January 2010 were retrospectively analyzed. For each patient and for each reconstruction method, the image quality was evaluated and the interobserver and intraobserver agreement was calculated according to Cohen statistics. RESULTS: The Pearson r between the observers for the common hepatic artery measurement (Hounsfield unit) was good (r = 0.88). The VR showed a Cohen κ value of 0.78, and the highest image-quality score was obtained using MIP (total value, 384; mean value, 3.01) for observer 1 and using VR and MIP for observer 2 (mean value of 2.94). CONCLUSIONS: Maximum-intensity projection and VR showed the optimal interobserver and intraobserver agreement and the highest quality scores and therefore should be used as postprocessing techniques when analyzing the hepatic arteries.

Several studies have shown that leukoaraiosis is a clinically relevant condition. Patients with leukoaraiosis have a negative prognosis in terms of death, stroke, and myocardial infarction. The aim of this study was to evaluate whether the presence and severity of leukoaraiosis correlate with degree of carotid stenosis and the presence of specific types of plaque (fatty, mixed, calcified) in a group of elderly patients with clinical indications for MDCT.From January 2004 to March 2007, 147 consecutively registered patients 65 years and older underwent MDCT. All patients enrolled in the study cohort were assessed for the presence and severity of leukoaraiosis. Degree of carotid artery stenosis according to the North American Symptomatic Carotid Endarterectomy Trial criteria and type of plaque were evaluated. Statistical analysis was performed to determine whether an independent interaction existed among the presence of leukoaraiosis, severity of leukoaraiosis, and degree of carotid artery stenosis associated with plaque type.A correlation was observed between the presence of leukoaraiosis and degree of carotid stenosis (Pearson correlation, 0.23; p0.001). A statistically significant correlation between advanced patient age and presence of leukoaraiosis (Pearson correlation, 0.32; p0.0001) and severity of leukoaraiosis (Pearson correlation, 0.55; p0.0001) was recorded. The data obtained showed a trend toward increased risk of development of leukoaraiosis (p = 0.08) in carotid arteries with fatty plaques.The results of this study showed a statistically significant correlation between the presence and severity of leukoaraiosis and degree of carotid stenosis. A trend toward increased risk of development of leukoaraiosis in carotids with fatty plaques also was observed. The data confirmed that the development of leukoaraiosis is strongly correlated with age.

BACKGROUND AND PURPOSE: LA is a condition caused by chronic cerebral ischemia and it represents an independent risk for stroke. The purpose of this work was to determine whether CAWT studied by using MDCTA is correlated with LA and its severity. MATERIALS AND METHODS: Ninety-eight patients ≥60 years of age were retrospectively studied by using multidetector row CT. Supra-aortic vessel analysis and brain CT were performed in the same procedure. In each patient, CAWT was measured with an internal digital caliper, and the presence and severity of LA were assessed. Correlation coefficients by using Spearman statistics and ROC curves were calculated. A P value < .05 was considered statistically significant. RESULTS: Measurements of the distal common CAWT ranged from 0.5 to 1.53 mm. A correlation between LA and increased CAWT was observed (Pearson correlation, 0.33; P < .001). On the basis of a threshold of 0.9 mm, an important statistical association between increased CAWT and LA (P < .0001) was found. With the same threshold, ROC curve analysis indicated a sensitivity of 55% and a specificity of 75% for LA. CONCLUSIONS: The results of this study show a statistically significant correlation between increased CAWT and LA (and its severity).

Our purpose was to investigate the multi-detector-row CT angiography (MDCTA) application in endoleak detection.Fifty-nine patients that underwent endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm with endoluminal stent graft were retrospectively studied. MDCTA scans were obtained after administration of 110-130 mL of contrast material using a 4-6 mL/sec flow rate. We made unenhanced, arterial (15-20 sec) and delayed (100 sec) acquisitions. For each patient four MDCTA datasets (pre-EVAR, 1, 6, and 12 months follow-up) were obtained. Each examination was studied by two observers. Kappa value was calculated in order to evaluate inter-observer agreement.Twenty-one endoleaks were detected in eighteen patients. Fifteen and eighteen endoleaks were detected by using biphasic arterial CT and biphasic delayed CT respectively (sensitivity of 71.4% and 85.7% respectively). We observed a positive correlation between the presence of endoleak and the increasement in aneurysm size. Interobserver agreement was 88.1% and kappa value was 0.685.Biphasic CT for endoleak detection is significantly superior to arterial and delayed phases respectively. We observed a good interobserver agreement.

Purpose Extracranial carotid artery stenosis is accepted as a significant risk factor for cerebrovascular events. The purpose of this paper was to evaluate whether the Stenosis Asymmetry Index (SAI) between carotid arteries (in symptomatic and asymptomatic patients) can be considered a further parameter in the stroke risk stratification. Materials and methods 60 consecutive symptomatic (males 36; median age 64) patients and 60 non symptomatic patients matched for gender and age, were analyzed using a 40-detector-row CT angiography. Each patient was analyzed by injecting 80mL of contrast material at a 5mL\s flow rate. Stenosis degree of 240 carotids was calculated according to NASCET method. For each patient, the ratio between the most severe stenosis and the contralateral was calculated to obtain the SAI. Multiple logistic regression analysis was performed and ROC curve was also calculated. Results Results of our study indicate a mean SAI of 1.48 (±0.35 SD) in the asymptomatic group and a mean SAI of 1.69 (±0.53 SD) in the symptomatic group with a statistically significant difference ( p value=0.0204). The multiple logistic regression analysis did not find statistically significant association between SAI and symptoms. The ROC curve analysis indicated that an SAI value of 1.8 has a specificity of 84.31% presence of cerebral symptoms whereas using a 1.2 SAI we obtained a sensitivity of 88.24%. Conclusion Results of our study suggest that a SAI>1.8 has a good sensitivity in identifying the association with cerebrovascular events.

Capillary telangectasia (CTS) is a vascular malformation, characterized by multiple thin-walled vascular channels, interposed between normal brain parenchyma. It has been hypothesized that CTS is an acquired lesion caused by other underlying venous anomalies but this theory is still debated. The clinical symptoms of CTS are described to be rather mild. In most cases CTS is not detectable by computed tomography and among imaging techniques, nowadays magnetic resonance imaging (MRI) represents the standard of reference in diagnosing this pathology. Usually, by analyzing the different signal characteristics it is possible to perform a differential diagnosis between CTS and the other pathologies that may affect the pons and the use of diffusion-weighted and Gradient-echo sequences increase the MRI specificity.

Background: After endovascular stent-graft placement, several complications may occur. Retrograde filling of the aneurysm (type-II endoleak) is the most common. Purpose: To evaluate the accuracy, image quality, and interobserver agreement of multidetector-row spiral computed tomography angiography (MDCTA) in the diagnosis of type-II endoleak, by using various types of reformatting techniques in comparison to regular axial images. Material and Methods: Twenty-four patients who had had endovascular repair of an infrarenal abdominal aortic aneurysm with stent graft were retrospectively studied. In 12 of 24 patients, a type-II endoleak was found. CT scans were obtained after intravenous administration of 130 ml of nonionic contrast material using a 4–6-ml/s flow rate. All patients were investigated with axial scans, multiplanar reconstruction (MPR), maximum intensity projection (MIP), shaded-surface display (SSD), and volume-rendering (VR) techniques. For each patient and for each reconstruction method, the image quality of the scans was scored as 0 for bad quality, 1 for poor quality, 2 for good quality, and 3 for excellent quality images. Two radiologists reviewed the CT images independently. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each reconstruction method, with the axial images as the reference method. Interobserver agreement and kappa value were also recorded. Results: MPR showed the highest sensitivity (83% and 67% for observers 1 and 2, respectively), PPV (91% and 80% for observers 1 and 2, respectively), and NPV (85% and 71% for observers 1 and 2, respectively), whereas VR showed the highest specificity (92% for both observer 1 and 2). Conclusion: Reformatting techniques provide good-quality images; nevertheless, their efficacy in the study of type-II endoleak was found to be suboptimal in comparison to regular axial images. The MPR technique is probably the best choice in conjunction with axial images.

The purpose of this study was to determine if carotid artery wall thickness (CAWT) studied by using multi-detector-row CT angiography (MDCTA) can be considered an effective parameter predictive of increased risk of stroke. A total of 217 patients were retrospectively studied by using MDCTA. In all patients CAWT was measured with an internal digital caliper. Continuous data were described as the mean value ± standard deviation (SD), and they were compared with Student’s t-test. Scatter plots to determine interobserver agreement were performed, and correlation coefficient was calculated with Pearson statistics. A P value

The therapeutic efficacy and tolerability of the combination of cyclosporin A, methotrexate and fluocortolone was evaluated after 96 months of treatment in 140 patients with rheumatoid arthritis.The initial dose of CyA was 5 mg/kg per day and was subsequently modified on the basis of the individual clinical response. Fluocortolone was initially administered at a dose that was sufficient to control disease activity (80-130 mg/week) and then was gradually tapered down to a maintenance dose of 15-20 mg/week. MTX was given intravenously at a dose of 15 mg once weekly for 4 consecutive weeks and then, after a 2-week interval, every 2 weeks or every month depending on the evolution of the disease.At the end of the study a statistically significant improvement was observed in both clinical (VAS, grip-strength, duration of morning stiffness, number of swollen joints, number of painful joints, Ritchie's index and Lee's functional index) and laboratory parameters: ESR (p = 0.000); alpha 2 globulins (p = 0.000); hemoglobin (p = 0.000); CRP (p0.001); and rheumatoid factor (p = 0.000). Radiological evaluation revealed little progression in anatomic lesions (Larsen score p = 0.699; number of erosions p = 0.344), thus suggesting that our protocol may be capable of showing down both bone resorption and cartilage loss. Renal toxicity, defined as an increase in plasma creatinine concentrations of more than 50% of the baseline value, was observed in 12 patients (8.5%), but the drug was discontinued in only one, who simultaneously presented high blood pressure.The positive results so far achieved in our study must be interpreted as being due to the combined action of the individual drugs, which made it possible for them to be used at relatively low dosages that minimised the onset of their side effects while maintaining the efficacy of their suppressive action.

Eleven patients with chronic sarcoidosis resistant to high-dose corticosteroids and other immunosuppressive treatments were treated with cyclosporine A at the initial daily dose of 5 mg per kg body weight (ideal weight in the case of overweight subjects) combined with flucortolone and methotrexate. A complete and lasting remission of the disease was obtained in all patients with total disappearance of pulmonary and extrapulmonary manifestations. In addition, the disease activity indexes normalized and remained normal for the rest of the follow-up period (24.82 +/- 8.22 months, range 12-33). No renal or hepatic toxicity was observed in any patient. Two of them presented hypertrichosis and one nausea.

The Authors have studied the radiosensitivity of lymphocyte cultures of patients affected by systemic lupus erythematosus in the active phase, and in the remissive phase after treatment with cyclosporine and fluocortolone, compared to a group of normal subjects. Total lymphocyte cultures and cultures of T, B, NK lymphocytes, T helper/inducer and T suppressor cytotoxic obtained with specific monoclonal antibodies were used and then irradiated with Co-60 gamma photons at scale doses between 0 and 10 Gy. Damage due to irradiation was evaluated using 3H-TdR. Patients in the clinically active phase of the disease showed an increased lymphocytic sensibility of the total lymphocytic population as well as of the various populations and T subpopulations studied. Radiosensitivity tended to become normal in patients in the remissive phase of the disease. The Authors conclude that a preliminary study of the lymphocytic sensitivity should be carried out in all patients treated with radiotherapy with autoimmune pathologies in order to avoid damages due to irradiation. Moreover, the Authors retain that a test for lymphocytic sensitivity to radiation could apply with regard to the evaluation of the clinical remissive conditions of patients affected by systemic lupus erithematosus.

The Authors described a particular ultrasound finding which can sometimes be observed in the echographic picture of diffused hepatic steatosis and which was seen by these Authors in 117 out of 312 patients affected by steatosis. This finding consists of the presence of one or more hypoechoic focal areas situated at the IV-V and/or II-III segment level surrounded by wide-spread increase in echogenicity of remaining parenchyma, which is typical of "bright liver". These areas, which can easily be mistaken for neoplastic formations, were instead seen to be limited areas of normal liver parenchyma free of fatty infiltration. In those patients presenting valid reasons for suspecting the presence of primary or secondary neoplastic formations, the Authors believe that echographic examination of these areas should always be accompanied by more invasive methods in order to confirm or exclude the possible presence of neoplastic formations with certainty. On the contrary, in those patients where no such diagnosis is suspected, it should prove sufficient to monitor these ares by means of ultrasound.

The authors describe a particular ultrasound finding which can sometimes be observed in the echographic picture of diffused hepatic steatosis and which was seen by these Authors in 117 out of 312 patients affected by steatosis. This finding consists of the presence of one or more hypoechoic focal areas situated at the IV-V and/or II-III segment level surrounded by widespread increase in echogenicity of remaining parenchyma, which is typical of "bright liver". These areas, which can easily be mistaken for neoplastic formations, were instead seen to be limited areas of normal liver parenchyma free of fatty infiltration. In those patients presenting valid reasons for suspecting the presence of primary or secondary neoplastic formations, the Authors believe that echographic examination of these areas should always be accompanied by more invasive methods in order to confirm or exclude the possible presence of neoplastic formations with certainty. On the contrary, in those patients where no such diagnosis is suspected, it should prove sufficient to monitor these areas by means of ultrasounds.

The authors report the determination of copper, ceruloplasmin and procollagen III peptide serum levels (sPIIIP) in patients affected by acute myocardial infarction. These measurements were taken daily during the first ten days after diagnosis and subsequently every five days until the fortieth after the acute event. A significant increase above the normal values was observed, proportioned to the extension of the infarctuated area, reaching a peak respectively for cupraemia, ceruloplasminaemia and sPIIIP on the fourth, sixth and eighth day after the acute event and still being evident in varying proportion till the 25th-35th day and even further, again in relation to the extension of the infarctuated area. The Authors relate this phenomenon to the involvement of the homeostatic mechanism supposed to face necrotic and critical processes as those which take place during acute myocardial infarction and subsequent riparation. The Authors suggest the clinical use of cupraemia, ceruloplasminaemia and sPIIIP determinations as diagnostic and prognostic indexes of acute myocardial infarction.

The authors report the results obtained in treatment of various autoimmune diseases using cyclosporin A (CyA) in association with fluocortolone and/or methotrexate and cyclophosphamide. In all patients treated, complete long-lasting remission of the disease both from a clinical point of view and regarding laboratory tests was obtained. In some cases, this remission has lasted for several years since onset of therapy. The results obtained demonstrate the efficacy of CyA in treatment of autoimmune diseases and show that association with fluocortolone and/or methotrexate and cyclophosphamide by exploiting the combined action of these drugs, has enabled relatively low doses to be used. These however are still sufficient to induce satisfactory immunosuppression and avoid side effects. In this context, the importance of monitoring drug blood levels is underlined, also in view of the fact that each patient has a different capacity for intestinal CyA absorption.

Nine patients with pulmonary cysts of echinococcus varying in size have been treated with Mebendazole. When the cysts were small or medium in size a complete disappearance or an important reduction was observed, whereas in four patients in which the cyst was big in size the treatment did not cause any decrease in size. The Authors point out the efficacy of the Mebendazole in the small or medium size cysts if the drug is given at high doses and for a long period. Nevertheless the use of this drug may be suitable also in the treatment of big size cysts together with surgical treatment to avoid possible secondary local or distant implant and in all cases of human inoperable echinococcal cyst.