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The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT.Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepatic retraction associated with the development of focal confluent fibrosis lesions was assessed using the ellipsoid volume formula and an arbitrary retraction index.Each radiologist identified 41 focal confluent fibrosis lesions. All lesions were identified by both radiologists. Twelve patients (46%) had a single lesion, 13 (50%) had two lesions, and one (4%) had three lesions. Thirty-four (83%) of 41 lesions were located in segment IV, VII, or VIII. Thirty-two lesions (78%) were hypoattenuating on unenhanced images, 25 lesions (61%) were hypoattenuating on hepatic arterial phase images, and 20 lesions (49%) were isoattenuating on portal venous phase images. Seven lesions (17%) were or became hyperattenuating at follow-up on portal venous phase images. Trapped vessels were found in six lesions (15%). The retraction index showed a significant increase over time (r = 0.423, por = 0.0001).The degree of capsule retraction associated with focal confluent fibrosis evolves with time and relates to the natural evolution of cirrhosis.

To identify pituitary iron overload in patients with transfusion-dependent thalassemia major causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 30 patients comparing spin-echo, gradient-echo imaging and pituitary T2 relaxation times measurement. We found that pituitary iron overload can best be assessed by MR imaging using gradient-echo T2*-weighted technique to establish signal reduction in the anterior lobe of the pituitary gland. This finding is correlated to increasing serum ferritin level — a parameter that reflects the severity of iron overload, and is more evident in patients with secondary hypogonadism. This finding is consistent with the hypothesis of hypogonadotrophic pituitary insufficiency due to iron-induced cellular damage.

The use of two different educator-centric learning management systems (LMSs), Moodle and Manila, for radiology e-learning was formatively evaluated and the implications of the future use of LMSs in radiology education were explored. NeuroRAD, a neuroradiologic digital library and learning community, is implemented with Moodle, one of the most popular open-source educator-centric LMSs. Pediatric-Education.org, a pediatric digital library and learning community, is implemented with Manila, a commercial educator-centric LMS. Quantitative and qualitative analyses of these LMSs were performed with World Wide Web server log file statistical programs and user-submitted comment forms. In 2005, NeuroRAD was used by 9959 visitors, who read 98,495 pages of information, whereas PediatricEducation .org was used by 91,000 visitors, who read 186,000 pages of information. Visitors represented a wide spectrum of medical learners and used the sites to answer clinical questions; to prepare for lectures, conferences, and informal teaching sessions; and to stay up-to-date and prepare for examinations. Early results indicate that radiology learning communities can be implemented with educator-centric LMSs relatively easily and at low cost by radiologists with minimal computer expertise, and can find receptive and appreciative audiences. Online radiology learning communities could play a significant role in providing education to radiologists the world over throughout their careers.

Purpose. The aim of this study was to compare computed tomography angiography (CTA) sliding-thin-slab (STS) multiplanar reformatting (MPR), STS maximum intensity projection (MIP) and three-dimensional (3D) volume rendering (VR) reformatting techniques in the evaluation of cervicocranial arteries. Materials and methods. Twenty patients examined with multislice CT were included in this study. CTA images were reformatted as STS-MIP, STS-MPR and 3DVR in orthogonal planes and in the oblique-coronal plane. Images were evaluated in consensus by two radiologists, with a third radiologist to resolve discordances in grading image quality parameters. The Spearman correlation analysis was performed to compare results and to obtain the correlation between scores resulting from the evaluation of parameters considered with the different techniques used (STSMIP,STS-MPR and 3DVR). Results. STS-MIP images were significantly superior to STSMPR images for all parameters considered (p

The purpose of this study was to describe the findings and evaluate the role of multidetector (40–slice) computed tomography (MDCT) in the preoperative assessment of gastrointestinal stromal tumours (GISTs). Thirteen patients with histologically proven GIST (size: 4–30 cm; mean: 9 cm) underwent 40–slice MDCT after the ingestion of 1,000 ml of water. Images were obtained before and 70 s after intravenous injection of 120 ml of iodinated contrast agent. Two experienced radiologists reviewed the CT findings to evaluate lesion site, size, margins, attenuation, growth pattern, enhancement pattern, ascites, lymphadenopathy, direct invasion to adjacent organs and distant metastasis. Multiplanar maximum intensity projection and three–dimensional (3D) reconstructions were also obtained. Seven out of 13 GISTs were located in the jejunumileum, 3/13 in the stomach, 2/13 in the rectum and in one case, the origin remained unknown. Eleven out of 13 were exophytic, and ten had well–defined borders. Two out of 13 showed calcifications. Thirteen out of 13 exhibited inhomogeneous enhancement due to areas of necrosis and cystic degeneration. Direct invasion to adjacent organs (n=3), ascites (n=3), and liver (n=1) and peritoneal (n=1) metastases were also detected. Bowel obstruction, vascular invasion and lymphadenopathy were never seen. MDCT allowed reliable preoperative assessment of GIST, providing useful clues for lesion characterisation.

We compared T2-weighted fast spin-echo (FSE) magnetic resonance (MR) imaging and conventional spin-echo (CSE) T2-weighted imaging in the detection of brain lesions of multiple sclerosis (MS). 20 patients with clinically definite MS underwent brain imaging with both FSE and CSE T2-weighted imaging. There was no significant difference in total number of lesions detected on FSE vs CSE (1354 vs 1378). Slightly more periventricular and subcortical lesions were detected using CSE than FSE, whereas more posterior cranial fossa lesions were detected by FSE. There was no statistically significant difference in the signal intensity (SI) ratio of MS lesions to that of surrounding normal white matter on FSE vs CSE, however the SI ratio of MS lesions was lower on FSE T2-weighted images (FSE ? 1.87 ± 0.39 vs CSE = 2.09 ± 0.36). Considerable time savings can accrue when substituting FSE for CSE sequences in T2-weighted imaging, and this is a compelling reason to employ such sequence in clinical practice. Our results suggest that although CSE sequences are required to confirm the diagnosis of brain involvement of MS lesions, T2-weighted FSE sequences can replace CSE sequences in long term monitoring especially when patient's movements preclude useful investigation and when optional scanning planes are required.

This paper describes our experience in developing a DICOM (Digital Imaging and Communications in Medicine) server based on widely available personal computers enabling to use X-ray digital images for teaching and scientific purposes.The system is based on a DICOM server running on a widely used personal computer. The selected DICOM images are collected directly from the radiological equipment or from a dedicated 3D image processing workstation through a LAN connection and converted into one of the standard formats (JPEG or GIF) to allow their direct importing into multimedia presentations for teaching or scientific purposes.This system allows fast and easy collection of radiological images in DICOM format directly from the diagnostic equipment or from the graphical workstation. These images may be used for scientific and teaching presentations without loss of image quality and colour characteristics in 3D images as there is no off-line acquisition process.The extensive possibilities of implement the system described on widely used PCs makes the system extremely versatile and facilitates the preparation of teaching material and scientific publications.

The aim of the present study is to report our experience using digital cineradiography to assess morphological and functional disorders of the pharynx in patients with prior partial or total laryngectomy.From March 2000 to October 2002, 21 patients (18 males and 3 females) with prior total laryngectomy (12 patients), total laryngopharyngectomy (2 patients) and partial laryngectomy (7 patients) were examined. A digital cineradiography with 12 frames/second acquisition was performed in all patients. In four patients the procedure was interrupted for massive barium aspiration, without cough (silent aspiration). In 17 patients standing in the left posterior oblique position and prone in the right posterior oblique position the oesophagus and oesophagogastric junction were also examined. The water siphon test was performed at the end of the procedure. Small boluses (10 ml) of liquid (60% w/v) and high-density (250% w/v) barium, barium paste (110% w/v), and solid meal (obtained spreading a dry biscuit with barium paste) were used.All patients with prior total laryngectomy and total laryngopharyngectomy showed morphological and functional disorders of the neopharynx: parapharyngeal diverticulum (2 cases), submandibular pouch (6 cases), fistulas (2 cases), lumen narrowing and post-surgical stenoses (2 cases), tumour recurrence (1 case), prominent cricopharynx (5 cases) and rhinopharyngeal reflux (4 cases). All patients with prior partial laryngectomy (7 cases) presented silent aspiration. Eleven patients had an oesophageal motility disorder, which was very serious in three of them with decrease in oesophageal clearing and barium retention in the oesophagus. Oesophagogastric junction evaluation showed hiatus hernia in six cases, two of them with associated gastro-oesophageal reflux.Digital cineradiography appears able to identify the organic and functional postoperative complications of patient treated with partial or total laryngectomy. A special swallowing study can suggest to the speech therapist the best compensatory mechanism for improving patient swallowing and therefore quality of life.

To assess the prognostic value of hyperattenuating middle cerebral artery sign at CT in acute cerebral infarction.Ninety-two patients with acute cerebral infarction in the sylvian area were retrospectively reviewed. All patients underwent unenhanced CT 12-24 hours after the onset of symptoms and follow-up CT within 48-72 hours. Initial CT scans were evaluated by consensus by three radiologists to confirm or exclude the presence of hyperattenuating middle cerebral artery sign. History, cardiovascular risk factors and neurological impairment at discharge (mean 25 days) were recorded for each patient. The degree of disability was graded 0 (no disability) to 6 (death). Patients were divided into two groups: patients without (group A) and patients with (group B) hyperattenuating middle cerebral artery sign. A logistic regression analysis was performed to compare the two groups. Results were correlated with cardiovascular risk factors. Kaplan-Meier survival curves were calculated for each group.Hyperattenuating middle cerebral artery sign was present in 18 patients (19.6%) (group B). The percentage of neurological deficits was significantly higher in group B than in group A (p0.05). Sixteen (88.9%) of the 18 patients in group B had a poor prognostic index (score 3 - 6) with a significantly higher percent difference (41.6%, p0.05) than patients of group A. Within 10 days of admission, 3 patients (16.7%) died in group A and 6 (8.1%) in group B. However, no significant differences were observed in the Kaplan-Meier survival curves. No correlation with cardiovascular risk factors was observed.Besides having an important diagnostic value, hyperattenuating middle cerebral artery sign is a reliable predictor of prognosis in terms of disability rather than mortality, as it reflect the larger extension of infarction.

We report the neuroimaging findings in a group of systemic disorders with a common pathophysiological pattern of derangements in cerebral vascular autoregulatory mechanism producting potentially reversible brain lesions.We reviewed the brain CT and MR examinations of 14 patients with clinical diagnosis of vasculopathy not related to atherosclerosis or cardiogenic embolism. The patients were admitted at the onset of neurologic deficit and were affected with one of the following systemic disorders: thrombotic thrombocytopenic purpura (TTP, 6 cases), uremic encephalopathy (4 cases), eclampsia (2 cases), 1 chronic renal failure from systemic lupus erythematosus and 1 cyclosporin neurotoxicity. All patients underwent neuroimaging follow-up within 7-20 days of the onset of neurologic deficit and the start of anti-edema therapy.CT and MR findings were characterized by cortical-subcortical or deep brain lesions related to edema. Ten patients presented bilateral lesions, which were symmetric in 4 cases. Edema resolution was demonstrated on follow-up examinations after therapy in 4 patients (2 with eclampsia, 1 with TTP and 1 with uremic encephalopathy). The lesions showed no signs of regression in 10 patients.Brain lesions with a common pathogenesis from derangements in vascular autoregulatory mechanism--i.e., not due to atherosclerosis or cardiogenic embolism--should be properly and promptly recognized because they can be reversible and readily treatable.

The main cause of death in beta-thalassemia major patients is congestive heart failure which is traditionally referred to myocardial iron overload. Recently, some investigators have found that cardiac failure is not caused by the iron overload. In their opinion, left-sided heart failure develops years after the onset of acute myocarditis and might be related to a late autoimmune process. Right-sided heart failure is related to the combination of left ventricular diastolic restriction and pulmonary hypertension. The aim of this work is to study myocardial iron overload by MRI and to correlate the signal intensity changes of the myocardium with cardiac function.Sixteen patients with beta-thalassemia major were examined with a .5 super-conducting unit. SE and cine-GE sequences were used in the 4 chamber and 2 chamber views. Left ventirclar ejection fraction (EF) was calculated by using the biplane area-length method. Right ventricular size was assessed by measuring the end-diastolic anteroposterior diameter (APD). Myocardial signal intensity was evaluated qualitatively and quantitatively (myocardium/subcutaneous fat) in all the beta-thalassemia patients and in 10 normal volunteers.Left ventricular function was decreased (EF55%) in 2/16 patients. The right ventricle was dilated in 5/16 patients (APD42 mm). The myocardium had a lower signal intensity than that of normal volunteers in 15/16 patients. No statistical correlation was found between myocardial signal intensity and serum ferritine levels or cardiac function.The small number of patients in our series does not allow any definitive statements. However, our results show that cardiac function is not influenced by myocardial iron overload.

Bladder hamartoma is a rare benign entity with only eight cases reported in the literature thus far, and whose general imaging features have not, to our knowledge, been previously discussed. The purpose of this report is to review the literature and to discuss the imaging findings in one case of bladder hamartoma where US features were those of an inhomogeneous solid mass with an unechogenic center, which was in accordance with the CT findings of a soft tissue mass with central inhomogeneous enhancement due to central necrosis.

The services we describe in this chapter are built on complex layers of networking and software. You don’t need to be an expert on internetworking or UNIX to set up the services, but you do have to understand the basic concepts. This introduction sticks closely to what you need to know to set up an Internet/Intranet service.

The dominant paradigm for the delivery of continuing education, the centralised lecture, usually delivered as one in a series of lectures in the day- or week-long continuing education course, is flawed for two reasons. First and foremost, this lecture is separated, both in location and time, from the clinical encounter and the patient care experience. Second, this paradigm is inconvenient as it requires physicians to travel to a central location to obtain the information; thus, it costs them time lost in travel and course attendance and it costs their patients the inability to see their doctor during this time. For these reasons, studies have shown that continuing-education lectures are ineffective and inefficient learning techniques, transmitting little useful information to the physicians attending them, and having little effect on changing the knowledge, attitudes and behaviours of physicians.

The aim of this project was to demonstrate the feasibility and effectiveness of a teaching files database on diagnostic radiology accessible via the Internet and the World Wide Web. The Italian experience in developing a national database named "RadioDB" is presented."RadioDB" is sponsored by the Italian Society of Radiology (SIRM) and is based on a multicenter academic collaboration. It constitutes a collection of multimedia case record and teaching files. "RadioDB" is based on a Pentium workstation running a Structured Query Language (SQL) database and a World Wide Web server. Each case record contains at least one radiological image and a text file for case comment with key words and codes from the American College of Radiology (ACR). In most cases, a complete teaching file is also available. Peer reviewed teaching files available on this server are contributed via anonymous file transfer protocol (FTP) through the Internet from various Italian academic Departments of Radiology.Worldwide users can easily access and search "RadioDB" database through a World Wide Web query interface and retrieve on-the-fly case record and teaching files. Users can search the database by author name, description, key words, free text or ACR codes."RadioDB" enlarges the base of current off-line educational materials offering and it allows radiologists to improve their medical education.

To identify the optimal MR imaging technique for diagnosing pituitary iron overload, we compared spin-echo and gradient-echo MR imaging with measurements of pituitary T2 relaxation times in 30 patients with secondary hemochromatosis due to transfusion-dependent beta-thalassemia major and in 10 healthy volunteers. We found that the optimal MR imaging technique to evaluate pituitary iron overload is the gradient-echo T2*-weighted technique, as it best demonstrated signal reduction in the anterior lobe of the pituitary gland.

An inexpensive, easy-access computer-based system is proposed, which was developed for the systematization of the clinical series of knee joint disorders studied with Magnetic Resonance Imaging (MRI). The system is based upon the integration of multimedia technology and Data Base Management Systems (DBMS). The hardware configuration for this project included an Apple Macintosh workstation based on a Motorola 68040 microprocessor and a customized application developed by the authors with the 4th Dimension software. The MR images available only on film were digitized off-line with a solid-state Charge Coupled Device (CCD) scanner with back-light cover for transparency. Otherwise, MR images were acquired on-line through an Ethernet-based local area network from the MR unit or from a SparcStation-Advantage Windows workstation connected with the MR unit. Image post-processing was performed with the Adobe PhotoShop software. The system was devoted to the systematization and analysis of a clinical series of 800 MR studies of the knee. A mean of 10 significant MR images were stored for each examination with a standard image compression algorithm--the Joint Photographic Experts Group (JPEG). This permitted us to save the system's storage space and at the same time to preserve image quality for consultation and teaching purposes, not for diagnosis which is made on the backboard or on the MR unit's or Advantage Window's monitor. Finally, MR findings were indexed with a customized check-list specific for knee joint disorders. On the basis of stored and selected information, it was thus possible to carry out a statistical analysis and to make detailed reports which are useful for scientific purposes, such as the preparation of lectures and papers. Moreover, the system was very useful for patients' follow-up and for the preparation of hypermedia teaching applications on knee joint disorders which are available on the Internet at our World-Wide Web server (URL: http://mbox.unipa.it/radpa/radpa ++ +.html). In conclusion, the system is a cost-effective and user-friendly solution for the multipurpose management of radiologic series.

Magnetic Resonance Imaging (MRI) is a valuable technique to study knee meniscal tears. A series of 330 patients with knee traumas was retrospectively reviewed to systematize the semiologic features of a particular kind of meniscal tear, the "bucket-handle" one. MR investigations were performed with an 0.5-T superconductive magnet, surface coil and spin-echo T1-weighted and gradient-echo (FFE) T2*-weighted sequences on the coronal and the sagittal planes. Twenty-nine patients exhibited bucket-handle tears, 25 of the medial and 4 of the lateral meniscus. In all 29 patients joint effusion was observed; in 18 patients capsulo-ligamentous lesions were associated. MR findings were confirmed by arthroscopy and/or surgery. Semiologic features characterizing the bucket-handle tear on the coronal plane are: truncated triangular shape of the peripheral meniscus and low-intensity band between the posterior cruciate ligament and the tibial plateau, corresponding to the central fragment displaced in the intercondylar notch. In the lateral meniscus, the fragment is found beneath the anterior cruciate ligament. On the sagittal plane this band parallels the posterior or anterior cruciate ligaments, depending on the involved meniscus, with a typical "second cruciate posterior or anterior ligament" or "third cruciate ligament" pattern. The semiology of such findings of bucket-handle meniscal tears is useful in the differential diagnosis with other kinds of meniscal tears.

It is widely known that US results strictly depends on operators and that each operator follows individual pathways. Therefore the authors have tried to develop high-interactivity tools, allowing the "customization" of learning to the user's demands. Progress linked to microprocessors' technology allowed a wide spread of cost-effective electronic processors with high graphic performances, capable of supporting sophisticated softwares which are useful to develop multimedial programs. Our experiment is aimed at integrating a multimedial management system for US studies, with the training activity of the medical staff US-expert. The system is structured on a hardware platform based on the Motorola microprocessor, class 68040, an application software developed by Apple. The environment for multimedial applications development uses the "Hypercard" interface of graphic presentation, by Apple. The software allows the realization of a multimedial environment of learning, where US images are associated with graphics, drawing and text references. The application allows a multimedial environment of learning for normal eidodiagnostic anatomy of the female reproductive system, where different courses can be followed autonomously. On the basis of a check performed on a group of students, although in a preliminary stage, the combination of conventional didactic material with either a paper or television support, with devices allowing the connection of texts, graphics and images in a dynamic way, proved to be very useful and to allow personal courses of learning, which can be always modified in an interactive way.

Retroaortic left renal vein joining the left common iliac vein is a rare congenital anomaly in the development of the inferior vena cava. To our knowledge, only one case has been reported in the literature; however, its imaging features have never been described. A 27-year-old male presented with a 1-year history of recurrent right flank pain, dysuria, hematuria, and fever (39 degrees C). Computed tomography and MR venography showed a retroaortic left renal vein joining the left common iliac vein. We present the CT and MR venography findings and discuss their feasibility in showing this congenital anomaly.

We report the results on a long-term study of the effects of hyperbaric oxygen (HBO) therapy on multiple sclerosis assessed by MR imaging. Ten patients with clinically definite multiple sclerosis were studied by MR imaging during a two year HBO treatment of disease. A transient benefit of HBO therapy on brain multiple sclerosis was revealed for patients with relapsing-remitting disease course that was demonstrated at MR imaging. However, no significant changes in the total number and size of brain lesions was demonstrated on MR images in long-term follow-up of patients treated with HBO in accordance with the results of clinical outcome observed in this study.

L'encefalopatia di Wernicke è patologia legata a deficit di tiamina, conseguente spesso ad alcolismo cronico, che presenta peculiari localizzazioni encefaliche e conseguenti manifestazioni cliniche. Viene descritto un caso di encefalopatia di Wernicke in un uomo di 25 anni, non alcolista, valutandone le lesioni alla risonanza magnetica in fase acuta e seguendone l'evoluzione. Il paziente, con anamnesi patologica prossima di colite amebica, presentava un progressivo e rapido deterioramento delle capacità cognitive preceduto da una severa ipoacusia e riduzione dell'acuità visiva, discromatopsia, allucinazioni visive, prosopoagnosia, disartria. Viene eseguita una RM dell'encefalo (con apparecchio Vectra, GE, operante a 0,5 T; sequenze SE DP e T2 ponderate e T1, prima e dopo Gd-DTPA) che evidenzia aree lesionali espresse da iperintensità, nelle sequenze a lungo TE, dei corpi mammillari, dei tubercoli quadrigemelli inferiori e (segno semeiologico, per quanto risulta da una revisione della letteratura, non descritto in precedenza tra i reperti dell'encefalopatia di Wernicke) dei tratti ottici. Ad una decisa integrazione alimentare con tiamina segue un repentino miglioramento clinico. Esami RM seriati rivelano una netta riduzione dell'estensione e delle alterazioni dell'intensità di segnale delle aree precedentemente coinvolte fino alla totale normalizzazione dei reperti. Viene discussa la clinica, l'istologia e la presunta patogenesi dell'elettiva localizzazione del danno da carenza di tiamina a carico dell'encefalo, e gli aspetti neuroradiologici, individuando il ruolo dell'RM nell'iter diagnostico di tale patologia.

Gli autori si propongono di valutare le modificazioni del segnale RM a livello ipofisario nella emosiderosi secondaria in pazienti affetti da beta-talassemia major. Lo studio è stato condotto prospetticamente su un gruppo di 20 pazienti in regime alto-trasfusionale e trattamento ferro-chelante e su 10 volontari sani come gruppo di controllo. Gli esami RM sono stati condotti con apparecchiatura a magnete superconduttivo a 0,5T con sequenze SE TI-dipendenti e GRE TE*-dipendenti. Il sovraccarico di ferro è stato valutato mediante il dosaggio della ferritina sierica. è stata effettuata una valutazione quantitativa delle immagini RM SE T1- e GRE T2*-dipendenti attraverso la misurazione, mediante ROIs, dell'intensità di segnale (IS) del lobo anteriore dell'ipofisi rapportata a quella del tessuto adiposo subcutaneo, nei pazienti e nel gruppo di controllo. Al fine di verificare l'esistenza di differenze statisticamente significative tra i valori rilevati nei pazienti e nel gruppo di controllo è stato applicato il test t di Student. Sono state dimostrate differenze statisticamente significative ( P La RM si è dimostrata metodica non invasiva utile nella valutazione del sovraccarico di ferro a livello ipofisario nei pazienti talassemici. Il reperto RM in questa evenienza è costituito dalla riduzione dell'intensità di segnale dell'ipofisi, e ciò è più evidente nelle immagini GRE TE*-dipendenti.

We present “RadioDB”, a national World Wide Web teaching file database on diagnostic radiology-neuroradiology which can be used in routine practice, training, and research activity. “RadioDB” constitutes the Italian teaching file database based on a multicentre academic collaboration and is sponsored by the Italian Society of Radiology (SIRM).

To investigate the correlations between traumatic injuries of the anterior cruciate ligament and other ligamentous, meniscal and bone traumatic injuries, a series of 193 patients with anterior cruciate ligament injuries studied with MRI between January 1992 and December 1994, was retrospectively reviewed. MR results were compared with arthroscopic and/or surgical findings in most (181) patients; in the remaining 12 patients, clinical follow-up was performed. We used two 0.5 superconductive MR units, with dedicated coils and T1-weighted spin-echo and T2*-weighted gradient-echo sequences on the axial, sagittal and coronal planes. Anterior cruciate ligament injuries were associated with other ligamentous, meniscal and bone injuries in 78% of patients. The patients were classified in 5 groups depending on biomechanics and the association of injuries: -group I: isolated injury of the anterior cruciate ligament (41 patients), most frequently caused by forced extension stress associated with "kissing contusions" of the anterior portion of the lateral femoral condyle and of the lateral tibial plateau; this type of injury is less frequently caused by forced flexion stress associated with avulsion fracture of the tibial eminence; -group II: associated injury of the anterior cruciate ligament and medial compartment (62 patients), caused by forced flexion-external rotation stress (abduction, valgism and external rotation). The classic association of this mechanism was the injury of the anterior cruciate ligament, medial collateral ligament and medial meniscus (O'Donoghue triad) (9 patients). Valgus stress and the pivot-shift phenomenon can impact the tibial and femoral articular surfaces, with consequent osteochondral contusion; -group III: associated injury of the anterior cruciate ligament and lateral compartment (26 patients), caused by forced flexion-internal rotation stress (adduction, varism and internal rotation). This mechanism can cause, as a typical bone lesion, Segond fractures; -group IV: associated injury of the anterior cruciate ligament, lateral and medial compartments observed in 52 patients with different associations of varus-valgus and rotatory stress; -group V: in 5 patients, anterior cruciate ligament injury was associated with traumatic injury of the posterior cruciate ligament; in this case, posterior displacement of the tibia and knee hyperextension were the most common mechanisms of injury. In conclusion, our results demonstrate that anterior cruciate ligament injuries due to traumatic sprains of the knee are rarely isolated (21%). Thus, it is important to know the biomechanics of knee trauma to read MR images in order to detect possibly associated injuries. The final goal is to assess the actual extent of the traumatic damage for best subsequent clinical-therapeutic management.

Evoked potentials recordings have been applied to many neurological disorders, localizing the lesions in the central nervous system (CNS) pathways. Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive degenerative disease involving the muscles of the face and shoulders. On the contrary, myotonic distrophy (MD), the most frequent and severe myotonic disease, is caracterized by myotonia (delay of relaxation after voluntary contraction), muscular atrophy and dystrophic changes in non-muscular tissues. In the present investigation, patients with clinically and electromyographically verified FSHD and MD were examined using somatosensory evoked potentials (SEP) and brainstem auditory evoked responses (BAEP). The main purpose of the investigation was to determine whether impaired central conduction in patients with MD or FSHD could be associated to specific cerebral abnormalities detected by MRI. Nine patients with FSHD (7 males, 2 females) 22 to 43 y.o. (mean age 35.11 +/– 9.32 y.o.) and ten patients with MD (8 males, 2 females), aged 24 to 48 (mean age 36.27 +/– 11.80 y.o.), were examined. Our results suggest that patients with FSHD may present subclinical involvement of the WM on MRI examinations and of the afferent sensory and auditory system at SEP/BAEP analysis irrespective of age, duration or clinical severity of the disease.

We investigated the role of Magnetic Resonance Imaging (MRI) in the diagnosis of neurotoxoplasmosis and in the evaluation of drug treatment response.Twenty-six AIDS patients (22 men and 4 women, mean age 26.7 years) with clinical suspicion of neurotoxoplasmosis were examined. A patient was considered to have neurotoxoplasmosis if there were signs of focal neurologic impairment and a positive/questionable response to the serum test for Toxoplasma gondii. MR images were acquired with T1-weighted spin-echo (SE) and inversion recovery (IR) sequences and with T2-weighted SE sequences. Gd-DTPA was administered in all cases. After the beginning of therapy with sulfadiazine and pyrimethamine all patients were submitted to clinical and neuroradiologic follow-up for 60 days.MR examinations on admission demonstrated at least one brain lesion in all patients and multifocal involvement in 70% of cases. Enhancing lesions were found in 90% of patients (83% ring enhancement, 4% focal enhancement, 3% mixed patterns). The most frequent lesion sites were the basal ganglia and thalami (70%). The brain lesions were subdivided into 4 groups by their morphology and signal patterns.The time course of clinical and neuroradiologic responses demonstrates a rapid improvement after the first week of therapy, which stabilized after the second week. Pearson correlation between clinical and neuroradiologic treatment responses showed a nearly linear correlation (r = .97; p.001). The diagnosis was then confirmed in all patients based on the positive response to the serum test for Toxoplasma gondii (IgG12 UI/mL) and/or clinical and neuroradiologic improvement after therapy.This study demonstrates the accuracy of MRI in the detection of toxoplasmosis brain lesions and in the evaluation of treatment response.

The aim of this study was to evaluate MR imaging changes of the pancreas in patients with transfusion-dependent beta-thalassemia major.Twenty patients with transfusion-dependent beta-thalassemia major were examined using MR imaging at 0.5 T, with spin-echo T1-weighted, fast spin-echo T2-weighted, and gradient-echo T2*-weighted sequences. Image analysis was performed to assess pancreas-to-fat signal intensity ratios for all pulse sequences. Pancreatic exocrine and endocrine function and serum ferritin levels were assessed. Twenty healthy volunteers underwent MR imaging with the same three sequences and served as a control group.The pancreas-to-fat signal intensity ratio was significantly decreased in 17 (85%) of the 20 patients on spin-echo T1-weighted images (p.05), fast spin-echo T2-weighted images (p.01), and gradient-echo T2*-weighted images (p.01) when compared with the 20 volunteers in the control group. The pancreas-to-fat signal intensity ratio was significantly increased in three (15%) of the 20 patients on spin-echo T1-weighted images (p.01) and fast spin-echo T2-weighted images (p.05). In addition, in the 20 patients, we found a significant correlation between increased pancreas-to-fat signal intensity ratios and decreased serum trypsin levels (r = -.77, p.01 for spin-echo T1-weighted sequences; r = -.75, p.05 for fast spin-echo T2-weighted sequences; and r = -.74, p.05 for gradient-echo T2*-weighted sequences). Likewise, for the 20 patients, we found a significant correlation between decreased pancreas-to-fat signal intensity ratios and increased serum ferritin levels for gradient-echo T2*-weighted images (r = -.65, p.01). No correlation was found for the other clinical parameters evaluated.MR imaging revealed signal intensity changes in the pancreas of patients with transfusion-dependent beta-thalassemia major. Patients with a major impairment of the exocrine pancreatic function had higher signal intensity of the pancreas because of fatty replacement of the parenchyma.

To investigate MR capabilities in assessing the extent of disease in chronic osteomyelitis of long bones, we examined 6 consecutive patients, 4 men and 2 women (age range: 27-67 years; mean: 42 years), with posttraumatic chronic osteomyelitis diagnosed at clinics, US, CT and radiography. The diagnosis had surgical or bioptical confirmation. MR studies were performed with an 0.5 T superconducting magnet, a surface coil and T1-weighted SE sequences-before and after Gd-DTPA administration-STIR and T2-weighted SE sequences, on the axial and coronal or sagittal planes. The signal intensity of the inflammation area was hypointense on short TR and TE images and hyperintense on long TR and TE images. After Gd-DTPA administration, granulation tissue surrounding the infection was enhanced in all cases and also the areas of vascularized inflammation within bone marrow were enhanced in two cases. MRI provided accurate and detailed information as to soft tissue and medullary canal involvement depicted sinus tracts in 5 cases and confirmed the presence of sequestrum in 5 cases, in agreement with previous CT findings. In our experience, MRI proved to be a reliable tool to assess the intramedullary and extracompartmental extent of osteomyelitis and also to plan surgery. MR specificity, which is often affected by post-traumatic or postoperative changes, improves markedly if some morphological features typical of the condition are also considered, such as sequestrum and sinus tracts.

We describe MR imaging of bilateral infarction of the paramedian portion of the mesencephalus and thalamus due to an occlusion of the Percheron artery. This entity is due to one of the anatomic variants of the perforating arteries supplying the thalamus and mesenchephalus. Clinically this kind of infarction presents with neurologic impairment as a disorder of consciousness, memory dysfunctions, various types of vertical gaze palsy and psychic changes, which need to be differentiated from delirium and coma. At MRI evaluation infarction of the paramedian portion of thalami and midbrain, with a “butterfly wings” pattern, was demonstrated as high signal intensity areas on FLAIR and FSE-T2W images and with diffusion restriction on DWI images.

We report a 23-year-old man who attempted suicide by hanging. There have been few reports of involvement of the brain parenchyma shown on CT, all showing ischaemic lesions. This is the first report of multifocal intracerebral haematomas due to hanging seen on CT.

The Internet, as a global computer network, provides opportunities to make available multimedia educational materials, such as teaching files and image databases, that can be accessed using "World-Wide Web" client browser to provide continuing medical education. Since August, 1995, at the Institute of Radiology-University of Palermo, we developed a World-Wide Web server on the Internet to provide a collection of interactive radiology educational resources such as teaching files and image database for continuing medical education in radiology. Our server is based on a UNIX workstation connected to the Internet via our campus Ethernet network and reachable at the uniform resource locator (URL) address: http:/(/)mbox.unipa.it/approximately radpa/ radpa.html. Digital CT and MR images for teaching files and image database are downloaded through an Ethernet local area network from a GE Advantage Windows workstation. US images will be acquired on-line through a video digitizing board. Radiographs will be digitized by means of a Charge Coupled Device (CCD) scanner. To set up teaching files, image database and all other documents, we use the standard "HyperText Markup Language" (HTML) to edit the documents, and the Graphics Interchange Format (GIF) or Joint Photographic Expert Group (JPEG) format to store the images. Nine teaching files are presently available on the server, together with 49 images in the database, a list of international radiological servers, a section devoted to the museum of radiology hosted by our Institute, the electronic version of the Journal Eido Electa. In the first 12 months of public access through the Internet, 12,280 users accessed the server worldwide: 45% of them to retrieve teaching files; 35% to retrieve images from the database; the remaining 20% to retrieve other documents. Placing teaching files and image database on a World-Wide Web server makes these cases more available to residents and radiologists to provide continuing medical education in radiology.