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Purpose. This study aimed to determine the prognostic value of coronary angiography with multislice computed tomography (MSCT) in a population of diabetic subjects with known or suspected ischaemic heart disease compared with a nondiabetic control population. Materials and methods. Forty-nine patients with type 2 diabetes mellitus (DM) [group 1; mean age 67.7 +/- 8.8 years; 32 men; mean body mass index (BMI) 28 +/- 3.9] and 49 patients without DM (group 2, with similar demographic and clinical characteristics) were studied with MSCT coronary angiography to exclude the presence of ischaemic coronary artery disease (CAD). Each group comprised 26 patients (53%) with no history of ischaemic coronary disease and 23 patients (47%) with a history of myocardial infarction and/or myocardial revascularisation. Clinical follow-up was performed by analysing correlations between the rate of cumulative cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina, and myocardial revascularisation), the severity of CAD identified on MSCT, and the presence of DM as a cardiovascular risk factor. Results. At mean follow-up of 20 months, univariate analysis of survival showed significant differences between the two groups (group 1 vs. group 2, p=0.046). Moreover, the cumulative cardiac event rate correlated significantly with the presence of significant CAD (>50% stenosis) in both groups (group 1: p=0.003; group 2: p=0.0004). Conclusions. Event-free survival is significantly lower in the diabetic population compared with the normal control population (p=0.046) and is closely correlated with the presence of significant CAD. MSCT is an effective method for stratifying such risk and, together with high diagnostic accuracy, provides additional prognostic value.

We assessed the effect of intra-coronary attenuation on diagnostic accuracy using 64-slice computed tomography coronary angiography (CT-CA). We enrolled 170 patients with suspected coronary artery disease who underwent conventional coronary angiography (CA) and 64-slice CT-CA (100 ml of Iomeprol 400 mg I/ml at 4 ml/s). The study population was divided into two groups (85 patients each based on median attenuation of 326 HU) based on mean arterial attenuation; group 1 with low attenuation and group 2 with high attenuation. Diagnostic accuracy for the detection of significant coronary artery stenosis was determined for both groups using CA as reference standard. Overall, 163 significant stenoses were detected in 1,030 assessable coronary artery segments in group 1 compared with 160 significant stenoses in 1,020 assessable segments in group 2. The average intra-coronary attenuation was significantly (P < 0.05) higher for group 2 (388 +/- 46 HU) compared with group 1 (291 +/- 33 HU). The corresponding sensitivity and specificity values for detection of significant coronary artery stenosis were higher for group 2 (96.3% and 97.6%, respectively) than for group 1 (82.8% and 93.2%, respectively) and were more marked in distal coronary segments than in proximal segments. Higher intra-coronary attenuation on CT-CA results in greater diagnostic accuracy for detection of coronary artery stenosis.

Ultrasonography is probably the most widely used medical imaging technique. In fact, its non-invasivity, portability, widespread distribution and good clinical results have made it the preferred method for a first imaging approach to patients in a large variety of clinical settings. Ultrasound technology is advancing rapidly, aimed to increase image quality. In particular, increased color-Doppler sensitivity is contributing to the diagnosis and staging of pancreatic disease. Doppler studies are in fact integral part of ultrasound examination of the pancreas evaluating the peripancreatic vascular structures enclose portal vein, splenic artery and vein, superior mesenteric artery and vein, aorta, and inferior vena cava. While flows in all peri-pancreatic vessels are well recognized, only few parenchymal vessels are usually appreciable in normal conditions. Anyway the increased Doppler sensitivity allows the visualization of smaller peri-pancreatic and intra-pancreatic vessels. This article will review the technical background underlying the clinical application of Doppler ultrasonography in pancreatic imaging, with particular emphasis to normal vascular anatomy of the pancreas, and to the main applications of Doppler techniques in the different pancreatic pathologies.

The purpose of this study was to compare the accuracy rates of unenhanced sonography, contrast-enhanced sonography, and MRI in displaying the anatomic features of cystic pancreatic masses larger than 1.5 mm in diameter.Unenhanced and contrast-enhanced sonographic and MRI examinations of 33 patients who underwent resection of a cystic pancreatic mass were retrospectively reviewed. Two radiologists blinded to the final histologic diagnosis reviewed the images, specifically assessing the presence of intralesional mural nodules and septa. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated on the basis of correlation with surgical findings. Results of unenhanced sonography, contrast-enhanced sonography, and MRI were compared by McNemar test. Correlation of unenhanced and contrast-enhanced sonographic versus pathologic results was established with Spearman's test. Interobserver variability was determined.Contrast-enhanced sonography correctly depicted intralesional septa in 14 of 15 lesions (sensitivity, 93.3%; specificity, 88.8%; positive predictive value, 87.5%; negative predictive value, 94.1%; accuracy, 90.9%) and nodules in six of eight lesions (sensitivity, 75%; specificity, 96%; positive predictive value, 85.7%; negative predictive value, 92.3%; accuracy, 90.9%). MRI correctly depicted intralesional septa in 14 of 15 lesions (sensitivity, 93.3%; specificity, 61.1%; positive predictive value, 66.6%; negative predictive value, 91.6%; accuracy, 75.7%) and nodules in seven of eight lesions (sensitivity, 87.5%; specificity, 80%; positive predictive value, 58.3%; negative predictive value, 95.2%; accuracy, 81.8%). The difference between the diagnostic accuracy of contrast-enhanced sonography and that of MRI was not significant (p = 0.05, McNemar test) in the identification of septa and nodules. The correlation between contrast-enhanced sonographic findings and pathologic results (Rs = 0.93; p0.001) was significantly better than that between sonographic and pathologic results (Rs = 0.52; p0.0001). Interobserver agreement had a kappa value of 0.86-0.94.Contrast-enhanced sonography compares favorably with MRI in displaying the anatomic features of cystic pancreatic masses seen on transabdominal sonography.

This paper aims to provide the tools for a complete anatomical evaluation of the coronary tree using 64-slice computed tomography (CT) and evaluate the prevalence of anatomical variants and anomalies in a population of 202 consecutive patients. Two hundred and two patients with suspected coronary artery disease underwent 64-slice CT with a standard protocol. Two observers working in consensus evaluated and collected the data regarding anatomical variants and anomalies of the coronary vessels. In the 202 consecutive patients, the prevalence of anatomical variants was: left dominant circulation (7%), absent left main (5%), presence of intermediate branch (17%), aortic origin of conus branch (13%) and circumflex origin of sinus node branch (15%). Coronary anomalies (origin and course, intrinsic and termination) showed an overall prevalence of 25%. CT is the ideal method for the three-dimensional evaluation of the coronary tree. Anatomical variants and anomalies of the coronary arteries are quite common and should be known and recognised promptly by the operators.

Interventional ultrasonography (US) is often used for the diagnosis and therapy of pancreatic pathologies, and its diffusion has definitely modified the diagnostic and therapeutic management of some diseases. US is particularly suitable for targeting percutaneous pancreatic interventional procedures and important technical features contribute to this result. First of all, US is dynamic, and thus the ongoing procedure can be continually monitored. Then, the high spatial resolution achieved by US imaging in recent years, its speed and availability and the low-cost of the technique, together with the technical features, have led to an ever-increasing use of US in pancreatic interventional procedures. This article will review the application of US as guide of diagnostic and interventional procedures in the different pancreatic pathologies.

This study was conducted to compare digital images obtained with cadence contrast pulse sequencing (CPS) and coherent contrast imaging (CCI) technologies for contrast-enhanced ultrasonography (CEUS). A CEUS study on 17 focal liver lesions was performed using CPS and CCI technologies with a second-generation contrast media. The lesion/liver ratio and conspicuity index were then calculated and compared with Adobe Photoshop 6.0. Lesion/liver ratio and conspicuity index using CCI ranged from 1.3 to 7.1 (mean value, 3) and 19 to 127 (mean value, 58), respectively; by using CPS, we obtained results ranging from 2 to 19.1 (mean value, 8.9) and 57 to 164 (mean value, 109.2). Lesion/liver ratio and the conspicuity index for the lesions using CPS showed significantly (p < 0.0001) superior results than those obtained using CCI. The computed analysis with standardization allows an objective evaluation of digital images of CEUS. CPS technology resulted in better lesion conspicuity compared to CCI during CEUS study on focal liver lesions.

Pituitary volumes were shown to be abnormally large in pre- or first-psychotic episode patients and abnormally reduced in established schizophrenia by magnetic resonance imaging (MRI) studies. We present here the results of the second ever published MRI study exploring pituitary size in a large population of patients with chronic schizophrenia recruited from the geographically defined catchment area of South Verona, Italy. No significant differences for pituitary volumes were reported between 65 subjects with chronic schizophrenia and 65 normal individuals (mean age+/-S.D.=42.31+/-11.44 and 40.54+/-11.12 years). In contrast to Pariante et al. (2004), normal pituitary size was found in our population of chronic schizophrenia. Discrepancies between these two studies may partially be accounted by sample age and gender. Considering increased pituitary volumes in pre- or first-psychotic episode patients, we put forward the hypothesis that pituitary size may normalize or reduce with the progression of the illness as a result of reduced numbers of acute episodes and consequent diminished hypothalamus-pituitary-adrenal axis activity. To better test this hypothesis, future large MRI studies should investigate pituitary volumes in chronic schizophrenia longitudinally, also collecting pituitary hormones and cortisol, and comparing the effects of typical and atypical antipsychotics on pituitary size in a randomized trial.

AIM: To assess the utility of contrast-enhanced ultrasonography (CEUS) with a second-generation contrast medium in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma. METHODS: From our radio-pathology database, we retrieved all the patients affected by mass-forming pancreatitis or pancreatic carcinoma who underwent CEUS. We evaluated the results of CEUS in the study of the 173 pancreatic masses considering the possibilities of a differential diagnosis between mass-forming pancreatitis and pancreatic tumor by identifying the “parenchymographic” enhancement during the dynamic phase of CEUS, which was considered diagnostic for mass-forming pancreatitis. RESULTS: At CEUS, 94% of the mass-forming pancreatitis showed intralesional parenchymography. CEUS allowed diagnosis of mass-forming pancreatitis with sensitivity of 88.6%, specificity of 97.8%, positive predictive value of 91.2%, negative predictive value of 97.1%, and overall accuracy of 96%. CEUS significantly increased the diagnostic confidence in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma, with receiver operating characteristic curve areas from 0.557 (P = 0.1608) for baseline US to 0.956 (P < 0.0001) for CEUS. CONCLUSION: CEUS allowed diagnosis of mass-forming pancreatitis with diagnostic accuracy of 96%. CEUS significantly increases the diagnostic confidence with respect to basal US in discerning mass-forming pancreatitis from pancreatic neoplasm.

Purpose To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions. Methods We studied 88 hypoechoic liver lesions (diameter range, 1–18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (US) with contrast-enhanced ultrasonography (CEUS). Final diagnosis was made using contrast enhanced helical CT, contrast enhanced MR, angiography (DSA), and/or histopathic confirmation or clinical imaging follow-up. Results There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (FNH), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. Malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (HCC) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (CCC) and 1 non-Hodgkin's lymphoma (NHL). CEUS characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. On the basis of the results obtained during the sinusoidal contrast enhanced phase of CEUS, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. The enhancement pattern of 13 small (< or = 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 FNHs, 4 HCCs, 4 metastatic endocrine tumors) was better demonstrated on CEUS than on helical CT. In these cases the hyper vascularization of the lesions shown on CEUS was not confirmed on CT. Conclusions CEUS distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%. © 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:164–172, 2005

Contrast-enhanced ultrasonography (CEUS) is a recently introduced field of ultrasonography (US). To assess the ability of CEUS to identify the vascularization of solid pancreatic tumors in comparison to helical CT.Forty-two resected pancreatic tumors, found at US, were studied with CEUS and helical CT. The tumor enhancement at CEUS was scored in comparison to the baseline aspect of the lesion and/or the extralesional pancreatic parenchyma together with the adjacent vessels during the dynamic study. All the lesions underwent pathological examination using HE stains and CD34 markers with an evaluation of the microvessel density (MVD). The correlation of CEUS and helical CT with the MVD of the lesions was established with Spearman's test.The correlation of CEUS with the MVD of the lesions was significantly superior (Rs = 0.914; p0.0001) to that of helical CT (Rs = 0.635; p0.0001).CEUS is better than helical CT in the identification of the vascularization of solid pancreatic tumors. CEUS, when the pancreatic gland is optimally visualized, should be therefore considered a complementary imaging modality in the characterization of pancreatic tumors. CEUS can be a valid onco-imaging modality for quantifying tumoral vascularization in a noninvasive and accurate way.

Endometriosis represents a common and important clinical problem of women of childbearing age. It is a disabling disorder manifesting with pain and infertility. The exact pathogenesis of the disease remains unclear, despite the different theories that have been formulated. The literature on endometriosis is extensive, but often in regard to classic endometrioma. It is surprising that, to the best of our knowledge, the many radiologic features of extraovarian endometriosis have not been well documented thus far. Although ultrasound (US) remains the imaging modality of choice in the radiologic evaluation of female patients with pelvic pain, the role of magnetic resonance imaging (MRI) in the evaluation of abdominal pain is expanding. In the young patient, MRI may be performed if a gynecologic disorder is not suspected at first, especially if US findings are equivocal or the abnormality extends beyond the field of view of the sonographic probe. Moreover, MRI is useful whenever further characterization of pelvic disorder is required. In fact, many causes of pelvic disorders and of endometriosis in particular demonstrate characteristic MRI findings. For these reasons, in this work we describe the protean US and MRI appearances of endometrial foci as encountered in daily experience.

Although thymic lesions are relatively common causes of anterior mediastinal masses, they can rarely arise in other mediastinal compartments, as it is well recognized that thymic tissue can lie in ectopic intrathoracic locations. A thymic mass within the middle mediastinum has rarely been reported, with only a single case of a thymic cyst described and no reports of a middle mediastinal thymoma. We report 2 thymic masses (1 thymoma and 1 thymic cyst) found to arise in the middle mediastinum.

The aim of our study was to assess the prevalence of variants and anomalies of the coronary artery tree in patients who underwent 64-slice computed tomography coronary angiography (CT-CA) for suspected or known coronary artery disease. A total of 543 patients (389 male, mean age 60.5 +/- 10.9) were reviewed for coronary artery variants and anomalies including post-processing tools. The majority of segments were identified according to the American Heart Association scheme. The coronary dominance pattern results were: right, 86.6%; left, 9.2%; balanced, 4.2%. The left main coronary artery had a mean length of 112 +/- 55 mm. The intermediate branch was present in the 21.9%. A variable number of diagonals (one, 25%; two, 49.7%; more than two, 24%; none, 1.3%) and marginals (one, 35.2%; two, 46.2%; more than two, 18%; none, 0.6%) was visualized. Furthermore, CT-CA may visualize smaller branches such as the conus branch artery (98%), the sinus node artery (91.6%), and the septal branches (93%). Single or associated coronary anomalies occurred in 18.4% of the patients, with the following distribution: 43 anomalies of origin and course, 68 intrinsic anomalies (59 myocardial bridging, nine aneurisms), three fistulas. In conclusion, 64-slice CT-CA provides optimal visualization of the variable and complex anatomy of coronary arteries because of the improved isotropic spatial resolution and flexible post-processing tool.

Objective. The purpose of this series is to describe the value of contrast-enhanced ultrasonography (CEUS) in the characterization of small pseudopapillary tumors (SPTs) of the pancreas. Methods. Two cases of SPTs found on conventional ultrasonography, both located at the pancreatic body, were studied with spiral computed tomography, magnetic resonance imaging, and CEUS. A final diagnosis was obtained with histologic analysis after distal pancreatectomy. Immunohistochemical analysis of the tumors with the CD34 antigen was performed. Results. At CEUS, the 2 SPTs had a slight peripheral rim enhancement in the early dynamic phases. The presence of this enhancement pattern at CEUS, not clear at spiral computed tomography or at magnetic resonance imaging, suggested the diagnosis of SPTs with a peripheral pseudocapsule deriving from the compression of the pancreatic parenchyma. The presence of a perilesional pseudocapsule was proved at immunohistochemical analysis of the tumors with the CD34 antigen. Conclusions. Contrast-enhanced ultrasonography can improve the characterization of SPTs by showing the typical rim enhancement of these pancreatic tumors.

Purpose: The aim of the study was to evaluate the prevalence of collateral findings detected in computed tomography coronary angiography (CTCA) in a multi-center registry. Materials and methods: We performed a retrospective review of 4303 patients (2719 males, mean age 60.3 ± 10.2 years) undergoing 64-slice CTCA for suspected or known coronary artery disease (CAD) at various academic institutions between 01/2006 and 09/2010. Collateral findings were recorded and scored as: non-significant (no signs of relevant pathology, not necessary to be reported), significant (clear signs of pathology, mandatory to be reported), or major (remarkable pathology, mandatory to be reported and further investigated). Results: We detected 6886 non-cardiac findings (1.6 non cardiac finding per patient). Considering all centers, only 865/4303 (20.1 %) patients were completely without any additional finding. Overall, 2095 (30.4 %) non-significant, 4486 (65.2 %) significant, and 305 (4.4 %) major findings were detected. Among major findings, primary lung cancer was reported in 21 cases. In every center, most prevalent significant findings were mediastinal lymph nodes >1 cm. In 256 patients, collateral findings were clinically more relevant than coexisting CAD and justified the symptoms of patients. Conclusions: The prevalence of significant and major collateral findings in CTCA is high. Radiologists should carefully evaluate the entire scan volume in each patient.

The authors sought to compare magnetic resonance imaging (MRI) and computed tomography (CT) for assessing left ventricular (LV) function parameters in a large patient population. The study was conducted on 181 patients who underwent cardiac MRI and cardiac CT for various indications. For MRI, we used two-dimensional cine balanced steady-state free precession (b-SSFP) sequences, and for CT we used multiphase short-axis reconstructions. Volume data sets were evaluated with dedicated software. Results were compared with a paired, two-tailed Student's t test, Pearson's correlation (r), and Bland-Altman analysis. A high level of concordance was observed between cardiac MRI and CT. Ejection fraction (EF) was 53 +/- 14% for MRI vs. 53%+/- 15% for CT. There was good correlation for EF (r=0.71; p > 0.05) and end-systolic volume (r=0.74; p > 0.05). End-diastolic volume (74 +/- 23 ml at MRI vs. 71 +/- 19 ml at CT; r=0.58; p < 0.05) and myocardial mass (63 +/- 20 g at MRI and 56 +/- 18 g at CT; r=0.89; p < 0.01) showed statistically significant differences, although the discrepancy had no clinical impact. MRI and CT show a good level of agreement in assessing LV function parameters, and both can be used interchangeably in clinical practice.

OBJECTIVE Thyroid volume quantification is an important parameter for radiotherapy dosing in cases of major thyroid diseases such as thyroiditis and carcinoma. In clinical practice, this calculation is performed by means of ultrasonography on the basis of an ellipsoid formula obtained from the 3 axes. The aim of our study was to compare the accuracy of volume calculation between B-mode ultrasonography and volumetric ultrasonography (VUS). METHODS Between April and May 2007, 27 consecutive patients selected for thyroidectomy were prospectively evaluated. One expert ultrasound operator calculated each thyroid volume with standard B-mode ultrasonography on the basis of the 3 axes of each lobe, and then the patients were analyzed with an offline workstation equipped with volumetric probes (VUS). On the offline workstation, 2 separate blinded operators (VUS1 and VUS2) calculated the thyroid volume with virtual organ computer-aided analysis. Data acquired were then compared with pathologic anatomy (PA). RESULTS The mean time for B-mode analysis was 6 minutes, whereas VUS analysis needed a mean time of 16.5 minutes. Interobserver variability between the median VUS1 and VUS2 measurements was 0.36 mL (interquartile range [IQR], -0.79 to 0.37 mL; P < .156). The median variability between B-mode ultrasonography and PA was -9.6 mL (IQR, -16.7 to 1.5 mL; P < .001), and that between VUS and PA was -2.87 mL (IQR, -11.97 to 9.51 mL; P = .019). The overall performance of B-mode ultrasonography in comparison with PA was -29.1% (IQR, -47.5% to -5.9%), and that of VUS in comparison with PA was -6.3% (IQR, -26.3 to 13.7%; P < .001). CONCLUSIONS Volumetric ultrasonography is a valid tool that compares better with PA than does B-mode ultrasonography.

PURPOSE: The aim of this study was to correlate left main (LM) coronary artery dimensions with the presence of atherosclerosis by multidetector-row computed tomography (MDCT) coronary angiography (CA) and to assess coronary atherosclerotic plaques with a semiquantitative method. MATERIALS AND METHODS: Sixty-two consecutive patients (41 men, mean age 60+/-11) with suspected coronary artery disease underwent 64-MDCT coronary angiography. LM dimensions (length, ostial and bifurcation diameters), quantitative [location, Hounsfield unit (HU) attenuation] and qualitative (composition, shape) analysis of plaques within the LM were performed. All patients underwent conventional CA. RESULTS: Thirty patients (mean age 55+/-10) without plaques in the LM presented the following average dimensions: length 10.6+/-6.1 mm, ostial diameter 5.5+/-0.7 mm, bifurcation diameter 4.9+/-0.9 mm. LM plaques (n=36) were detected in 32 patients (mean age 64+/-10) with the following LM average dimensions: length 11.3+/-4.0 mm, ostial diameter 6.0+/-1.2 mm and bifurcation diameter 6.0+/-1.2 mm. Plaques were calcified (40%, mean attenuation 742+/-191 HU), mixed (43%, mean attenuation 387+/-94 HU) or noncalcified (17%, mean attenuation 56+/-14 HU) and were frequently eccentric (77%). Age was significantly different in the two groups (p

The main coronary artery variants and anomalies are completely asymptomatic and are discovered incidentally or as they rise symptoms. Multidetector computed tomography coronary angiography represents an excellent technique for noninvasive assessment of the coronary tree mainly because of the multiplanar imaging modalities of computed tomography. Thin collimation permits to depict thin vessels such as the sinus node artery, as reported in this case. In this brief report, we describe a case of a rare anomaly of termination the coronaries, a double fistula between the sinus node artery, and the right atrium in a patient with atypical chest pain.

Purpose. The aim of the study was to investigate the prevalence of the noncardiac collateral findings during multislice computed tomography coronary angiography (MSCT-CA). Materials and methods. Six hundred and seventy patients undergoing MSCT-CA with 16-slice and 64-slice CT scanners for suspected atherosclerotic disease of the coronary arteries were retrospectively reviewed. All data sets obtained with a large field of view (FOV) were analysed by two radiologists using standard mediastinal and lung window settings. Collateral findings were divided according to clinical importance into nonsignificant, remarkable and compulsory to be investigated. Results. Eighty-five percent of patients revealed coronary artery disease (CAD). Only 138/670 (20.6%) were without any additional finding. An additional 1,234 findings were recorded: nonsignificant 332 (26.9%), mild 821 (66.53%), compulsory for study 81 (6.56%). A total of 81 patients (12.08%) had significant noncardiac pathology requiring clinical or radiological follow-up. Among these, newly discovered pathologies were revealed in two patients (2.46%). Conclusions. A significant number of noncardiac findings might have been missed in MSCT-CA scans; the appropriate approach should be as a team trained in cardiology and radiology.