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In-stent restenosis (ISR) is a common superficial femoral artery (SFA) stenting complication, occurring in more than one third of patients within 2–3 years after the index procedure. Moreover, there is no standard treatment for ISR, and although many options are available, there is still limited data regarding its optimal management. We report a paradigmatic case report of a patient complaining of symptomatic peripheral arterial disease, underwent multiple endovascular revascularizations for recurrent femoro-popliteal ISR. A step-by-step approach was followed. At the time of the first presentation, the ISR was treated by drug-eluting balloon (DEB) angioplasty. The repeated ISR was treated by laser debulking, achieving a good angiographic result. Finally, after the third repeated restenosis, a combined approach with laser debulking and DEB angioplasty guaranteed a good acute angiographic result. Long-term duplex-scan follow-up demonstrated the good patency of the femoro-popliteal target lesion.

Gastrointestinal angiodysplasia (GIAD) represents one of the most frequent causes of recurrent lower gastrointestinal bleeding in the elder population. Clinical manifestations are highly variable, diagnosis is done with colonoscopy or CT and management consists of either endoscopic or, more conservatively, endovascular approach. Trans-arterial embolization (TAE) reduces blood flow into the lesion and may complicate with perforation, dissection, vasospasm and bowel ischaemia. To date, coils and Gelfoam represent the most employed embolizing agents, followed by PVA and onyx. We report the successful embolization of GIADs in four patients with n-butyl 2-cyanoacrylate (NBCA) and Lipiodol Ultra-Fluid (LUF): despite the reported higher risk of bowel infarction when compared with the other agents, no major complication or short-term recurrence occurred in our series.

Since their discovery in ancient China, fireworks rapidly spread throughout the world, where they have always been used to celebrate either popular or private events. Their use is nonetheless related to several risks, especially within production factories, since several injuries or even death can occur following an accidental ignition. In cases of major disasters related to fireworks explosions, stating the accidental or intentional nature of the event might prove challenging, thus raising the need of a multidisciplinary approach. In this regard, we here discuss the case of an accidental explosion that occurred in a fireworks production factory, accountable for five deaths and two hospitalisations.

In this short report we present a series of thirteen patients with locally advanced, unresectable, pancreatic cancer treated with a COMBO-Therapy consisting of: STEP-1: induction chemotherapy; STEP-2: concomitant chemoradiotherapy; STEP-3: stereotactic body radiotherapy boost. After four weeks from the end of each step all patients had a re-staging and a surgical re-evaluation. All patients completed STEP-1 and STEP-2. STEP-3 has been successfully delivered to 8/13 patients with a median dose of 12 Gy (range 10-21 Gy) in 1-3 fractions. The median LC was 20 months (range 10-32) with a 2-year LC of 72.9%, and none of the patients developed G3 acute or late toxicities. The median OS was 21.5 months (range 12-34), and the 2-year OS was 53.9%; the median PFS was 17.5 months (range 10-27). Our non-surgical COMBO-Therapy has demonstrated a feasible profile with good tolerance. Further prospective protocols are needed to confirm our preliminary results.

The increased incidence of childhood obesity and related non-alcoholic fatty liver disease (NAFLD) has determined the need to identify a non-invasive technique to diagnose and monitor NAFLD. Two-dimensional shear wave elastography (2D-SWE) has emerged as a reliable, non-invasive, tool to evaluate liver tissue elasticity in clinical practice. Aims of this study were to longitudinally evaluate 2D-SWE changes in relation to weight loss, metabolic profile, and body composition modifications and to investigate the correlation between 2D-SWE variation and clinical and biochemical indices of cardio-metabolic risk in obese children. Thirty-three children underwent anthropometric, bioimpedenziometric, fasting biochemical assessments, ultrasound, and SWE evaluations, at baseline (V0) and after a 12-months of follow-up (V12). Diet and physical activity programs have been prescribed to all patients according to European Society of Endocrinology and Pediatric Endocrine Society recommendations. Adherence to the prescribed diet and physical activity program was checked every 3 months during the 12-month of follow-up. Variation of all parameters was evaluated in intragroup and intergroup comparison analysis in children, who had not lost weight (Group A) and those who had lost weight (Group B) at V12. Study population was also analyzed dividing it into two groups with respect to 2D-SWE liver elasticity value ≤10.6 kPa or >10.6 kPa. A significant reduction of mean 2D-SWE value was demonstrated both in the entire cohort (p = 0.002) and in Group B children (p = 0.004). Intragroup comparison analysis, between V0 and V12, documented a significant decrease of 2D-SWE and BMI SDS and a significant improvement of metabolic profile (decrease of HOMA-IR, HbA1c, oral glucose tolerance test 120-min glucose and insulin, triglycerides, triglycerides/HDL-ratio, transaminases, uric acid, and increase of Matsuda-index and HDL) in children of Group B but not in those of Group A. Intergroup comparison analysis showed significant differences for BMI, BMI SDS, transaminases and several parameters of glucose and lipid metabolism, between Group A and Group B children after 12-months of follow-up. No significant differences were documented with regard to clinical and biochemical variables by dividing the population in accordance with the 2D-SWE cut-off of 10.6 kPa. These results suggested a relation between weight loss, metabolic profile improvement and 2D-SWE value reduction. SWE could play a significant role in the non-invasive assessment of NAFLD in children and adolescents with obesity.

Ultrasound (US) detection of liver nodules in cirrhotic patients requires further radiological examinations and often a follow-up with repeated short-term evaluations to verify the presence of hepatocellular carcinoma (HCC). Aims of the study were to assess the rate of HCC diagnosis and to identify HCC predictors in a cohort of cirrhotics followed-up after US detection of the liver nodule(s). One-hundred-eighty-eight consecutive cirrhotic patients (124 males, mean age 64.2 years) with liver nodule(s) detected by US were enrolled. All patients underwent second-level imaging [computed tomography (TC) or magnetic resonance (MR)], and those without a definite diagnosis of HCC were followed-up with TC and/or RM repeated every 3–6 months up to 18 months if HCC was not diagnosed. After 18 months, non-HCC patients came back to routine US surveillance. HCC was diagnosed in 73/188 cases (38.8%). In 66/73 patients (90.4%) HCC was identified at first radiological evaluation after US, while in the remaining seven subjects it was diagnosed at the subsequent imaging examination. Age (p = 0.001) and nodule dimension (p = 0.0001) were independent predictors of HCC at multivariate analysis. Fourty-nine/188 patients were lost at follow up after 18 months. Twenty/139 remaining patients developed HCC and 3/139 cholangiocarcinoma; 77 died between 3 and 110 months from the beginning of the study (61 for end-stage liver disease, 8 for extrahepatic causes, eight for unknown causes). Patients who developed liver cancer earlier during the follow up had the shortest overall survival. US-detected liver nodules are not neoplastic in more than half of cirrhotic patients. A definite diagnosis may be obtained at the time of the first radiologic evaluation after US in the vast majority of the cases. Patients in whom nodules are found not to be tumoral may return to the US surveillance program routinely applied to all cirrhotics.

Purpose of this report is to describe safety and effectiveness of selective artery embolization in the treatment of bleeding angiomyolipomas (AMLs) of the kidney using a mixture of Lipiodol and Cyanoacrylate.Two patients with bleeding AMLs underwent to superselective embolization of the lesions using microcatheter and Lipiodol mixed with Cyanoacrylate in the ratio 3:1.Primary bleeding control rate was 100% with no major complications. Follow-up CT (mean time 18 months) demonstrated a significant reduction in size (about 50%) of the lesions.In conclusion, selective artery embolization with Lipiodol and Cyanoacrylate appear to be safe and effective in the treatment of bleeding AMLs. Keywords: Angiomyolipoma, Embolization

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a multisystemic involvement. Usually, radiological imaging does not play a central role in evaluating SLE patients, although it may be helpful in assessing complications, allowing a more accurate evaluation of the patient. Lupus enteritis is one of the most common and potentially lethal manifestations of the gastrointestinal involvement of SLE. Among the imaging modalities, computed tomography scan is now considered the gold standard in evaluating lupus enteritis, although it is impaired by the radiation exposure. On the other hand, during the last decade magnetic resonance enterography has achieved a remarkable importance in evaluating small bowel lesions in patients affected by Crohn's disease. We describe the first case report of lupus enteritis evaluated with magnetic resonance enterography, putting forward the proposal of a reliable and radiation-free alternative to computed tomography scan in evaluating the intestinal involvement of SLE. Keywords: Magnetic resonance enterography, Lupus enteritis

Case series Patients: Female, 23 • Female, 27 Final Diagnosis: SMA syndrome Symptoms: Abdominal pain • vomiting Medication: — Clinical Procedure: — Specialty: Radiology Objective: Rare co-existance of disease or pathology Background: Superior mesenteric artery syndrome is caused by vascular compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. It may occur with acute or chronic symptomatology, such as vomiting or postprandial abdominal pain, and it is usually caused by a lack of mesenteric fat pad under conditions of severe weight loss. Crohn’s disease can be one of them. Case Reports: We report 2 cases of Crohn’s disease patients with clinical suspicion of jejunal stricture who underwent MR-enterography with a novel approach. In fact, the examinations were performed including prone position of the patients inside the scanner, drinking of contrast medium during the examination, and prompt acquisition of fluoroscopic sequences. Both the exams showed an abrupt termination of the duodenum on its third portion and a decreased aortomesenteric distance, allowing the diagnosis of superior mesenteric artery syndrome. Conclusions: A correlation between Crohn’s disease and superior mesenteric artery syndrome has never before been reported in the literature. The present study provides some practical steps that may be useful in order to improve MRE standard protocol in recognizing this condition while evaluating Crohn’s disease bowel lesions.

The portal vein derives from the vitelline veins, a component of the extraembryonic venous system, and is normally formed by the confluence of the superior mesenteric and splenic vein. The knowledge of the anatomy of the portal vein and its abnormalities is important for interventional and surgical procedures. Variant portal architecture is a common finding during imaging studies. Ultrasonography, computed tomography and magnetic resonance are non-invasive methods for studying and understanding portal vein's anatomy and abnormalities. We describe a rare case of variation in the formation and course of the portal vein. To the best of our knowledge, there is no evidence of this kind of abnormality in literature.

Limited liver metastases represent a clinical challenge. Surgical approach is the most frequently reported treatment option, however, some patients are not eligible for surgical interventions. Relatively recent technologic advances have permitted the safe use of ablative techniques employed in the cure of hepatic metastases. Among these, radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) have emerged as valid treatments in a significant proportion of patients with intrahepatic oligometastatic disease. This review offers an up-to-date of current available literature on this issue focusing on the use and outcomes of RFA and SBRT, according to the PICO (Population, Intervention, Comparison and Outcomes) criteria.

The postmortem interval is probably the most important puzzle piece in clarifying the circumstances in case of death occurred in unknown conditions. Over the years, radio-imaging modalities have proved their worth in forensic field, providing additional and significant improvements and findings. CT-scan is characterized by wide availability, fast scan times and sustainable healthcare costs. Detection of gas, hemorrhage and bone fractures are points of strength of CT-scan. A reliable evaluation of the post-mortem interval is interesting in the victims of a mass disaster, also following a natural disaster, for the individuation of responsibility in the efficiency of the help and assistance. This work is based on the postmortem CT-scan evaluation of 26 people sadly died during a tragic flood occurred in 2009 in Giampilieri (Italy). In particular, the gas distribution within the skeletal bones was evaluated, with recognition of specific patterns that were then related to the time of death. The identification of intraosseous gas could represent a helpful tool in the estimation of postmortem interval.

Within the gastrointestinal system, the small bowel represents the most difficult site to approach with imaging modalities. During the last decades, magnetic resonance enterography has reached an increasing interest, up to be considered an essential part in the diagnostic framework of Crohn's disease patients. Nevertheless, the distention of the intestinal loops provided by the administration of oral contrast medium, the possibility of a dynamic evaluation, and the lack of radiation exposure are huge advantages that can be exploited for the assessment of other clinical conditions affecting the small bowel. Physicians and radiologists should be aware of the possibilities offered by this technique, looking at it as a trustful alternative to the well-worn radiological examinations. In this respect, the purpose of this work is to show some uncommon clinical conditions that can be assessed with magnetic resonance enterography and that fall within the various differential diagnosis of the intestinal disorders.

Multidetector computed tomography (CT) and volumetric rendering techniques have always been a useful support for the anatomical and pathological study of the maxillofacial district. Nowadays accessibility to multidetector CT scanners allows the achievement of images with an extremely thin collimation and with high spatial resolution, not only along the axial plane but also along the patient's longitudinal axis. This feature is the main theoretical assumption for multiplanar imaging and for an optimal 3-dimensional postprocessing. Multiplanar reconstruction (MPR) techniques permit images along any plane in the space to be obtained, including curved planes; this feature allows the representation in a single bidimensional image of different anatomical structures that develop on multiple planes. For this reason MPR techniques represent an unavoidable step for the study of traumatic pathology as well as of malformative, neoplastic, and inflammatory pathologies. Among 3-dimensional techniques, Maximum Intensity Projection and Shaded Surface Display are routinely used in clinical practice. In addition, volumetric rendering techniques allow a better efficacy in representing the different tissues of maxillofacial district. Each of these techniques give the radiologist an undoubted support for the diagnosis and the characterization of traumatic and malformative conditions, have a critical utility in the neoplastic evaluation of primary or secondary bone involvement, and are also used in the planning of the most modern radiosurgical treatments. The aim of this article is to define the main technical aspects of imaging postprocessing in maxillofacial CT and to summarize when each technique is indicated, according to the different pathologies of this complex anatomical district.

We reported the results of post mortem computed tomography of the liver in 27 subjects dead simultaneously during a flood. The aim of our work was to identify the different patterns of post mortem intrahepatic gas distribution and the timing of its appearance. Although post mortem CT is the method of choice for the evaluation of gas distribution, controversies exist about the first site of appearance of intrahepatic gas (portal veins versus hepatic veins) as well as the timing and steps of intrahepatic gas spreading. In each subject we performed thin slice CT scanner (Somatom Definition, Siemens) and post processing of native CT images with Minimum Intensity Projection technique. Our results show that the first site of appearance of intrahepatic gas is portal veins. Gas in hepatic veins was never seen without the presence of the gas in portal vein. Gaseous cysts in hepatic parenchyma represent a further and usually more tardive pattern of intrahepatic gas distribution. In addition, we demonstrated that differences in timing of gas spreading was statistically significative for exclusive presence of portal veins gas before 48h as well as for complete substitution of hepatic parenchyma by cysts 64h after death. In conclusion, our work shows that the CT study of postmortem intrahepatic gas distribution could be a useful complementary tool both in demonstrating the mechanism of intrahepatic gas spreading and in estimating post mortem interval.

The purpose of this article is to quantify the CT radiation dose increment in five organs resulting from the administration of iodinated contrast medium.Forty consecutive patients who underwent both un-enhanced and contrast-enhanced thoracoabdominal CT were included in our retrospective study. The dose increase between CT before and after contrast agent administration was evaluated in the portal phase for the thyroid, liver, spleen, pancreas, and kidneys by applying a previously validated method.An increase in radiation dose was noted in all organs studied. Average dose increments were 19% for liver, 71% for kidneys, 33% for spleen and pancreas, and 41% for thyroid. Kidneys exhibited the maximum dose increment, whereas the pancreas showed the widest variance because of the differences in fibro-fatty involution. Finally, thyroids with high attenuation values on unenhanced CT showed a lower Hounsfield unit increase and, thus, a smaller increment in the dose.Our study showed an increase in radiation dose in several parenchymatous tissues on contrast-enhanced CT. Our method allowed us to evaluate the dose increase from the change in attenuation measured in Hounsfield units. Because diagnostic protocols require multiple acquisitions after the contrast agent administration, such a dose increase should be considered when optimizing these protocols.

The purpose of this study was to describe the MR imaging findings of Nuck canal endometriosis (NCE).In a 10-year period, 486 out of 612 patients, with laparoscopically and/or surgically proven diagnosis of pelvic endometriosis, underwent MR imaging examination. The examinations were reviewed by two urogenital experienced radiologists working in consensus. Data analysis included: lesions location, size, morphological and signal intensity pattern, involvement of the adjacent muscles, and tendons.In 372 out of 486 patients an MRI diagnosis of endometriosis was made. NCE was found in eight patients. All the lesions were located on the right side. The mean size of the lesions was 2.5 cm (range 1.5-4.5 cm). Two patterns of NCE were found: type 1, prevalently cystic (n = 2); and type 2, prevalently solid with small scattered cysts within lesion (n = 6). In all the patients, hemorrhagic hyperintense cysts could be seen on T1-weighted images. In four patients, the lesions involved the inguinal canal, and in another four patients, the lesions were only outside the inguinal canal. Involvement of the abdominis rectus muscle was seen in two patients, and of the adductor common tendon in two patients.MR imaging permits the diagnosis of NCE as well as the evaluation of exact extension of the disease.

In the Greek and Roman periods, the fortified town of Tindari's military and trading importance combined with its strategic location in north-east Sicily allowed it to control traffic on the Tyrrhenian Sea for many centuries. Historical sources (Polybius, Cicero, Livy and Appian) testify to the flourishing maritime activity of the ancient town, but do not supply any information on the location, size or configuration of its harbour. Because a town as important as Tindari must have had a landing place for ships, we examined new sources of information with the aim of identifying its location. Historiographical and archaeological surveys produced evidence of a well-organised harbour. Geomorphological investigations, performed along the Tindari Promontory, identified Holocene uplifted and submerged notches indicating past sea level changes. Furthermore, it was found that in the last four centuries the combined actions of marine and fluvial dynamics had produced a progressive filling of the Oliveri lowl...

To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in comparison to CT angiography (CTA) to identify and classify endoleaks following abdominal aortic aneurism repair with endoprosthesis.A retrospective analysis of 181 patients treated with EVAR, from September 2009 to September 2014, was performed. Patients were evaluated with CEUS, CTA and angiography in the cases requiring treatment. Sac diameter, sac integrity, identification and classification of endoleaks were taken into consideration. Sensitivity, specificity, accuracy and negative predictive values were considered for each modality of endoleak identification.Forty-two endoleaks (23.2%; type II: 39 cases, type III: 3 cases) were documented. Sensitivity and specificity of CEUS and CT were, respectively, 97.6 and 90.5, 100 and 100%. In two cases, CEUS was able to better classify endoleaks compared to CT.CEUS accuracy to identify endoleaks following EVAR is similar to CT. CEUS should be considered as an effective modality for the long-term surveillance of EVAR because of its capability to correctly classify endoleaks with no ionizing radiation exposure.Valutare l’accuratezza dell’eco-contrastografia (CEUS), confrontandola con angiografia con tomografia computerizzata (CT) per l’identificazione degli endoleak dopo trattamento di aneurisma dell’aorta addominale con endoprotesi.Da Settembre 2008 a Dicembre 2014, 181 pazienti consecutivi trattati con EVAR sono stati valutati con CEUS, CTA, ed anche con angiografia nei casi da ritrattare. Sono stati valutati: diametro della sacca, valutazione dell’integrita della sacca, identificazione e classificazione degli endoleaks. Sensibilità, specificità, accuratezza e valore predittivo negativo sono stati valutati per ogni modalita nell’identificazione degli endoleak.Quarantadue endoleak (23.2%; tipo II: 39 casi, tipo III: 3 casi) sono stati documentati. La Sensibilita della CEUS e della TC e stata rispettivamente del 97.6, 90.5%, mentre la specificita per entrambe e stata del 100%. In due casi la CEUS e stata in grado di classificare meglio gli endoleak rispetto alla CT. La sacca aneurismatica presentava alla CEUS e CDUS un diametro massimo compreso tra 39-82 mm, mentre alla TC tra 38 e 78 mm, senza significativa differenza tra le due metodiche.L’accuratezza della CEUS nell’identificazione degli endoleak e nella misurazione della sacca dopo EVAR, e simile alla TC con maggiore sensibilita ma analoga specificita. La CEUS e da considerarsi una modalita efficace per la sorveglianza a lungo termine degli EVAR in quanto capace di classificare correttamente gli endoleak senza esposizione a radiazioni ionizzanti.

The attenuation of seismic waves is one of the basic physical parameters used in seismological studies and earthquake engineering, which is closely related to the seismicity and regional tectonic activity of a particular area. In this work, the seismic attenuation in the Straits of Messina, affected by several and strong historical earthquakes, was studied using waveforms recorded by a local seismic network composed of seven stations. We measured: the coda quality factor ( Q c ) in the Single Scattering model hypothesis; the direct quality factor ( Q d ) applying the Coda Normalization method for S-waves; and the intrinsic and scattering quality factor ( Q i and Q s ) by the Multiple Lapse Time Window Analysis (MLTWA) method. Coda Q values were obtained using different lapse times (40, 60 and 80 s) for the frequency bands centred at 1.5, 3, 6 and 12 Hz. Our findings indicate that Q c increases with increasing lapse time and that Q c is frequency dependent. This behaviour is usually correlated to the degree of tectonic complexity and to the presence of heterogeneities at several scales. In fact, by using the Coda Normalization method we obtained low Q d values, as expected for a heterogeneous and active zone. Finally, by the MLTWA method we observe that the contribution of the scattering attenuation ( Q s − 1 ) prevails on the intrinsic absorption ( Q i − 1 ) until 3 Hz. Conversely, Q i − 1 and Q s − 1 seem to be of the same order in the higher frequency bands.

Clinical evaluation and ultrasound examination are the first steps in the evaluation of a patient with a swelling of the parotid region. After the detection of a nodular lesion, cytological or histological confirmation is usually performed to achieve the diagnosis, while the choice of cross-sectional imaging (computed tomography scan and magnetic resonance imaging) may significantly vary from one physician to another, on the basis of the degree of confidence that both radiologist and surgeon have with this kind of imaging. This work focuses on some essential “reporting points” in cross-sectional imaging evaluation of parotid nodules, chiefly helpful to the radiologist when the ultrasonography assessment is considered incomplete and requires a further evaluation.

Pancreatic pseudocyst formation is a well-known complication of pancreatitis. It represents about 75% of the cystic lesions of the pancreas and might be located within or surrounding the pancreatic tissue. Sixty percent of the occurrences resolve spontaneously and only persistent, symptomatic or complicated cysts need to be treated. Complications include infection, hemorrhage, gastric outlet obstruction, splenic infarction and rupture. The formation of fistulas to other viscera is rare and most commonly occurs within the stomach, duodenum or colon. We report a case of a patient with a pancreatic pseudocyst in communication with the common bile duct. There have been only few cases reported in the literature. We successfully managed our case by performing an endoscopic ultrasound-guided drainage of the pancreatic collection and a contemporaneous stenting of the common bile duct. Performed independently, both drainages are effective, safe and well-coded and the expertise on these procedures is widespread. By our knowledge this therapeutic approach was never reported in literature but we retain this is the most correct treatment for this very rare condition.

The anisotropic attenuation of macroseismic intensity for a seismogenetic zone is dealt with using a new modelling of intensity distribution. The analysis, carried out starting from the intensity maps of the earthquakes of different seismogenetic zones of Central and Southern Italy, allows the determination of the attenuation coefficients for each seismogenetic zone by an anisotropic attenuation law. The obtained results show the reliability of the proposed modelling within seismic hazard evaluation studies.

Regional migratory osteoporosis (RMO) is an uncommon self-limiting disease characterized by migrating bone marrow edema and osteoporosis. RMO of the knee with intra-articular migration is very rare. In such cases, different parts of the femur are usually involved. We report a case of intra-articular RMO of the knee migrating from the femur to the tibia—a pattern of migration that has not been previously described in the literature.

A vectorial modelling of observed macroseismic intensity aimed at the analytical determination of the epicentre is proposed here. The methodology is based on the determination of a plane system of vectors which characterises the macroseismic intensity distribution. The epicentre of each seismic event considered is determined as the centre of this vector system by an analytical expression which is independent from all possible directions of seismic energy propagation. The analysis of the intensity distribution is carried out by a new model called a macroseismic plane, different from the one known as macroseismic field, formed by a set of small areas built around the observed intensity points; hence its name.

We report a case of post-surgical temporary functional stenosis of the sphincter of Oddi and biliary leak in a patient with a previous Billroth II reconstruction who had undergone cholecystectomy, surgical choledochotomy and sphincterotomy for biliary calculi. The patient was treated by creation of an internal/external biliary drainage using the T-tube access with an unreported technique.

Contrast medium administration is one of the leading causes of acute kidney injury (AKI) in different clinical settings. The aim of the study was to investigate occurrence and predisposing factors of AKI in cirrhotic patients undergoing contrast-enhanced computed tomography (CECT). Datasets of 1279 consecutively hospitalized cirrhotic patients were retrospectively analyzed. Two hundred forty-nine of 1279 patients (mean age 64 ± 11 years, 165 male) who had undergone CECT were selected on the basis of the availability of serum creatinine (sCr) values evaluated before and after CECT (CECT group). In analogy, 203/1279 cases (mean age 66 ± 10 years, 132 male) who had not undergone CECT and had been tested twice for sCr in 7 days were also included as controls (Control group). AKI network criteria were employed to assess contrast-induced AKI (CI-AKI) development. Apart from lack of narrowed double sCr measurements, additional exclusion criteria were active bacterial infections, nephrotoxic drugs intake, and estimated glomerular filtration rate

A methodology for the anisotropic characterization of macroseismic fields is proposed, in order to evaluate seismic hazard, based on the real geometry of the isoseismals of the field. The proposed methodology, independent of the macroseismic intensity attenuation law, allows both for a single field and for several fields in the same source zone, the determination of minimum and maximum attenuation values and of the relative directions.

Distal bypass has been considered as a primary choice for the treatment of critical limb ischemia (CLI). When bypass failed with limb threatening ischemia, the amputation rate is high in patients with increased surgical risks and lack of conduit. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI even in patients with failed bypass graft. The aim of this study was to review our experience and results of extreme endovascular revascularization in patients with CLI following occluded lower limb bypass graft.Retrospective review from January 2005 to June 2008 of patients with CLI following occluded bypass graft who underwent PTA was performed. All patients were studied by Duplex scanning and dual-energy computed tomographic angiography (DE-CTA) bone removal technique. Stents were used in cases of residual stenosis or dissection. Technical success was defined as a residual stenosis less than 30%. Demographics, comorbidities, functional status, details of the procedure information were recorded. Descriptive, logistic regression and life-table analyses performed.Thirty-six patients with occluded bypass grafts were treated. The mean age was 69 years (range 56-89), 44% were older than 80 years, 83% had diabetes mellitus, 88% of limbs treated had multiple lesions included Tasc C and D lesions. Technical success was achieved in 91%. Mean follow-up was 24 months. At follow-up, there were 19 PTA failures which were followed by subsequent procedures: redo PTA in 16 limbs, redo bypass in 2, amputation in 5. Cumulative primary patency was 60% (±0.08 SE) and 24% (±0.07 SE). Secondary patency was 96% (±0.03 SE) and 83% (±0.08 SE). Limb salvage was 84% (±0.06 SE) and 70% (±0.10 SE). Freedom from surgical revision was 78% (±0.07 SE) and 54% (±0.11 SE). Overall survival was 89% (±0.05 SE) and 58% (±0.11 SE) at 12 and 24 months, respectively.Endovascular revascularization of patients with CLI and occluded bypass graft is a safe and feasible procedure with reasonable technical and clinical success and limb salvage. PTA may be the only alternative to amputation in these patients with extensive comorbidities and limited life expectancy.

The seismic hazard for the Calabro-Sicilian area is evaluated using an anisotropic formulation of the Grandori attenuation law. For each macroseismic field two main directions are identified: minimum and maximum attenuation of the macroseismic intensity. The results of the investigation show that the anisotropic formulation improves the compatibility level of the model (with respect to the isotropic one) with the intensities observed and produces probabilistic expected intensities which compare favourably with the values of seismic history in the investigated area when the zonation defined by the Messina University research group was used.

To examine the usefulness of dual-echo dual-flip angle spoiled gradient recalled (SPGR) magnetic resonance imaging (MRI) technique in quantifying muscle fat fraction (MFF) of pelvic and thighs muscles as a marker of disease severity in boys with Duchenne muscular dystrophy (DMD), by correlating MFF calculation with clinical assessments. We also tried to identify characteristic patterns of disease distribution. Twenty consecutive boys (mean age, 8.6 years ± 2.3 [standard deviation, SD]; age range, 5–15 years; median age, 9 years;) with DMD were evaluated using a dual-echo dual-flip angle SPGR MRI technique, calculating muscle fat fraction (MFF) of eight muscles in the pelvic girdle and thigh (gluteus maximus, adductor magnus, rectus femoris, vastus lateralis, vastus medialis, biceps femoris, semitendinosus, and gracilis). Color-coded parametric maps of MFF were also obtained. A neurologist who was blinded to the MRI findings performed the clinical assessments (patient age, Medical Research Council score, timed Gower score, time to run 10 m). The relationships between mean MFF and clinical assessments were investigated using Spearman’s rho coefficient. Positive and negative correlations were evaluated and considered significant if the P value was

To compare pancreatic virtual unenhanced (VUE) and true unenhanced (TUE) images and to calculate the potential dose reduction by omitting the conventional unenhanced scan.Fifty-one patients with known or suspected pancreatic masses underwent contrast-enhanced computed-tomography (CT) during unenhanced and portal venous phases acquired in single-energy (SE) mode, and pancreatic parenchymal phase acquired in dual-energy (DE) mode. The image quality (IQ) and image noise (IN) of TUE and VUE images were evaluated. The effective dose of a combined DE/SE dual-phase protocol was compared with that of a theoretical standard SE triple-phase protocol. The results were tested for statistical significance using the Cohen's k, the Wilcoxon's signed rank test, and the paired t-test; p-values of less than 0.05 were considered significant.Mean TUE and VUE IQ were 1.5 ± 0.6 and 1.6 ± 0.6 (k = 0.891), with no significant difference (p 0.05). Mean TUE and VUE IN were 12.3 ± 1.6 and 10.3 ± 1.5 HU, and resulted significantly different (p 0.001). Mean effective doses for a combined DE/SE dual-phase protocol and SE triple-phase protocol were 8.9 ± 2.4 mSv (range 4.8-16.2 mSv) and 12.1 ± 3.1 mSv (range 6.4-21.1 mSv). The calculated mean dose reduction achievable by omitting the unenhanced scan was 26.7 ± 9.7% (range 10-46.1; p 0.001).VUE images are feasible for pancreatic abdominal CT. A combined DE/SE dual-phase protocol permits a significant reduction in dose exposure to patients.

The purpose of our study was to evaluate the value of dual-source dual-energy CT with colored iodine overlay for detection of endoleaks after endovascular abdominal aortic aneurysm repair. We also calculated the potential dose reduction by using a dual-energy CT single-phase protocol.From November 2007 to November 2009, 74 patients underwent CT angiography 2-7 days after endovascular repair during single-energy unenhanced and dual-energy venous phases. By using dual-energy software, the iodine overlay was superimposed on venous phase images with different percentages ranging between 0 (virtual unenhanced images) and 50-75% to show the iodine in an orange color. Two blinded readers evaluated the data for diagnosis of endoleaks during standard unenhanced and venous phase images (session 1, standard of reference) and virtual unenhanced and venous phase images with colored iodine overlay images (session 2). We compared the effective dose radiation of a single-energy biphasic protocol with that of a single-phase dual-energy protocol. The diagnostic accuracy of session 2 was calculated.The mean dual-energy effective dose was 7.27 mSv. By using a dual-energy single-phase protocol, we obtained a mean dose reduction of 28% with respect to a single-energy biphasic protocol. The diagnostic accuracy of session 2 was: 100% sensitivity, 100% specificity, 100% negative predictive value, and 100% positive predictive value. Statistically significant differences in the level of confidence for endoleak detection between the two sessions were found by reviewers for scores 3-5.Dual-energy CT with colored iodine overlay is a useful diagnostic tool in endoleak detection. The use of a dual-energy single-phase study protocol will lower radiation exposure to patients.

A method for the calculation of seismic waves velocities at focal depth is here proposed. A stratified earth model with spherical symmetry and the analytical relationship between the epicentral distance and the travel times of seismic waves are used.

The results of a macroseismic investigation carried out in 362 inhabited centres of the provincies of Reggio Calabria, Messina, Catania, and Catanzaro are presented in relation to the Reggio earthquake of 16 January 1975. The importance and the location of damage, as well as

The attenuation structure of the Messina strait area is studied using the single-scattering model of coda wave generation. Data are short-period seismograms belonging to a swarm occurring in the middle of the Messina strait (Italy). The coda-Q appears to be frequency dependent following the empirical law Q = Q0 ƒn, with Q0 and n depending on the coda duration interval. A strong lapse time dependence of Qc (coda-Q) is found. This dependence is interpreted as a depth effect, in the sense that longer codas sample deeper portions of the lithosphere. A simple geometrical model is used to infer from the lapse time dependence in a layered Q-structure of the crust and upper lithosphere. Our results are compared with those obtained in other tectonically active and non-active areas, showing that the inferred Q-structure can be used as a tectonic indicator.

Strain precursors prior to great earthquakes determined from tide gauge records worldwide are discussed. The records at four sites in the Tyrrhenian Sea (1883–1922) are used to identify an anomaly in the sea level before the catastrophic Messina earthquake of December 28, 1908, with Io = XI. There are pre-seismic, co-seismic and post-seismic phases in the crustal movements. The pre-seismic anomaly began at least 5–8 years before the event (ΔT⩾ 5–8 yr) and occurred as far as 530–870 km (D ⩾ 530–870 km) from the epicentre. The strain precursors of this earthquake are compared with other similar cases and the worldwide relations of M α D and M α T.