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Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.

The treatment of chronic wrist pain, due to posttraumatic, degenerative, or inflammatory arthritis, is challenging to adequately manage. The ideal surgical procedure should preserve wrist mobility and provide long-lasting pain relief. In this regard, denervation aims to decrease wrist pain by interrupting sensory innervation, without impairing motor function, and avoids the need for postoperative immobilization to decrease the risk of stiffness. For these reasons, denervation is particularly attractive as a possible treatment for chronic wrist pain. Our aim was to describe our novel technique for partial percutaneous wrist denervation, performed by radiofrequency ablation of the posterior and anterior interosseous nerves, and to report on the prospective outcomes over a 1-year follow-up for 3 patients (4 wrists) treated as of March 2019. The technique is performed on an outpatient basis and does not require postprocedure wrist immobilization or restriction in activities of daily living or work. Findings at the 1-year follow-up indicate that partial denervation improved grip strength, provided pain relief, maintained wrist motion, and improved subjective report of disabilities of the arm, shoulder, and hand. One patient did not report a benefit of the procedures, with other patients being very satisfied. Our percutaneous procedure is an evolution of the traditional partial denervation technique, providing advantages of being less invasive, not requiring restriction of movement or activities in the postoperative phase, can be performed on an out-patient basis, and does not preclude the subsequent use of invasive surgical procedures, as needed.

Pelvic floor dysfunctions embrace a large series of different conditions in which functional abnormalities of the pelvic floor lead to impairment in urinary and sexual functions and in rectal voiding. A multidisciplinary approach is needed in the evaluation of these patients, as well as the adoption of imaging studies adequate to explore the complex anatomy of the region and its dynamic functionality. Available imaging studies include: endoanal and transperineal ultrasound, X-ray defecography and MR defecography. The purpose of this review article is to illustrate the technique, indications, the current role, and diagnostic value of each one of these. The recent availability of new imaging techniques and related advantages will also be discussed.

More than two million people tear their anterior cruciate ligament (ACL) each year, and ACL reconstruction occupies a significant proportion of everyday orthopedic practice, being one of the most commonly performed sports medicine surgical procedures. Patients with postoperative symptoms are frequently imaged to monitor ligament grafts and to identify complications. Given the number of patients undergoing ACL reconstruction, knowledge of the potential complications of this surgery is essential for radiologists. This article provides a review of imaging of ACL reconstruction procedures and the potential complications specific to this surgery.

Aim To create an animal model of acute renal ischemia induced by systemic hypoperfusion, controllable and reproducible to study, in real time, hemorrhagic shock changes with micro-imaging.Animals and methods Hemorrhagic shock was induced in rats activating a syringe pump setup to remove 1 mL/min of blood, through the femoral artery catheter. The withdrawal was continued until the mean arterial pressure (MAP) dropped to 25-30 mmHg. For the next 60 min, the MAP was maintained at a constant pressure value, by automatic pump infusion and withdrawal. Micro-ultrasound imaging was performed using the Vevo 2100 system with the MS250 transducer (13-24 MHz). Renal size, morphology and echogenicity were evaluated in B-mode. Renal blood flow was evaluated using color and PW-Doppler.Results After 1 h of ischemia, B-mode images documented slight changes in kidney echogenicity. Color and PW-Doppler analysis showed a reduction in renal blood flow in kidneys during the hypoperfusion with a progressive and significant change from baseline values of resistive index (RI). At the histological evaluation, 60 min of hypoperfusion resulted in ischemic changes in the kidneys.Conclusions The results of this experimental study encourage the use of the described model to study acute renal ischemia trough severe hypoperfusion. The histological data confirmed that the model was able to produce injury in renal parenchyma. It can be used to assess acute ischemic damage not only in the kidney but also in other organs by using all available dedicated small animals imaging techniques.

Background Percutaneous Achilles tendon repair has been developed to minimise soft tissue complications following treatment of tendon ruptures. However, there are concerns because of the risk of sural nerve injury. Few studies have investigated the relationship between the Achilles tendon, the sural nerve and its several anatomical course variants. Methods We studied 7 cadaveric limbs (7 Achilles tendons) in which a percutaneous repair of the Achilles tendon was performed. On each tendon, high resolution real time ultrasonography examination was performed by an experienced musculoskeletal radiologist before and after the procedure, with the surgeons blind to the results of the scan both before and after surgery. Results In two instances, high resolution real time ultrasonography examination revealed nerve entrapment at the level of most proximal lateral suture. Conclusions Since the sural nerve can be easily visualised using high-frequency high resolution real time ultrasonography, intraoperative ultrasound can be of assistance during percutaneous repair of Achilles tendon rupture. Clinical relevance The sural nerve can be readily visualised by high-frequency high resolution real time ultrasonography probes. It could be beneficial to use high resolution real time ultrasonography intraoperatively or perioperatively to minimise the risks of sural nerve injury when undertaking percutaneous repair of Achilles tendon tears.

The pathogenesis of acute ischaemic colitis depends on two different forms of vascular colonic insult: occlusive injury and non-occlusive injury. Clinically, ischaemic colitis may be classified as two major forms: mild (non-gangrenous) and acute fulminant (gangrenous). The classic presentation is abdominal pain, diarrhoea and/or rectal bleeding, but it is not specific and highly variable and so the diagnosis usually depends on clinical suspicion and is supported by serologic and colonoscopic findings. Imaging methods have their role in diagnosing IC. While plain radiography and ultrasound can orient the diagnosis, CT allows to define the morphofunctional alterations discriminating the non-occlusive forms from the occlusive forms and in most cases to estimate the timing of ischaemic damage. Purpose of the review is to define the role of CT in the early identification of pathological findings and in the definition of evolution of colonic ischaemic lesions, in order to plan the correct therapeutic approach, suggesting the decision of medical or surgical treatment.

Among patients admitted in emergency departments for acute cervical spine trauma, only a few have a confirmed and significant injury requiring surgical intervention. Imaging plays a key role in screening for unstable lesions that can be responsible for devastating neurologic complications or death. The complex anatomy of the cervical spine is associated with a wide spectrum of osseous and ligamentous pathologies. This review focuses on the imaging features of the main cervical spine fractures that can be encountered in emergency radiology.

The aim of this study was to find whether there are manometric pharyngeal changes that may have diagnostic and prognostic relevance in the amyotrophic lateral sclerosis (ALS) patient who does not show changes in contrast-medium oropharyngeal transit in a videofluoroscopic swallowing study. Ten ALS patients, with an ALS Severity Scale Score of at least 7, no need to change dietary habit, no aspiration and/or penetration, and no other changes in contrast-medium oropharyngeal transit, were collected from our institution’s database of videofluoromanometric swallowing studies. They were included in the study together with a group of 11 healthy volunteers. For each subject, 12 manometric items—7 for the pharyngeal phase and 5 for UES functionality—were evaluated. Statistically significant differences between the ALS patients and the healthy volunteers were found for pharyngeal contraction time of the upper region (median = 1,120, range = 880–1,420 vs. median = 970, range = 800–1,140), pharyngeal contraction time of the intermediate region (median = 1140, range = 960–1,360 vs. median = 770, range = 280–1,180), pharyngeal contraction time of the lower region (median = 1,320, range = 920–1,760 vs. median = 800, range = 620–1,780), and residual pressure after the relaxation of the UES (median = 2.2, range = −20.2 to 27.8 vs. median = −5.7, range = −2.9 to 8.4). A videofluoromanometric swallowing study may show an increase in the pharyngeal contraction time and in residual pressure after relaxation of the UES in ALS patients without videofluoroscopic changes in contrast-medium oropharyngeal transit.

Photoacoustic imaging is an emerging modality that exploits the photoacoustic effect to combine the high contrast of optical imaging with the spatial resolution and penetration depth of ultrasound. A key feature of PA imaging methods is that they exploit optical contrast but employ US detection principles. The PA effect offers a way to take advantage of the ability of light to penetrate into the body and let us defeat light diffusion by using US waves to “see” the penetrating light. The main advantage of this hybrid approach is that the optical properties of biological tissue, including high contrast and spectral specificity, are encoded in an ultrasound signal. Resolutions of better than 1 mm can be obtained at depths measured in centimeters (up to 7) and not in millimeters, depending on the laser wavelength and transducer frequency used, opening up entirely new regimens of “optical imaging.” From a clinical standpoint, PA imaging is complementary in nature and synergetic with US and a combined US and PA imaging system can be easily implemented due to the presence of a shared detector and associated electronics. Furthermore, such a system will be readily accepted by clinicians familiar with US imaging.

This study was undertaken to identify the early magnetic resonance imaging (MRI) findings of small bowel obstruction (SBO) and to analyse their evolution over time comparing them with histological findings. SBO was surgically induced in 10 rats divided into two groups monitored at predetermined time points until the 8th hour: group 1, macroscopically observed and group 2, investigated with 7-Tesla micro-MRI (7T μ-MR). At the end of observation, the bowel was excised for histological analysis. 7T μ-MRI T2-w sequences acquired 15 min after SBO, showed early evidence of bowel wall hyperintensity and a small amount of peritoneal free fluid. At 1 h, a hyperintensity of the loop proximal to the obstruction was found and, after 4 h, free fluid between the loops, bowel wall thickening and increased wall hyperintensity were also found. After 6 h hypotonic reflex ileus (only gas-filled dilated loops) was detected, which became paralytic ileus (dilation with air–fluid levels) after 8 h. The MRI findings were all confirmed at histological examination. This study allows definition of the early MRI features of SBO (peritoneal free fluid and hyperintensity of the injured bowel) and their chronological evolution, also confirmed by histological examination. Our data suggest a potential role of MR imaging in the early diagnostic assessment and management of patients with SBO. The chance to achieve an early detection of bowel injury and to correlate the histological pattern with imaging findings could contribute to a finer and earlier diagnosis and a more effective treatment.

Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled cysts are located in the bowel wall; it can represent a wide spectrum of diseases and a variety of underlying diagnoses. The present report describes the case of an 86-year-old man with symptomatic primary PI of small bowel treated with surgical approach after periodic episodes of cysts rupture and superimposed inflammation revealed on the basis of a clinical suspicion thanks to abdominal computed tomography. Moreover, after one year of followup, there has been no recurrence of digestive symptoms.

"OBJECTIVES: . . The aim of this study is to analyze the chronological development of macroscopic, microscopic and magnetic resonance imaging (MRI) findings in a rat model of Superior Mesenteric Venous (SMV) ligation, and to evaluate the role of MRI in the diagnosis of mesenteric venous thrombosis.. . METHODS: . . Thirty adult Sprague-Dawley rats were used and divided in two different groups that underwent a different surgical model and a different monitoring of ischemic damage. Group I underwent macroscopical and histological observation; Group II underwent 7T μMRI evaluation and histological analysis.. . RESULTS: . . The first alterations occurred 30 min after SMV ligation and progressively worsened until the eighth hour. The morphological and MRI findings showed the same course.. . CONCLUSIONS: . . This study provides a systematic evaluation of early anatomopathological and MRI findings following the SMV ligation. MRI allows to identify the early pathological findings of venous mesenteric ischemia and allows to correlate those to the histopathological features. Our data suggest a relevant role of MRI in the diagnostic management of mesenteric venous thrombosis, allowing to non-invasively identify and characterize the histopathologic findings. So, thanks to these skills, its future application in early diagnosis of human mesenteric venous ischemia is supposable.. "

Small-bowel neoplasms are the 3%–6% of all gastrointestinal tract neoplasms. Due to the rarity of these lesions, the low index of clinical suspicion, and the inadequate radiologic examinations or incorrect interpretation of radiologic findings, a delay in diagnosis of 6–8 months from the first symptoms often occurs. Even if conventional enteroclysis and capsule endoscopy are the most common procedures used to accurately depict the bowel lumen and mucosal surface, their use in evaluating the mural and extramural extents of small-bowel tumors is limited. Instead multidetector computed tomographic enteroclysis and magnetic resonance enteroclysis have the potential to simultaneously depict intraluminal, mural, and extraintestinal abnormalities. In particular MR enteroclysis has an excellent soft tissue contrast resolution and multiplanar imaging capability. It can provide anatomic, functional, and real time information without the need of ionizing radiation. MR findings, appearances of the lesions, combined with the contrast-enhancement behavior and characteristic of the stenosis are important to differentiate small-bowel neoplasm from other nonneoplastic diseases.

Dedicated small animal imaging represents an innovative and fast-growing tool that has demonstrated promising results in the field of preclinical research. New technologies constitute a key factor in the success and timelines of research because of the possibility of conducting longitudinal studies on the same animal. In this chapter, we report an example from our experience with the analysis of bowel ischemia via micro–magnetic resonance imaging to highlight the use of preclinical imaging as a helpful support to the pathophysiological comprehension of diseases.

Recent development of ultra high-resolution ultrasound systems, with frequencies as high as 70 MHz and capability resolution as fine as 30 μm, could permit new diagnostic applications to small parts. A variety of superficial targets within the first 1 cm of the skin surface could be imaged, including dermatological applications such as assessment of skin layers, hair follicles and the nail unit. Nail disorders are frequent but they are diagnosed mainly based on clinical examination; although biopsies and scrapings can provide clinically significant information, most patients do not perceive biopsies positively. To image the skin layer and annexes is often difficult with conventional ultrasound but, because of anatomical details obtained with the newest systems, this method holds great promise for addressing important biomedical applications offering unique advantages over the existing non-invasive imaging modalities. This will enable physicians to assess and manage the conditions involving the nails of a large and growing segment of the population in a better way.

Alimentary tract perforation is a frequent emergency condition. Imaging plays an important role to make an accurate diagnosis, defining the presence, the level, and the cause of the perforation, essential information to enable the most correct therapeutic choice. Plain radiography is generally performed as the first choice. In case of a clinically suspected bowel perforation, not detected on x-ray imaging, the contribution of computed tomography is essential. Magnetic resonance is not yet widely used in diagnostic workup of patients with acute abdominal pain, but it can be useful in the differential diagnosis of acute abdomen in specific patients (pregnancy and pediatric patients).

New and improved imaging methods have recently become available, assuming a crucial role not only in clinical practice—in which they are indispensable in the diagnostic evaluation and therapeutic management of patients—but also in preclinical research. In this field, miniaturized versions of clinical diagnostic modalities have greatly improved our ability to longitudinally study various animal models of human disease. These modalities include, but are not limited to X-ray, micro-ultrasonography, micro–magnetic resonance imaging, micro–computed tomography (CT), and radionuclide imaging such as micro–positron emission tomography and micro–single photon emission CT. This chapter describes the most common applications of the different instruments for diagnostic imaging and their relative advantages and disadvantages.

We compared the efficacy of non-anatomical lung resections with that of three other techniques: monopolar electrocautery; neodymium-doped yttrium aluminium garnet laser and harmonic technology. We hypothesized that the thermal damage with harmonic technology could be reduced because of the lower temperatures generated by harmonic technology compared with that of other devices. OBJECTIVES We compared the efficacy of non-anatomical lung resections with that of three other techniques: monopolar electrocautery; neodymium-doped yttrium aluminium garnet laser and harmonic technology. We hypothesized that the thermal damage with harmonic technology could be reduced because of the lower temperatures generated by harmonic technology compared with that of other devices. METHODS Initial studies were performed in 13 isolated pig lungs for each group. A 1.5-cm capsule was inserted within the lung to mimic a tumour and a total of 25 non-anatomical resections were performed with each device. The damage of the resected lung surface and of the tumour border were evaluated according to the colour (ranging from 0 - pink colour to 4 - black colour), histological (ranging from Score 0 - no changes to Score 3 - presence of necrotic tissue) and radiological (ranging from Score 0 - isointense T2 signal at magnetic resonance imaging to Score 3 - hyperintense T2 signal) criteria. A total of seven non-anatomical resections with harmonic technology were also performed in two live pigs to assess if ex vivo results could be reproducible in live pigs with particular attention to haemostatic and air-tightness properties. RESULTS In the ex vivo lung, there was a statistical significant difference between depth of thermal damage (P < 0.0001) in electrocautery (1.3 [1.2-1.4]), laser (0.9 [0.6-0.9]) and harmonic (0.4 [0.3-0.5]) groups. Electrocautery had a higher depth of thermal damage compared with that of the laser (P = 0.01) and harmonic groups (P = 0.0005). The harmonic group had a less depth of thermal damage than that of the laser group (P = 0.01). Also, histological damages of tumour borders (P < 0.001) and resected lung surface (P < 0.001), radiological damage of tumour borders (P < 0.001) and resected lung surface (P < 0.001) and colour changes (P < 0.001) were statistically different between three study groups. Resections of in vivo pig lungs showed no bleeding; 2 of 7 cases of low air leaks were found; however, they ceased by sealing lung parenchyma with harmonic technology. CONCLUSIONS Our experimental data support the resections performed with the use of harmonic technology. The lack of severe tissue alterations could favour healing of parenchyma, assure air tightness and preserve functional lung parenchyma. However, randomized controlled studies are needed in an in vivo model to corroborate our findings.

Alimentary tract perforations represent an emergency and life-threatening condition requiring prompt diagnosis and surgical treatment. The clinical diagnosis, particularly in the early stage, is difficult as the symptoms may be variable and nonspecific. The imaging plays an important role to determine the diagnosis and ensure an appropriate treatment to these patients. In this chapter, the diagnostic approach to alimentary tract perforations is discussed focusing on each of the following imaging methods: plain abdominal X-ray, ultrasound (US), computed tomography (CT), and magnetic resonance (MR). Plain abdominal X-ray still remains the most frequently requested imaging examination in the emergency department; the US and CT traditionally have been the dominant cross-sectional imaging modalities for evaluating acute thoracic, abdominal, and pelvic conditions; MR can be useful in the differential diagnosis of acute abdomen in specific patients.

Contrast enhancement of the vertebral body marrow may be seen secondary to collateral venous blood flow via the vertebral venous plexus in the setting of superior vena cava obstruction. We report a 48-year-old woman presenting with bilateral brachiocephalic vein obstruction and multilevel thoracic spine hyperdensities as seen on venous-phase CT angiography (CTA), initially concerning for sclerotic neoplastic lesions. A contrast-enhanced CT of the neck obtained 1 day prior to the chest CTA did not demonstrate any osseous abnormality, and inspection of the chest CTA demonstrated filling of perivertebral venous collateral vessels. The abnormal vertebral body enhancement was therefore feltsecondary to retrograde collateral venous flow via the basivertebral venous plexus in the setting of functional SVC obstruction. Vertebral body enhancement should be considered in patients with thoracic central venous obstruction when enhancement or apparent sclerosis of the vertebral bodies is seen on CTA.

Purpose. This paper aims at evaluating CT findings of occlusive and nonocclusive ischemic colitis (IC), in correlation with the etiology and the different phases of the disease.Materials and Methods. CT examination and clinical history of 32 patients with proven IC were retrospectively reviewed. The CT findings were analyzed according to the different phases of the disease (acute, subacute, and chronic).Results. Among the 32 CT examinations performed in the acute phase, 62.5% did not present signs of occlusion of the superior mesenteric artery (SMA) or inferior mesenteric artery (IMA), whereas IMA occlusion was detected in 37.5% of CT examinations. In the acute phase, the presence of pericolic fluid was found in 100% of patients undergoing progressive resorption from acute to subacute phase if an effective reperfusion occurred; the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in subacute phase. The unthickened colonic wall was found in all conditions where ischemia was not followed by effective reperfusion (71.9% of cases), and it was never found in chronic phase, when the colon appeared irregularly thickened.Conclusion. CT allows determining the morphofunctional alterations associated with the IC discriminating the occlusive forms from the nonocclusive forms. CT, furthermore, allows estimating the timing of ischemic damage.

Objectives The aim of this study was to detect the onset, evolution, and meaning of extraluminal free fluid in a rat model of small-bowel obstruction using high-frequency microsonography. Methods Small-bowel obstruction was surgically created in 8 rats divided into 2 groups of 4 rats each. All rats were examined by high-frequency microsonography to monitor the evolution of small-bowel obstruction and the abdominal sonographic findings. In group 2 rats, the obstruction was resolved 2 hours after surgery. Results In all rats, free peritoneal fluid was detected just near the obstructed loop after 1 hour and in the hepatorenal recess after 2 hours. These features progressively increased in the following hours in group 1 rats. In group 2, the amount of free fluid decreased shortly after removing the obstruction. Conclusions Free fluid is an early finding in small-bowel obstruction, and the increase or decrease of its amount is correlated with the worsening or resolution of the obstruction.

Intestinal intussusception in adults is a rare condition, accounting for about 0.003–0.02 % of all hospital admissions. This condition in adults represents only 5 % of all cases of intussusceptions and is different from paediatric intussusception, which is usually idiopathic. In contrast, almost 90 % of cases in adults are secondary to various pathologies that serve as a lead point, such as polyps, Meckel’s diverticulum, colonic diverticulum, or malignant or benign neoplasm. The aim of the present study was to assess the capabilities of multislice computed tomography (MSCT) in the diagnosis and correct characterisation of intussusception, especially in distinguishing between intussusceptions with a lead point and those without. Indeed, although the MSCT findings that help to differentiate between lead point and non-lead point intussusceptions have not been well studied, abdominal MSCT remains the most sensitive radiological tool to confirm bowel intussusceptions. Moreover, differentiating intussusceptions with a lead point condition from those without is crucial for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary.

Background: Dysphagia consists in alteration of the swallowing mechanism, due to different pathological conditions, which can occur at different levels. The exact prevalence of dysphagia is unclear, even if some AA suggest that 15% of the elderly population is affected. Aim of this study is to analyze the main VFMSS findings in elderly dysphagic patients. Materials and methods: The VFMSS of 59 elderly dysphagic patients (32 women, 27 men, ranging in age from 68 to 89 years, mean 81 years) who undergone speech therapy assessment and videofluoromanometric (VFM) investigation of the swallowing process at our institution from January 2011 and December 2012, were retrospectively reviewed. Results: In the oral phase the preparation and the initial stage of swallowing should be explored by videofluoroscopy evaluating the ability to contain food in mouth and to form a bolus and whether there is an inadequate convergence of Passavant’s ridge with preswallowing aspiration. In the pharyngeal phase is necessary to evaluate at videofluoroscopy if there is penetration and/or aspiration and the efficacy of laryngeal closure should be assessed too. The major manometric indicators are: proximal pharyngeal pressure (mmHg), distal pharyngeal pressure (mmHg), relaxation and coordination of upper esophageal sphincter (UES). In the esophageal phase is important to evaluate the esophageal motility and the presence of peristalsis. The manometric parameters used for LES were resting pressure, total length and percentage of post-deglutitive relaxation. Conclusion: The VFSS represents a fundamental examination in the management of the dysphagic patient; this investigation may be associated with manometry providing anatomical and functional informations.

Background Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods Basing on our institutions experience, 163 cases of mesenteric ischemia/infarction from various cases, investigated with CT and undergone surgical treatment were retrospectively evaluated, in particular trought the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial, venous) and non occlusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion The radiological findings of mesenteric ischemia have different course in case of different etiology. In venous etiology the progression of damage results faster than arterial even if the symptomatology is less acute; bowel wall thickening is an early finding and easy to detect, simplifying the diagnosis. In arterial etiology the damage progression is slower than in venous ischemia, bowel wall thinning is typical but difficult to recognize so diagnosis may be hard. In the NOMI before/without reperfusion the ischemic damage is similar to AAMI with additional involvement of large bowel parenchymatous organs. In reperfusion after NOMI and after AAMI the CT and surgical findings are similar to those of AVMI, and the injured bowel results quite easy to identify. The prompt recognition of each condition is essential to ensure a successful treatment.

PURPOSE: Acute mesenteric ischaemia (AMI) is a life-threatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution. METHODS: Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the first group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI. RESULTS: Macroscopically, a reflex spastic ileus followed by reflex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fluid levels, free intraperitoneal fluid and bowelwall oedema. Histological analysis confirmed ischaemia and earlier damage involving the central portion of the ileum. CONCLUSIONS: This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.

Background Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods Basing on experience of our institutions, over 200 cases of mesenteric ischemia/infarction investigated with both US and CT were evaluated considering, in particular, the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial,venous) and nonocclusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion At present, the reference diagnostic modality for intestinal ischaemia is contrast-enhanced CT. However, there are some disadvantages associated with these techniques, such as radiation exposure, potential nephrotoxicity and the risk of an allergic reaction to the contrast agents. Thus, not all patients with suspected bowel ischaemia can be subjected to these examinations. Despite its limitations, US could constitutes a good imaging method as first examination in acute settings of suspected mesenteric ischemia.

In the elderly there seems to be an increase in functional and motility disorders of the gastrointestinal tract. Among them dysphagia is one of the more serious conditions since it can lead to severe consequences, such as malnutrition, dehydration, aspiration pneumonia or airway obstruction.

Gastrointestinal tract ischemia and infarction comprises different clinical syndromes characterized by inadequate blood perfusion to the bowel. The age of onset depends on gender and the etiology of the ischemia, even if the majority of patients are over age 60. These disorders have been increasing over the past decade and constitute approximately 1–2 % of admissions for abdominal pain in the USA and 3.7 % of surgical intervention for acute abdomen in Italy. The increase in incidence can be attributed to various factors, including increased clinical awareness, aging population, and improvement in diagnostic imaging techniques. The mortality rate is very high, between 50 and 90 %, hence, timely diagnosis is essential to improve the outcome. The pathogenesis and symptoms of intestinal ischemia are extremely variable, and the diagnosis largely depends on clinical suspicion.

To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting.A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n = 8), autopsy (n = 2), angiography (n = 1) or endoscopy (n = 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, Kolmogorov-Smirnov (K-S) and Fisher's exact tests were used for statistical analysis.A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D = 0.75, p = 3.7 × 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p = 0.026), bowel wall thickening (p = 3.2 × 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p = 2.8 × 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p = 0.034).Analysis of not only vessels findings but also mesentery and bowel CT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists.CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting.

Ischemic colitis (IC) is the most common vascular disorder of the gastrointestinal tract with a reported incidence of 6.1-44 cases/100,000 person years with confirmatory histopathology. However, the true incidence of IC poses some difficulty, and even vigilant clinicians with patients at high risk often miss the diagnosis, since clinical presentation is non-specific or could have a mild transient nature. Detection of IC results is crucial to plan the correct therapeutic approach and reduce the reported mortality rate (4-12%). Diagnosis of IC is based on a combination of clinical suspicion, radiological, endoscopic and histological findings. Some consider colonoscopy as a diagnostic test of choice; however, preparation is required and it is not without risk, above all in patients who are severely ill. There are two manifestations of vascular colonic insult: ischaemic and reperfusive. The first one occurs above all during ischaemic/non-occlusive mesenteric ischaemia; in this case, the colonic wall appears thinned with dilated lumen and fluid appears in the paracolic space. When reperfusion occurs, the large bowel wall appears thickened and stratified, because of subepithelial oedema and/or haemorrhage, with consequent lumen calibre reduction. Shaggy contour of the involved intestine and misty mesentery are associated with the pericolic fluid. The pericolic fluid results are a crucial finding for IC diagnosis since its evidence suggests the presence of an ongoing damage thus focusing the attention on other pathological aspects which could be otherwise misdiagnosed, such as thinned or thickened colonic wall. Moreover, the pericolic fluid may increase or decrease, depending on the evolution of the ischaemic damage, suggesting the decision of medical or surgical treatment. Radiologists should not forget the hypothesis of IC, being aware that multidetector CT could be sufficient to suggest the diagnosis of IC, allowing for early identification and grading definition, and in a short-term follow-up, discriminating patients who need urgent surgery from patients in whom medical treatment and follow-up can be proposed.

Plain abdominal radiography and computed tomographic (CT) enteroclysis are 2 essential radiological investigations in the study of gastrointestinal tract. Errors in patient preparation, execution, and interpretation may lead to severe consequences in the diagnosis and thus in patient outcome. Abdominal radiography is one of the most frequently requested radiographic examinations, and has an established role in the assessment of the acute abdomen. CT enteroclysis has revolutionized the assessment of small-bowel pathology, especially in patients with inflammatory bowel. The purpose of this article is to describe the pitfalls in the execution and interpretation of plain abdominal film and CT enteroclysis.

Physicians are subjected to an increasing number of medical malpractice claims, and radiology is one of the specialties most liable to claims of medical negligence The etiology of radiological error is multifactorial, deriving by poor technique, failures of perception, lack of knowledge, and misjudgments. Reducing errors will improve patient care, may reduce costs, and will improve the image of the hospital. The main reason for studying medical errors is to try to prevent them. This article focuses on the spectrum of diagnostic errors in radiology, including a classification of the errors, and highlights the malpractice issues in methods for functional alimentary tract examination: swallowing act study, 3-dimensional endoanal ultrasound, defecography, and defecography in magnetic resonance.

To investigate the effectiveness of head compensatory postures to ensure safe oropharyngeal transit.A total of 321 dysphagia patients were enrolled and assessed with videofluoromanometry (VFM). The dysphagia patients were classified as follows: safe transit; penetration without aspiration; aspiration before, during or after swallowing; multiple aspirations and no transit. The patients with aspiration or no transit were tested with VFM to determine whether compensatory postures could correct their swallowing disorder.VFM revealed penetration without aspiration in 71 patients (22.1%); aspiration before swallowing in 17 patients (5.3%); aspiration during swallowing in 32 patients (10%); aspiration after swallowing in 21 patients (6.5%); multiple aspirations in six patients (1.9%); no transit in five patients (1.6%); and safe transit in 169 patients (52.6%). Compensatory postures guaranteed a safe transit in 66/75 (88%) patients with aspiration or no transit. A chin-down posture achieved a safe swallow in 42/75 (56%) patients, a head-turned posture in 19/75 (25.3%) and a hyperextended head posture in 5/75 (6.7%). The compensatory postures were not effective in 9/75 (12%) cases.VFM allows the speech-language the-rapist to choose the most effective compensatory posture without a trial-and-error process and check the effectiveness of the posture.

Background: In recent years, several new technologies for small-animal imaging have been developed. In particular, the use of ultrasound in animal imaging has focused on the investigation of accessible biological structures such as the heart, of which it provides a morphological and functional assessment. The purpose of this study was to investigate the role of micro-ultrasonography (μ-US) in a longitudinal study on BIO14.6 cardiomyopathic hamsters treated with gene therapy. Methods: Thirty hamsters were divided into three groups (n = 10): Group I, untreated BIO 14.6 hamsters; Group II, BIO 14.6 hamsters treated with gene therapy; Group III, untreated wild type (WT) hamsters. All hamsters underwent serial μ-US sessions and were sacrificed at predetermined time points. Results: μ-US revealed: in Group I, progressive dilation of the left ventricle with a change in heart morphology from an elliptical to a more spherical shape, altered configuration of the mitral valve and subvalvular apparatus, and severe reduction in ejection fraction; in Group II, mild decrease in contractile function and ejection fraction; in Group III, normal cardiac chamber morphology and function. There was a negative correlation between the percentage of fibrosis observed at histology and the ejection fraction obtained on μ-echocardiography (Spearman r: -0.839; p < 0.001). Conclusions: Although histological examination remains indispensable for a conclusive diagnosis, high-frequency μ-echocardiography, thanks to the high spatial and contrast resolution, can be considered sufficient for monitoring therapeutic efficacy and/or the progression of dilated cardiomyopathy, providing an alternative tool for repeatable and noninvasive evaluation. Background: In recent years, several new technologies for small-animal imaging have been developed. In particular, the use of ultrasound in animal imaging has focused on the investigation of accessible biological structures such as the heart, of which it provides a morphological and functional assessment. The purpose of this study was to investigate the role of micro-ultrasonography (-US) in a longitudinal study on BIO14.6 cardiomyopathic hamsters treated with gene therapy. Methods. Thirty hamsters were divided into three groups (n = 10): Group I, untreated BIO 14.6 hamsters; Group II, BIO 14.6 hamsters treated with gene therapy; Group III, untreated wild type (WT) hamsters. All hamsters underwent serial -US sessions and were sacrificed at predetermined time points. Results: -US revealed: in Group I, progressive dilation of the left ventricle with a change in heart morphology from an elliptical to a more spherical shape, altered configuration of the mitral valve and subvalvular apparatus, and severe reduction in ejection fraction; in Group II, mild decrease in contractile function and ejection fraction; in Group III, normal cardiac chamber morphology and function. There was a negative correlation between the percentage of fibrosis observed at histology and the ejection fraction obtained on -echocardiography (Spearman r: -0.839; p < 0.001). Conclusions: Although histological examination remains indispensable for a conclusive diagnosis, high-frequency μ-echocardiography, thanks to the high spatial and contrast resolution, can be considered sufficient for monitoring therapeutic efficacy and/or the progression of dilated cardiomyopathy, providing an alternative tool for repeatable and noninvasive evaluation. © 2011 Belfiore et al; licensee BioMed Central Ltd.

Acute mesenteric ischaemia (AMI) is a life-threatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution.Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the first group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI.Macroscopically, a reflex spastic ileus followed by reflex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fluid levels, free intraperitoneal fluid and bowelwall oedema. Histological analysis confirmed ischaemia and earlier damage involving the central portion of the ileum.This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.