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BACKGROUND AND PURPOSE: The identification of plaque characteristics that determine its vulnerability is extremely important. The purpose of this work was to evaluate CPE after administration of contrast material and to assess whether there is a statistical association between CPE and cerebrovascular symptoms. MATERIALS AND METHODS: Ninety-seven consecutive patients (69 men, 28 women; mean age, 62 years; age range, 39–82 years), studied by using an MDCT scanner, were retrospectively analyzed. Examinations were performed before and after administration of contrast medium. Plaque enhancement was analyzed, and the obtained data were compared with the patient9s symptoms. Patients were classified as symptomatic (TIA or stroke with a temporal window of 6 months) or asymptomatic according to neurologic assessment and the TOAST criteria. The ROC curve and Az were calculated, and multiple logistic regression analysis was performed. RESULTS: Thirty-nine patients were excluded because they had calcified plaques (40.2%). CPE was observed in 74% of the remaining 58 patients. A statistically significant difference was observed between symptomatic and asymptomatic patients for the presence of CPE (P = .0013; OR = 7.5). Moreover, we observed that CPE was higher in fatty plaques (P = .035) than in mixed ones and more frequent in the former (P = .0119). The ROC curve demonstrated that a threshold of 15 HU is associated with a specificity and sensitivity of 83.33% and 76.47%, respectively. Multiple logistic regression showed that CPE and symptoms are associated (P = .0315). CONCLUSIONS: The results of our study suggest that for noncalcified carotid plaques, the presence of CPE is associated with cerebrovascular symptoms. Fatty plaques are more likely to have CPE compared with mixed plaques.

Purpose: Carotid artery plaque with a disrupted fibrous cap is characterized by a higher tendency to rupture, resulting in a higher rate of transitory ischemic attack and stroke. The purpose of our study was to evaluate whether there is a statistically significant correlation between the presence of fissured fibrous cap (FFC) (assessed by using multi-detector-row CT angiography (MDCTA)) and ipsilateral symptomaticity. Material and Methods: 147 patients (105 males, 42 females; mean age 63 years, range 37–84) with a stenosis of at least 50% or a plaque alteration at sonography were retrospectively studied, yielding a total of 294 carotid arteries, by using a multi-detector-row CT (MDCT) scanner. A search for detection of FFC and a correlation with previously registered data about patients’ symptomaticity by using statistical assessment were performed. Each examination was assessed independently by two readers and interobserver agreement was calculated. Results: Among the 147 patients included in the study group, 15 were excluded because of inadequate quality images. In the 132 remaining patients, for a total of 264 carotids assessed, 30 FFCs were detected by using MDCTA and overall there were 36 symptomatic patients (12 ipsilateral symptomatic patients with FFC). A statistical correlation between the presence of FFC and symptomaticity (p = 0.0032) was found. The κ value between readers was 0.781. Conclusions: MDCT may depict FFC and the results of our study suggest that FFC may be used as an indicator for prediction of potential cerebrovascular pathology. The interobserver agreement obtained was good.

The prevalence of infertility in the United States is 15-20% and this condition represents an important medical problem. The purpose of this work was to evaluate therapeutical efficacy of 2 consecutive hysterosalpingography (HSG) followed each other after 4 week compared with the fallopian tube recanalization (FTR).Two groups of 80 patients paired for mean age and age range (age range, 23-37 years; mean age, 30 years), were assessed for pregnancy rate (two-year follow-up) by using two consecutive HSG in one group and HSG and tube recanalization in the second group. Pain perception and dose delivered were assessed. Statistical analysis was performed to evaluate significant differences between the two approaches.Pregnancy rate after TFR was 51% whereas pregnancy rate after two consecutive HSG was 31.3% (P= 0.016; OR 2.31) and all the pregnancies were observed in those women that showed a positive variation in second HSG with a pregnancy rate of 47% (P=0.776; OR=1.18). In one case a serious complication was observed (1.25%): a tubal perforation. Minor bleeding sometimes lasted for as long as 48 h but never required any medical treatment. Pain assessment and dose delivered were statistically different by using these two methods (P= 0.027 and P0.001, respectively)Therapeutical efficacy of two consecutive HSG followed each other after four week compared with the FTR are similar when the second HSG shows the presence of Fallopian tube patency.

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

We report the case of a 49-year-old man admitted to our Institute because he suffered acute abdominal pain induced by eating. Sonography don't revealed pathological findings. Then underwent a multi-detector row computed tomography angiography (MDCTA) that revealed an intimal flap separating true and false lumens that was located 2 cm from the origin of the superior mesenteric artery (SMA) and with an extension of 8 cm. Since the dissection was limited without occlusion of the SMA and the mesenteric marginal artery served as a collateral vessel on the distal side of the SMA, the treatment has been conservative. Improved CT technology facilitates the diagnosis of superior mesenteric artery dissection. Prompt diagnosis and treatment result in the lowest mortality rate and minimize the prevalence of intestinal infarction. Only 107 cases (including the present case) of isolated spontaneous SMA dissection without associated aortic dissection were identified from the literature.

Abdominal aortic aneurysms (AAA) are an important cause of death in elderly men. Most used treatment options are endovascular aneurysm repair (EVAR) and open surgical repair. After the endovascular stent graft placement, however, several complications may occur and an important complication of EVAR is endoleak formation which occurs in approximately one-fourth of patients. Endoleak represents a blood flow outside the stent graft lumen but within the aneurysm sac. For these reasons, unlike the minimal imaging follow-up that is typically performed after surgical repair, patients undergoing EVAR require a life-long postoperative surveillance imaging. In the last years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (multidetector CT angiography, MDCTA), CT imaging became the most commonly used examination for endoleak detection. Moreover, the volume data obtained can be further rendered to generate high quality two-dimensional (2D) and three-dimensional (3D) images, that allow a better distinction between Endoleak type II, III and IV. Purpose of this study was to review and describe MDCTA potentialities in the detection of endoleak after EVAR procedures.

The aim of this paper was to analyze the concept of volume rendering (VR) technique in order to define and visualize the muscles by using multi-detector-row computed tomography (MDCT) scanner. Second, to understand the current indications for performing MDCT study of the muscles underlining radiation exposure and diagnostic efficacy. Thanks to the use of fast scanning and thin collimation, MDCT can obtain near-isotropic voxels, providing an excellent image detail. Moreover, with the use of postprocessing procedures it is possible to obtain volumetric images with an impressive visual impact (dissection-like images). With the use of correct techniques, in particular VR reconstruction, it is currently possible to define body musculature detecting pathological alterations. The aim of this review was to describe the procedure to obtain a correct visualization of the body muscles and to show volume rendered images supplied by this postprocessing technique. The authors retrospectively studied 30 patients by using a MDCT. Each time projection data were reconstructed to generate section thickness as thinnest as possible which were then reprocessed to obtain VR images. For the whole patient cohort the authors generated multiple VR reconstructed images in order to define the most efficient strategies to evaluate the different types of muscles. MDCT can provide excellent visualization of the superficial musculature, in particular it defines with accuracy normal anatomy. A correct reconstruction of projectional data is important to achieve high quality images.

Osteoma is an uncommon benign slow growing neoplasm of the bone, characterized by proliferation of osteoblasts forming bone trabeculas in a connective tissue stroma. After paranasal sinus, mandible is its second most frequent location. The osteoma can be central, peripheral or of extraskeletal type. Peripheral osteomas are quite uncommon. This fact suggests that peripheral osteoma of the mandible may be traumatically damaged, mostly because of muscle traction. This paper reports a case of peripheral osteoma located in the mandible. The patient underwent a multi-detector-row computed tomography (MDCT) in order to plan corrective surgery. MDCT images were post-processed with volume rendering techniques.

Stroke is the third leading cause of mortality in the world and the stenosis degree is considered a fundamental parameter for the definition of the therapeutic approach. With the development of Multi-Detector-Row CT (MDCTA) scanner, computed tomography has become a widely used imaging technique for categorizing carotid artery stenosis degree. The purpose of this paper is to compare two CT post-processing procedures, maximum intensity projection (MIP) and multi planar reconstruction (MPR) in order to evaluate their sensitivity and inter-technique agreement.For the purpose 45 patients (35 males and 10 females), that underwent MDCTA for carotid artery evaluation, have been retrospectively evaluated. Data set were processed with the study group's workstations, by using MPR and MIP algorithms. Each patient was assessed for stenosis degree by using North American Symptomatic Carotid Endarterectomy Trial method. Statistic analysis was performed to determine the sensitivity of the used procedure. The Cohen kappa test was applied to assess the level of intra-observer agreement. Image quality was also evaluated.MPR sensitivity was 87.8% (95% confidence interval [CI] 81-94.5%) and MIP sensitivity was 91.1% (95% CI 85.2-97%). Agreement in MPR was 0.792 with a standard error (SE) of 0.066, and agreement in MIP was 0.836, with a SE of 0.072.Results of the study indicate the MIP algorithm is more sensitive than MPR. Best intra-observer agreement and image quality results were also observed in the MIP. Data suggest also that MIP should be the post-processing procedure to be utilized in the evaluation of carotid artery stenosis degree, when using MDCTA. Presence of big calcified plaque can determine difficulties in MIP evaluation of stenosis degree.

Objective:Carcinoma cuniculatum is a rare variant of low-grade squamous cell carcinoma. We report the second case of carcinoma cuniculatum of the larynx in the literature.Method:Case report and review of the world literature concerning carcinoma cuniculatum of the larynx and upper aerodigestive tract.Results:A histologically proven carcinoma cuniculatum of the larynx is reported in a 72-year-old man. The patient underwent a supracricoid laryngectomy with crico-hyoidopexy, and was free of disease at 70 months after surgery. We emphasise the clinical presentation, histology and therapeutic approach of this rare tumour.Conclusion:To our knowledge this is the second report in the world literature of carcinoma cuniculatum of the larynx. Carcinoma cuniculatum of the larynx must be considered as a distinct ‘clinicopathological entity’ and close cooperation between the clinician and the pathologist is essential for the correct diagnosis of these tumour as regards to the correct classification and therapy.

The aim of this study was to evaluate the reported diagnostic efficacy of multidetector-row computed tomography (MDCT) for bowel ischemia and to identify the radiological signs that permit diagnosis. Based on a review of the literature, spiral CT sensitivity and specificity data were compared, as was the impact of last-generation CT scanner technology on the diagnosis of bowel ischemia. The data source was the PubMed database, from which 106 articles published in English from January 1998 to January 2006 were selected: 18 studies met the inclusion criteria. MDCT was reported to be more sensitive than CT for diagnosing bowel ischemia. The most frequent signs of disease were bowel wall thickening, intramural pneumatosis, mesenteric or portal venous gas, and mesenteric arterial or venous thromboembolism. The results of the literature review suggest that MDCT has high sensitivity for detecting bowel ischemia. Moreover, the use of MDCT angiography to evaluate abdominal vessels offers a better definition of vascular mapping and of the complications of bowel disease.

BACKGROUND AND PURPOSE: Carotid plaque ulceration is an important risk factor for stroke, and its diagnosis may be very important to plan a correct therapeutic approach. We hypothesized that axial scans and various reconstruction methods could have different specificity and sensitivity in the study of plaque ulceration. The object of this study was to evaluate their role and diagnostic efficacy in patients with carotid plaque complicated by ulceration through the comparison with surgical results. Materials and METHODS: From January 2004 to November 2005, 109 patients who underwent a carotid endarterectomy were analyzed using CT angiography for a total of 218 carotid arteries. We assessed every carotid for the presence of ulcerations. For each patient axial image, maximum intensity projection (MIP), multiplanar reconstruction (MPR), shaded surface display (SSD), and volume rendering (VR) reconstructions were obtained. RESULTS: Multidetector row CT angiography (MDCT) found 32 ulcerations; surgical confirmation underlined an overall 93.9% sensitivity (95% confidence interval [CI] 0.858–1.021), and a 98.7% specificity (95% CI, 0.961–1.012). Axial scans and volume rendering images demonstrated the highest sensitivity (90.9% and 87.9%, respectively); SSD, on the contrary, showed the lowest sensitivity: 39.4% (95% CI sensitivity, 0.227–0.561). CONCLUSION: Axial scans plus VR reconstruction techniques offer superior depiction of carotid plaque ulceration compared with MIP, MPR, and SSD.

We describe the case of a 72-year-old woman who presented a symptomatology characterized by recurrent episodes of confusion, weakness with cerebral vasculopathy. The high values of ammonium were correctly defined thanks to the diagnostic multidetector-row CT information and we referred the symptoms to porto-systemic shunts with the exclusion of hepatic vascularization due to an inferior vena cava stenosis.

PURPOSE AIM: To asses the diagnostic value of hysterosalpingo-contrast sonography (HyCoSy) with Levovist(R) as alternative to conventional hysterosalpingography (HSG) in the study of infertility.From September 1988 to March 2000 we evaluated 120 patients with a history of infertility. Thirty patients underwent both HyCoSy and HSG. HyCoSy was performed in the pre-ovulatory phase of mestrual cycle. The tecnique was the same for both examinations. After administering 15 ml contrast medium, we visualized the endometrial cavity, the flow of the contrast medium along the fallopian tubes and its passage into the peritoneum.In all cases Color-Power Doppler allowed visualization of the uterine cavity and of the spilling of the contrast medium into the peritoneum, yielding information on tube patency that was comparable to that obtained by conventional HSG. In 28 cases (93%) we obtained optimal visualization of the contrast medium at the level of both the endometrial cavity and the fallopian tubes. HyCoSy proved to be superior to conventional HSG in evaluating adjacent myometrial structures, adnexa and degree of follicular maturation, equal to HSG in visualizing the passage of the contrast medium into the peritoneum but inferior to HSG in imaging the fallopian tubes owing to their tortuosity.The absence of ionising radiation makes HyCoSy a possible first choice examination in the evaluation of fallopian tube pathology. Conventional HSG should be kept for doubtful cases or for surgical procedures to correct mono- or bilateral obstruction.

Fallopian tube catheterization with selective ostial [correction of osteal] salpingography is a new technique for the diagnosis of tubal factors of infertility and also for the treatment of proximal tubal occlusion (PTO). In this study, 246 women were considered, 20-42 years old, with primary or secondary infertility, who presented a unilateral or bilateral PTO at hysterosalpingography (HSG). Catheterization and selective salpingography have been successful in 93.9% of the cases. Failures (5.6%) have been ascribed to obstructive organic diseases, where it was impossible to overcome the stenosis with the catheter or the guide-wire. Twenty-six spontaneous pregnancies were obtained (15 full-term deliveries) and 17 patients became pregnant after GIFT (13 full-term deliveries). At follow-up, after 12 months 4 of 10 patients had normal tubes, while 6 patients presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, ectopic pregnancy is a possible event, because of the mechanically re-established patency in a nonfunctioning tube.

Technical and clinical data concerning 731 controlled patients submitted to nonsurgical percutaneous biliary drainage (PBD) for preoperative or palliative purposes were collected from eight institutions. Using a computerized analysis program, general and special statistics were obtained, with special attention given to 536 neoplastic cases. Technical success, type, level and nature of the lesions, purpose of drainage, surgery performed, complications, and other clinical and technical information were considered and compared with the clinical results. Statistically significant data were obtained comparing, respectively, bilirubin levels with duration of drainage, survival with type of treatment (PBD alone or followed by radical or palliative surgery), operative with post PBD mortality, survival with type of PBD (external catheter, internal catheter, and endoprosthesis), and complications with type of PBD used.

We have studied the elimination kinetics of iopamidol employing radioactivation and radiochemical separation. This method offers the advantage of guaranteeing absolutely no interference by radiation with tissue distribution or elimination kinetics of the analyzed compound. Our results show that iopamidol does not cross the blood-brain barrier, has no effect on thyroid iodine uptake and does not accumulate in the liver.

Changes in intrahepatic arterial blood flow after intraarterial injection of degradable starch microspheres (DSM) were studied in four patients undergoing hepatic arterial chemotherapy. All four livers contained metastases, three from colorectal cancer and one from melanoma. Using a CT scanner with a dynamic program, 8 mm liver sections were studied in each patient before and after the DSM infusion (180(-6) in 3 min). Density plots were obtained from 12 tumoral and 12 parenchymal areas after 5 ml push arterial injections of nonionic contrast medium. The areas under the curves (ID) were calculated. The ID after DSM infusion was reduced by 94% in a single hyperdense colorectal metastasis and by a mean of c. 82% in ten parenchymal areas. By contrast, nine hypodense colorectal metastases showed an average ID decrease of c. 156%. The ID of two melanoma metastases was reduced after DSM (-48% and -68%), while the ID of two matched parenchymal areas showed an approximately similar degree of increase (+36% and +64%). Since ID after contrast injection can be assumed to be a function of blood volume, mutual changes of parenchymal and tumoral blood flow appear to take place in metastases-bearing liver after arterial infusion of DSM. This phenomenon may be of diagnostic and therapeutic value for intraarterial chemotherapy of liver tumors.

This study analyzes the usefulness of two diagnostic methods: endorectal echotomography and adenolymphoscintigraphy. Echotomography is an important means for determining the extent of a tumor beyond the rectal wall, whereas lymphoscintigraphy is useful in demonstrating the metastatic locations in lymph nodes. These two modes of evaluation may permit an evaluation of the extent of the tumor and the possible involvement of regional lymph nodes before a surgical operation. Although the case material is limited, the statistical data can lead one to believe that, in the near future, a reasoned choice will be possible between local excision and abdominoperineal resection. The study includes 60 endorectal echotomographies and 26 lymphoscintigraphies (20 with 99mTc colloid and six with 201-Tl colloid).

The paper discusses the usefulness of endorectal echotomography and adenolymphoscintigraphy--two new diagnostic methods which allow surgeons to know preoperatively tumor extension beyond the rectal wall and lymph nodes involvement. Though the statistical data presented are not numerous, it is hoped that, using these two diagnostic methods in cases of rectal tumors, surgeons will be able to choose better between local excision and abdominoperineal resection thus avoiding unnecessary and mutilating operations.