Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model. / Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino.

OBJECTIVE: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. MATERIAL AND METHODS: Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. RESULTS: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). CONCLUSION: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered.

[Imaging of acute brain inflammatory disease]. / Imaging della patologia infiammatoria acuta dell'encefalo.

The central nervous system inflammatory disease can be due to any kind of infective agent (bacterial viral, fungal and parasitic), but entails also multiple sclerosis, a primary demyelinating disease in which the causal agent is unknown. MR imaging is, in most often, the procedure of choice, due to her multiplanar and multiparametric imaging, and to her better contrast resolution. The post-contrast imaging with double dose of gadolinium and late sequences enable visualisation of smallest pathologic foci or slightest blood-brain barrier alterations, with a sensibility very higher than post-contrast CT scan. In addition, RM provide to many functional informations, by means of diffusion, perfusion and spectroscopy studies, Bold technique for cortical activation studies and Fiber Tracking technique, in order to demonstrate pathologic modification earlier than they are evident on morphologic imaging. Functional imaging is also employed to monitor response to treatment and damage reversibility.

[Vertebral fractures: radiological diagnosis, differential diagnosis and prognostic implications]. / Fratture vertebrali: diagnosi radiologica, diagnosi differenziale e implicazioni prognostiche.

Vertebral fractures are a relevant problem for the heavy clinical implications and carrying disability. Vertebral fractures can be traumatic or pathologic, the latter can be benign or malignant, both mostly frequent in the elderly. An initial approach to this issue can use plain radiographs, but the correct extension and evaluation must involve CT and MR imaging. In particular MR is a useful tool for the prognostic evaluation of spine marrow injuries and the differential diagnosis of osteoporotic and metastatic fractures.

[Child abuse: imaging of multiorgan damages]. / Il bambino maltrattato: imaging dei danni multiorgano.

An abused child can present with every lesion known to medicine, but some of these lesions can be specific of child abuse. The most frequent skeletal lesions are that of the long bones, of the head and the chest. Head damages are responsible for 80% of the dead in abused child. These kind of lesions are very important because they can produce important neurological deficits. Most frequent are extraxial bleeding and intraparenchimal lesions. Abdominal damages are the second cause of dead in the abused child. They can be asymptomatic and so they can be misdiagnosed. They are not so frequent but if they are present, they are letal. Conventional radiology, CT and MRI are very important in the management of child abuse because they allow to reveal multiorgan damages which, in some instances, can be specific of a child abuse.

[New CT and MR imaging techniques in non-traumatic neurological emergencies]. / Nuove metodiche di imaging TC e RM per le emergenze neurologiche non traumatiche.

New CT and MR imaging techniques used for non-traumatic neurologic emergencies (represented mostly by ischemic stroke) fulfil the exigency to know quickly and with high accuracy the presence of abnormalities in cerebral perfusion, with the final aim to practise immediately all the treatments needed to prevent the progression of the neurologic damage, by selecting those patients to undergo fibrinolysis, which is useless and not indicated in many occasions. The diagnosis of ischemia is only the first goal reached by these new diagostic tools, while it is nowdays possible and required to stratify the risk factors for the therapy and to accurate select those patients candidates to fibrolnilysis, in order to minimize the risck related to the inadequate treatment choice.

[Neuroimaging of Alzheimer disease: current role and future potential]. / Neuroimaging del morbo di Alzheimer: ruolo attuale e potenzialità future.

Alzheimer disease (AD), the most common cause of dementia in the elderly, is a progressive neurodegenerative disorder, associated with deterioration in cognition and behaviour. With the availability of newer drugs for symptoms treatments there is a general agreement to the need of an early diagnosis and an the development of new sensitive tools, to identify and/or monitor early cerebral changes, suggestive for AD. CT and MRI are recommended for routine evaluation, in order to exclude treatable causes of dementia and to exactly evaluate the degree of cerebral atrophy and the presence of parenchymal signal abnormalities. Functional imaging, including PET, SPECT and functional MR techniques, are able to investigate physiological cerebral function, such as blood perfusion, metabolism, activation, molecular composition and water diffusibility, and have the potential to detect subtle pathological changes earlier during course of disease. MRI can provide both an accurate morphological assessment and a functional evaluation. Further investigations are needed to precisely define which will be the role of the different MR techniques. Most likely an exhaustive evaluation of AD will include information obtained by conventional and functional imaging, combined with clinical, laboratory and genetic findings.

[Role of magnetic resonance in shoulder disease]. / Ruolo della risonanza magnetica nella patologia della spalla.

Next to the knee, the shoulder is the most common joint to be referred for MRI. Excellent soft tissue contrast and multiplanar acquisition provide optimal assessment of muscle, tendons, hyaline and fibrous cartilage, joint capsule, fat, bursae and bone marrow. In this article the most common indications for shoulder MRI are reviewed and discussed, but we focused primarily on the rotator cuff syndrome and shoulder instability. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. Moreover, technical improvements continuously augment the ability of MRI to study the shoulder; for example Magnetic Resonance arthrography is superior to the other imaging techniques in evaluation of glenohumeral joint. This interdependence between technical development in MRI and clinical advance in shoulder therapy ensures that MRI will continue to play an important role in the routine management of patients with shoulder disease.

[The role of MRI in the diagnosis and evaluation of extension of the disease and condition of patients with neurofibromatosis]. / Ruolo della RM nella diagnosi, nel bilancio d'estensione e nella gestione dei pazienti affetti da neurofibromatosi.

Neurofibromatosis 1 (NF 1) and Neurofibromatosis 2 (NF 2) have been recently recognized to be distinct disorders through genetic linkages. MR imaging can be used to identify abnormalities of the head and spine in patients with these disorders. This review highlights some important but lesser known aspects of the two more common phakomatoses. The role of newer imaging technique such as contrast-enhanced MR imaging in the evaluation of these disorders also are discussed.

[Tumors of the nose, paranasal sinuses and facial bones: the role of computerized tomography and MRI in the assessment of the damage]. / Tumori del naso, dei seni paranasali e delle ossa facciali: apporto della tomografia computerizzata e della risonanza magnetica nell'accertamento della estensione della malattia.

The authors examine the use of CT and MR comparatively in tumours of nose, paranasal sinuses and facial bones. Both CT and MR are much more useful to assess the real extent of the pathology than to give specific diagnose. The resolution of the images and the possibility of examining them on many different planes give evident advantage to MR as regards the evaluation of tumors in this region. Nevertheless, CT with bone algoritme gives better details about bone structure.

[Magnetic resonance of the encephalon in 17 patients with ocular Behçet's disease]. / Risonanza magnetica dell'encefalo in 17 pazienti affetti da malattia di Behçet oculare.

Behçet's disease is a chronic relapsing disorder of unknown etiology characterized by oral aphthous ulcerations, uveitis, genital ulcerations and bone lesions. A variety of other signs including polyarthritis, vascular conditions (blood vessel occlusions and aneurysms), epididymitis, gastrointestinal, pulmonary and heart lesions may also occur. Central nervous system (CNS) involvement is reported in 10-49% of cases and it is the first symptom of the disease in 5% of subjects. The neuro-Behçet's syndrome may appear as a brainstem syndrome, meningoencephalitis and an organic confusional syndrome or dementia. Cranial hypertension, mostly related to cerebral venous thrombosis, is also present in neuro-Behçet's disease and its incidence is reported in up to 10% of Behçet's patients. MRI is reportedly the most sensitive neuroradiologic approach to detect the focal lesions related to neuro-Behçet's disease and several single cases or series of Behçet's patients with neurologic signs have been examined with MRI. We used MRI to investigate CNS involvement in Behçet's disease patients with and without previous neurologic signs. MRI was carried out on 17 patients with ocular Behçet's disease without neurologic symptoms to assess the possible subclinical involvement of the CNS. Cerebrospinal fluid spaces were enlarged in 8 patients and 5 patients exhibited cortical atrophy. PD and T2-weighted hypersignal foci were demonstrated in parietal, frontal, subcortical and periventricular white matter in 6 subjects. Neuroradiologic abnormalities were found only in the patients with complete disease and with the disease diagnosed more than 10 years earlier. Even though the pathogenesis of these neuroradiologic abnormalities and their correlation with Behçet's disease remain to be clarified, our study suggests the possibility of subclinical CNS involvement in these patients, which may affect the therapeutic approach and their prognosis.

[Imaging technics in the evaluation of malformations, traumatic and expansive disorders of the orbital region]. / Tecniche ad immagini nella valutazione della patologia malformativa, traumatica ed espansiva della regione orbitaria.

In this paper the authors evaluate the usefulness of the new radiological techniques in the study of the orbital region. They describe the role of modern computerized imaging in the planning of their correction of malformative and traumatic diseases of the orbit. Furthermore, the authors evaluate the usefulness of US, CT, and MR imaging in the differential diagnosis of growing masses of the orbit.

[Tumors of the oral cavity, oropharynx and salivary glands. Role of TC and MRI in neoplasm staging]. / Tumori del cavo orale, dell'orofaringe e delle ghiandole salivari. Ruolo della TC e della RM nella stadiazione.

MRI and CT have an important role in the study of neoplasms of oropharynx, oral cavity and salivary glands. They play an invaluable role in the diagnosis and in the evaluation of the tumor growth. Moreover MRI allows multiplanar studies with the advantage of a more sensitive evaluation of the extension of the lesions.

[The role of imaging technics in assessing laryngeal neoplasms]. / Ruolo delle tecniche ad immagini nella valutazione delle neoplasie del laringe.

In this work the most frequent malignant diseases of the larynx are been evaluated. The authors want to emphasize the importance of CT and MRI to perform a careful assessment of the disease to choose an adequate surgical therapy.

[Magnetic resonance in AIDS-related encephalopathy]. / La risonanza magnetica nella encefalopatia da AIDS.

Fifty-eight patients with AIDS disease were studied with MR imaging in the aim of detecting the grade of brain involvement. The examinations were performed with a 1.5 Tesla magnet. Thirty-seven showed white matter lesion (63.5%), twenty-five patients showed cerebral atrophy (43%), in eight patients the MR appearance was consistent with toxoplasmosis infection (13.5%), two patients showed a linfoma (3.4%) and two patients micrococcosis (3.4%). Seventeen out of the thirty-seven patients with white matter disease showed focal well circumscribed lesion (46%), while twenty showed diffuse involvement. Between the twenty-five patients with cerebral atrophy, twelve showed a prevalence of the cortical involvement and eight a subcortical atrophy. In five patients a concomitant, cortical and subcortical atrophy was found. Between the eight patients with neurotoxolesion and two of them a widespread encephalitis picture. The MR appearance of the two limphomas was that of periventricular, space occupying, masses. In two patients with micrococcis a nodular aspect of leptomeningeal lesions was found.

[Role of CT and MR in the assessment of lumbar degenerative disk disease]. / Ruolo della TC e della RM nella valutazione della patologia degenerativa discale lombare.

The application of CT and MR techniques for the evaluation of degenerative disease of lumbar disk is illustrated in this work. A critical review of the literature was done.

[Tumors of the temporal bone and the cerebellopontine angle. Diagnosis, characterization and assessment of extension by using imaging technics]. / Tumori dell'osso temporale e dell'angolo ponto-cerebellare. Diagnosi, caaratterizzazione e bilancio di estensione con le tecniche ad immagini.

We discuss in this paper the reliability of neuroimaging techniques in the diagnosis of neoplastic masses of the posterior-lateral skull base. We also discuss the role of TC and MRI in the evaluation of the extension pattern of these masses.

[Role of CT and MRI in the evaluation of tumoral pathology in the rhinopharynx, the parapharyngeal space and the masticatory apparatus]. / Ruolo della TC e della RM nella valutazione della patologia tumorale del rinofaringe, dello spazio parafaringeo e dello spazio masticatorio.

In this paper we discussed the usefulness of CT and MR imaging in the study of tumors of nasopharynx, paraphararyngeal space and masticatory space. We also stressed the role of the techniques in the characterization and in assessing the extension of these diseases.

Trials and tribulations of two-dimensional modeling for the Nooksack River, Washington

Computer modeling has been the basis for mapping floodplains for many years. Until now, most detailed floodplain maps have been based on results produced by one-dimensional steady-state computer models. New, faster computers have made it possible to develop two-dimensional models for river floodplains that give much more detailed flooding information. The purpose of developing a two-dimensional model of the lower Nooksack River was to create a better set of tools for long-term flood hazard management in Whatcom County. In the past, flooding along the river has been extremely costly. Unfortunately, regulations based on the existing floodplain mapping allow development in potentially hazardous areas

[Neoplastic involvement of the cranial base. Role of computerized tomography and magnetic resonance]. / Coinvolgimento neoplastico della base cranica. Ruolo della tomografia computerizzata e della risonanza magnetica.

We discussed in this paper the abilities and limits of CT Scan and MR Imaging in the diagnosis of skull base tumors. We stressed the role of computerized neuroimaging in the characterization and evaluation of the extension of these tumor masses involving the skull base.