Dual-source CT coronary angiography: prospective versus retrospective acquisition technique.

PURPOSE: The aim of our work was to compare image quality and radiation dose in a group of patients who underwent cardiac dual-source computed tomography (DSCT) with prospective electrocardiographic (ECG) gating with those of a control group studied with retrospective gating. MATERIALS AND METHODS: Sixty patients were randomly assigned to two groups of 30 individuals each. Patients with heart rates >70 bpm and body mass index (BMI) >30 kg/m(2) were excluded. Group A was examined with prospective ECG gating and group B with retrospective gating. The dose-length product (DLP) was recorded to calculate the radiation dose, whereas the effective dose was normalised to a standard 12-cm scan of the heart. RESULTS: Applying the best reconstruction interval, 98.6% of segments in the prospective group and 99.3% in the retrospective group were diagnostic. No significant difference (p>0.05) in image quality was observed between groups. Mean normalised radiation dose was 4.91 ± 0.4 mSv in the prospective-gating group and 14.62 mSv ± 4.36 in the retrospective-gating group (p<0.01). CONCLUSIONS: Coronary CT with prospective ECG gating, a standard feature on new scanners, allows for a significant reduction in radiation dose without causing any significant decrease in image quality or in the number of segments assessed. The prospective technique is thus recommended for patients with heart rates £70 bpm and BMI £30 kg/m(2).

Tailored Vessel-Catheter Diameter Ratio in a Direct Aspiration First-Pass Technique: Is It a Matter of Caliber?

BACKGROUND AND PURPOSE: The aspiration technique has gained a prominent role in mechanical thrombectomy. The thrombectomy goal is successful revascularization (modified TICI ≥ 2b) and first-pass effect. The purpose of this study was to evaluate the impact of the vessel-catheter ratio on the modified TICI ≥ 2b and first-pass effect. MATERIALS AND METHODS: This was a retrospective, single-center, cohort study. From January 2018 to April 2020, 111/206 (53.9%) were eligible after applying the exclusion criteria. Culprit vessel diameters were measured by 2 neuroradiologists, and the intraclass correlation coefficient was calculated. The receiver operating characteristic curve was used for assessing the vessel-catheter ratio cutoff for modified TICI ≥ 2b and the first-pass effect. Time to groin puncture and fibrinolysis were weighted using logistic regression. All possible intervals (interval size, 0.1; sliding interval, 0.01) of the vessel-catheter ratio were plotted, and the best and worst intervals were compared using the χ2 test. RESULTS: Modified TICI ≥ 2b outcome was achieved in 75/111 (67.5%), and first-pass effect was achieved in 53/75 (70.6%). The MCA diameter was 2.1 mm with an intraclass correlation coefficient of 0.92. The optimal vessel-catheter ratio cutoffs for modified TICI ≥ 2b were ≤1.51 (accuracy = 0.67; 95% CI, 0.58-0.76; P = 0.001), and for first-pass effect, they were significant (≤1.33; P = .31). The modified TICI ≥ 2b odds ratio and relative risk were 9.2 (95% CI, 2.4-36.2; P = 0.002) and 3.2 (95% CI, 1.2-8.7; P = .024). The odds ratio remained significant after logistic regression (7.4; 95% CI, 1.7-32.5; P = .008). First-pass effect odds ratio and relative risk were not significant (2.1 and 1.5; P > .05, respectively). The modified TICI ≥ 2b best and worst vessel-catheter ratio intervals were not significantly different (55.6% versus 85.7%, P = .12). The first-pass effect best vessel-catheter ratio interval was significantly higher compared with the worst one (78.6% versus 40.0%, P = .03). CONCLUSIONS: The aspiration catheter should be selected according to culprit vessel diameter. The optimal vessel-catheter ratio cutoffs were ≤1.51 for modified TICI ≥ 2b with an odds ratio of 9.2 and a relative risk of 3.2.

Preliminary experience with abdominal dual-energy CT (DECT): true versus virtual nonenhanced images of the liver.

PURPOSE: The aim of this work was to compare the quality and noise of true non-enhanced (TNE) and virtual non-enhanced (VNE) images in patients undergoing dual-energy computed tomography (DECT) of the liver. MATERIALS AND METHODS: Twenty consecutive patients (mean age 54.7±19.9 years) prospectively underwent abdominal DECT to assess the liver using a triphasic protocol consisting of precontrast, arterial-phase and portal-phase acquisitions. Exclusion criteria were allergy to iodinated contrast material, impaired renal function and a body mass index (BMI) >35 kg/m(2). The DE portal-phase acquisition was performed with automatic dose modulation (CARE Dose 4D). Nonionic iodinated contrast material (Iomeron 400) was administered at 0.625 gI/kg with a flow rate of 3.5 ml/s. Axial VNE images were reconstructed based on the portal data set using a collimation and an increment of 5 mm and were compared with TNE images reconstructed with the same parameters. The average image quality and noise were analysed by two radiologists in separate reading sessions. RESULTS: No statistically significant difference (p>0.05) in image quality was observed between VNE (4.00±0.85) and TNE images (4.35±0.58). A sufficient diagnostic quality was found in 95.0% (19/20) of VNE images and in 100% of TNE images. No statistically significant difference (p<0.05) was observed in the average image noise of VNE (9.5±0.7) and TNE (12.3±1.1) images. CONCLUSIONS: Abdominal DECT allows acquisition of liver VNE images with similar image quality and lower noise than TNE. Nevertheless, a few technical limitations related to the small field of view of the second detector in patients with a high BMI and heterogeneous iodine subtraction restrict the application of this technique to selected patients only.

Preoperative coronary risk assessment with dual-source CT in patients undergoing noncoronary cardiac surgery.

PURPOSE: The aim of our work was to assess the role of dual-source computed tomography (DSCT) in the preoperative evaluation of coronary artery disease in patients scheduled for noncoronary cardiac surgery. MATERIALS AND METHODS: One hundred patients were prospectively evaluated. Patients negative for coronary disease at DSCT (n=81) underwent surgery without coronary angiography. Patients positive for significant lesions or with nondiagnostic image quality due to artefacts or severe calcifications underwent coronary angiography (n=19) and were excluded from the study. In patients who underwent surgery with only a DSCT diagnosis, we evaluated the frequency of major adverse cardiac events (MACEs) during the perioperative period and at 3 months follow-up. RESULTS: No MACEs were recorded during the perioperative period; three noncardiac complications (one surgical revision for bleeding, one cardiac tamponade and one respiratory insufficiency) and one death related to severe respiratory insufficiency were observed. None of the 80 patients had MACEs during the 3-month follow-up period. CONCLUSIONS: Coronary evaluation with DSCT is able to rule out the presence of coronary disease in patients scheduled for cardiac surgery, without the need for coronary angiography confirmation. Patients with significant stenosis or nondiagnostic image quality should be referred for coronary angiography.

Male/female ratio in centenarians: a possible role played by population genetic structure.

All the demographic surveys on the centenarians have highlighted that females outnumber males. The centenarians' male/female (M/F) ratio reported by most studies ranges between 1:4 and 1:7. A puzzling 1:2 ratio was observed in Calabria, a Southern Italian region. To our knowledge only in Sardinia a similar phenomenon had been previously observed. We have therefore used the data of the Italian Institute of Statistics to figure out the centenarians' M/F ratio in the Italian regions. We found that this ratio gradually decreases from South to North. Such a result is certainly due to many factors. Thus, we have explored the possibility, it is also influenced by the genetic structure of the Italian population. In fact, the distribution of the centenarians' M/F ratio turned out to be significantly correlated with the genetic structure of the Italian population as outlined by the principal component analysis.

DiGeorge anomaly with renal agenesis in infants of mothers with diabetes.

We report on 2 infants with the DiGeorge anomaly born to diabetic mothers treated with insulin. Both infants had unilateral renal agenesis. One of the mothers has manifestations suggestive of velo-cardio-facial syndrome (VCFS). Cytogenetic studies on both patients and the mother with apparent VCFS were normal. Molecular studies utilizing probes from the DiGeorge critical region did not demonstrate a 22q11 microdeletion in either patient or the mother with apparent VCFS. We conclude that maternal diabetes is a pathogenetic factor in the DiGeorge anomaly, and infants of diabetic mothers who have this anomaly should also be screened for renal agenesis.

Atrial rupture in a child from cardiac massage by his parent.

A 4-year-old boy presented with a single seizure following a viral syndrome. He had a pericardial effusion on admission, and this increased suddenly on the third day of hospitalization, producing cardiac tamponade. After blood was aspirated from the child's pericardial cavity, the father revealed that he performed cardiac massage on his son following the seizure. A laceration of the right atrium was repaired at operation, and the boy made a good recovery. Cardiopulmonary resuscitation by lay persons is not without hazard, and patients with such a history should be watched carefully for the possibility of damage to intrathoracic structures.

Presence and indigenous nature of Lyme disease in southern Italy.

Lyme disease is very common in the countries of the northern hemisphere. In Italy it is endemic in some regions of the northern part of the country and it is more frequent during summer. In Calabria (south Italy) no cases have been reported. To document the presence and indigenous nature of Lyme disease in this territory we conducted a study from 1999 to 2002. We defined as indigenous cases those with erythema migrans with the following characteristics: dimensions equal to or greater than 5 cm; localization on an area of the skin where there was a tick bite; appearance between 4 and 30 days after the tick bite; appearance in patients who had not resided out of Calabria in the previous 3 months. We found 23 patients with the necessary characteristics to be defined indigenous cases. Since 15 of these cases (65.2%) were observed in the October - December trimester and no case was found in the July - September trimester, we suspect that in Calabria the disease follows a seasonal distribution which differs with respect to countries where it is historically endemic.

Initial fluid therapy for children with meningitis with consideration of the syndrome of inappropriate anti-diuretic hormone.

A review of 85 children with meningitis admitted to the University Children's Hospital at Hermann Hospital revealed that only six patients (7%) had sufficient clinical and laboratory evidence to be compatible with the diagnosis of inappropriate secretion of antidiuretic hormone (SIADH). This is in contrast with various communications in the pediatric literature that have reported an association between the two conditions of as high as 85%. Hyponatremia (serum sodium 135 mEq/L) was observed in 27 (32%), but neither the initial laboratory data nor the subsequent follow-up data supported the diagnosis of SIADH. Moderate to severe dehydration was documented in 16 patients (19%) and suspected in more than 50% of the cases (serial weight determinations indicating an increase in weight from admission to discharge). Although the incidence of neurologic sequelae in this series was not influenced significantly by the presence or absence of hyponatremia, SIADH, or fluid restriction, the numbers are still small. Based on these data, routine fluid restriction cannot be recommended unless there is confirmatory evidence of SIADH.

[Ketanserin and metoprolol in the treatment of essential hypertension]. / Ketanserina e metoprololo nel trattamento dell'ipertensione essenziale.

In a controlled clinical study, 30 adult patients (16 females, 14 males, mean age 46.0 +/- 7.6, mean body weight 69.4 +/- 10.2 kg) with mild-moderate essential hypertension were treated with ketanserin (20 mg twice daily) or metoprolol (100 mg daily) for the first month and 40 mg twice daily or 100 mg twice daily during the second month. Results showed antihypertensive efficacy and systemic tolerability of ketanserin to be equal to that of metoprolol and better cardiac tolerance for ketanserin.

[Angiomyofibroblastoma of the spermatic funiculus. A case report of this lesion of the spermatic funiculus].

The authors are hereby presenting a rare case of angiomyofibroblastoma of the funiculus in a 20-year-old patient, having a non-aching tumefaction at the left region of the scrotum. This tumefaction was solid and non homogeneous, both on ultrasonography and MRI, of about 5cm in diameter, fully separated from the testicle. The markers were all negative. We proceeded with surgical treatment of the neoformation. It is mandatory to include this lesion within the differential diagnosis of testicle masses. The case is presented for its absolute histopathologic rarity and for the difficulty in diagnosis.

Experimental phase synchronization of a chaotic convective flow.

We report experimental evidence of phase synchronization of high dimensional chaotic oscillators in a laboratory experiment. The experiment consists of a thermocapillary driven convective cell in a time dependent chaotic regime. The synchronized states emerge as a consequence of a localized temperature perturbation to the heater. The transition to phase synchronization is studied as a function of the external perturbations. The existence and stability conditions for this phenomenon are discussed.

Aortic valve injury 10 years after tetralogy of Fallot repair.

Although recognized by pediatric cardiac surgeons, aortic insufficiency as a technical complication after tetralogy of Fallot repair is poorly documented, especially if it occurs late. The case of a boy with aortic insufficiency 10 years after complete tetralogy repair is described. No documentation in the literature other than summary statements in textbooks of this occurrence was found.

[The computed tomographic semeiotics of rhino-sinusal inflammatory pathology]. / Semeiotica della patologia flogistica rino-sinusale con Tomografia Computerizzata.

Recent advances in "functional" endoscopic surgical techniques require the radiologist to understand the anatomy and pathophysiology of the nose and paranasal sinuses as well as their normal and abnormal CT patterns. Endoscopy and CT are complementary procedures, but in the evaluation of the extent of chronic inflammation and in the demonstration of possible associated local and regional complications, the latter method has become the imaging technique of choice, providing a detailed map for the functional sinus surgeon and replacing plain radiography. The authors reviewed a personal series of 322 coronal thin-slice CT examinations of the paranasal sinuses relative to 169 patients with chronic or acute sinusitis and polyposis. The main CT findings of sinusitis (mucosal thickening, fluid retention, mucous cysts, bone alterations, mucoceles and polyposis) and their complications are reported. Finally, ostiomeatal conditions are considered, particularly the obstruction of ducts and ostia which provide aeration and mucous clearance from the paranasal sinuses.

Spontaneous hemoperitoneum from a giant multicystic hemangioma of the liver: a case report.

We describe a rare case of hemoperitoneum due to spontaneous rupture of a giant cavernous hemangioma of the liver. CT demonstrated both the intraperitoneal hemorrhage and the hepatic lesion, which showed an atypical multicystic appearance. Furthermore, CT showed the site of rupture of the hemangioma.

MRI T-staging of laryngeal tumours: role of contrast medium.

Our aim was to evaluate the relative diagnostic accuracy of MRI without contrast medium and MRI before and after contrast medium in the assessment of T-staging of laryngeal tumours. We studied 25 men (mean age 51.8, range 41-61) with laryngeal squamous cell carcinomas, using Spin-echo (SE) T1-weighted and fast SE T2-weighted sequences. The T1-weighted sequences were then repeated after gadolinium-diethylene-triaminepenta-acetic acid (Gd DTPA) 0.1 ml/kg. All patients then underwent biopsy and surgery. Two radiologists independently assessed the anonymised images by filling-out two multiple-choice forms, one for each technique, at a 2 week interval. The forms included a judgement concerning tumour identification and infiltration of the anterior commissure, supraglottic region, arytenoid cartilage, Morgagni's ventricle, paraglottic space, thyroid and cricoid cartilages, thyro-hyo-epiglottic space, vocal cords, subglottic region, and epiglottis. Similar forms were filled out by the surgeon and the pathologist after surgery. The sensitivity, specificity and diagnostic accuracy of MRI were unaffected by the use of contrast medium. Since it did not provide additional staging information, its continued routine use in these cases is not justified.

[Computerized tomography in the assessment of obstructive jaundice caused by hepatic hydatid cysts]. / La Tomografia Computerizzata nella valutazione dell'ittero ostruttivo determinato da cisti idatidee epatiche.

This paper reports on the CT findings of obstructive jaundice caused by hydatid cysts of the liver, which are an unusual event occurring in 5-10% of cases. Thus, only a few reports can be found in the literature dealing with the CT features of this syndrome. Eight patients with obstructive jaundice were selected from 87 patients with hydatid disease of the liver and examined with CT. The CT diagnosis of rupture into the largest bile ducts is based upon the demonstration of hepatic hydatid cysts together with intrabiliary hydatid sand, membranes and scolices and/or the identification of parietal discontinuity with communication between the cyst and the biliary tree. Rupture into the largest bile ducts was demonstrated in 7 patients. The following CT patterns were observed: 1) intrahepatic biliary tract dilatation (all cases); 2) extrahepatic biliary tract dilatation (6 cases); 3) cyst wall interruption (5 cases--in 3 of them the communication between the cyst and the dilated bile duct was demonstrated); 4) daughter cysts, fragmented membranes or hydatid sand in the biliary tree (5 cases); 5) hydatid material in the gallbladder (1 case) and, finally, disappearance of the daughter cyst visible on a previous CT examination (1 case). In another patient, the diagnosis of compressive jaundice without biliary communication was suggested because a bulky hydatid cyst was found near the hilum of liver. CT findings were confirmed with ERCP or at surgery. CT failed to reveal small tears with minute biliary radicles, which are usually asymptomatic, whose diagnosis could be made only with preoperative cholangiography. Hydatid cysts of the liver can cause obstructive jaundice because of main bile duct compression or of large bile duct perforation with consequent passage of hydatid material into the biliary tree. This complication should be promptly managed surgically to avoid potentially fatal complications, which makes a preoperative diagnosis essential.

Air-space pattern in lung metastasis from adenocarcinoma of the GI tract.

PURPOSE: We retrospectively reviewed a series of proven lung metastasis to evaluate the frequency and CT features of metastases showing an air-space (lepidic) pattern of growth. METHOD: CT examinations of 65 patients with proven lung metastasis from GI carcinomas were reviewed by three observers. Four CT features were used to classify lesions as air-space metastases: (a) air-space nodules; (b) parenchymal consolidation containing air bronchogram and/or showing angiogram sign; (c) focal or extensive ground-glass opacities; and (d) nodules(s) with a "halo" sign. RESULTS: Six of 65 patients showed air-space metastases: three from pancreatic carcinoma, two from colonic carcinoma, and one from jejunal carcinoma. In one case, metastasis appeared as extensive parenchymal consolidation associated with ground-glass opacities; in one as an area of ground-glass opacity; in one as an extensive parenchymal consolidation with air bronchogram; in one as parenchymal consolidations with angiogram sign and multiple nodules, some of these with halo sign; in one as air-space nodules and patchy air-space consolidations; and in one as a solitary nodule with halo sign. CONCLUSION: Our study shows that air-space lung metastasis from GI carcinomas is uncommon but not rare. On CT as well as microscopically, differential diagnosis between air-space metastasis and bronchioloalveolar carcinoma may be impossible.