[Actual role of MR in the small bowel studies: dynamic sequences and bowel distension]. / Attuali possibilità della RM nello studio dell'intestino tenue: sequenze dinamiche e distensione digiuno-ileale.

Magnetic resonance (MR) is even more becoming important in the evaluation of the small bowel, thanks to the technologic advances of the machines and thanks to the improvement of specific diagnostic protocols of study. MR is a pivotal in identifying acute stenosis and alterations of the bowel wall and in differentiating between inflammatory and fibrotic alterations. Diffusion techniques and dynamic MRI allows the assessment of the degree of disease activity of IBD, although nuclear medicine represents the gold standard.

[Role of nuclear imaging in the management and follow-up of patients with inflammatory bowel disease]. / Ruolo delle tecniche di medicina nucleare nella programmazione terapeutica e nel follow-up della malattia infiammatoria intestinale.

The modern approach to diagnostic imaging includes multimodal evaluation of patients. Physician knowledge of the clinical potential of each available imaging technique combined with efficient integration of functional and morphological data is mandatory in order to achieve a timely diagnosis and treatment, and to avoid unnecessary invasive examinations. Recent years have witnessed important advances in nuclear medicine techniques, including the development of a great variety of metabolic tracers that allow accurate detection, characterization and staging of diverse disease states other than neoplastic conditions. Nuclear medicine techniques play an important role in the diagnostic evaluation of different forms of inflammatory bowel disease (Crohn's disease, ulcerative rettocolitis, indeterminate colitis), and can provide optimal anatomo-functional information when used in association with multidetector CT and MRI, enabling tailored therapeutic interventions.

[Striatal dopamine transporter levels in patients with REM sleep behavior disorder: assessment with 123I-FP-CIT SPECT]. / Livelli striatali del trasportatore della dopamina nei pazienti affetti da disturbo comportamentale del sonno REM: uno studio SPECT con 123I-FP-CIT.

REM sleep Behaviour Disorder (RBD) is a sleep disorder that can precedes the development of motor signs of Parkinson's disease by years. The aim of this study was to assess the functional integrity of nigrostriatal dopaminergic system in RBD patients using 123I-2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) Single-Photon Emission Computed Tomography (SPECT). 5 patients with RBD and 5 normal healthy controls were included in the study and underwent SPECT imaging 3 hours after injection of 111-185 MBq of 123I-FP-CIT. All RBD patients showed reduced 123I-FP-CIT striatal binding. 123I-FP-CIT SPECT is a useful diagnostic tool in RBD patients.

[Posterior reversible encephalopathy syndrome: description of a case in the setting of severe infection]. / Encefalopatia posteriore reversibile: descrizione di un caso associato a stato infettivo.

Posterior reversible encephalopathy syndrome (PRES) is a well recognized neurotoxic state coupled with a unique neuroradiological appearance. This syndrome is associated with a broad spectrum of complex conditions (preeclampsia/eclampsia, bone marrow/organ transplantation, chemotherapy, autoimmune disease). We report the case of a female patient who developed PRES in the setting of severe infection, and we discuss the possible mechanisms underlying the development of cerebral edema by describing the inherent neuroradiological features.

[Perineural tumor spread from the ophthalmic branch of the trigeminal nerve: a case report]. / Metastasi perineurale della branca oftalmica del trigemino: descrizione di un caso.

Perineural tumor spread of head and neck malignancies is a well known form of metastatic disease in which a lesion can migrate away from the primary site along the cranial nerves. Nerve function can be preserved even in advanced stages of the disease, making neuroradiological assessment of perineural tumor location and extension of utmost importance, as radiological or pathological examination may reveal normal or nonspecific nerve function. Computed Tomography is useful in detecting foraminal enlargement or more destructive bone patterns. Magnetic Resonance imaging is the modality of choice because it can provide direct (nerve enlargement and enhancement) and indirect evidence of the disease (neuropathic muscular atrophy, obliteration of fat planes) owing to its superior soft-tissue contrast resolution, its multiplanar imaging and the decreased amount artifacts from dental hardware. Fat suppression images after contrast injection are mandatory to better detect nerve enhancement. We report the case of a female patient with perineural diffusion along the ophthalmic branch. This clinical picture is very rare, compared to those involving the mandibular and maxillary branches of the fifth cranial nerve.

[Role of imaging techniques in the evaluation of chyluria]. / Chiluria notturna: ruolo della diagnostica per immagini.

Lymphoscintigraphy is a first-line imaging technique for the assessment of abnormal lymphatic drainage in chyluria. It can provide information about the site of origin of chyluria, and may be helpful in selecting patients for surgery and assessing treatment efficacy. We report the case of a 59-year-old male with chyluria correctly diagnosed with lymphoscintigraphy.

[Evaluation of the small bowel with computed tomography enteroclysis: technical applications and clinical indications]. / La valutazione del piccolo intestino con radiologia computerizzata: l'enteroclisi TC. Tecnica di esecuzione ed indicazioni cliniche.

CT enteroclysis is an imaging technique that allows better visualization of the small bowel than standard abdomino-pelvic CT. It is more accurate than CT enterography and provides complementary diagnostic information to digestive endoscopy. Multiplanar reconstruction allows better evaluation of the diseases arising from the small bowel wall, or from surrounding organs, resulting in increased accuracy and effectiveness of this imaging technique. CT enteroclysis often enables a comprehensive assessment of small bowel disease, allowing a definite diagnosis and characterization of intestinal bowel disease, or of other related pathological conditions.

[Lymphoscintigrams with anatomical landmarks obtained with vector graphics]. / Linfoscintigrafie distrettuali e whole body associate a profilo anatomico modificabile, prodotte con tecnica vettoriale.

Nuclear medicine images are difficult to interpret because they do not include anatomical details. The aim of this study was to obtain lymphoscintigrams with anatomical landmarks that could be easily interpreted by General Physicians. Traditional lymphoscintigrams were processed with Adobe© Photoshop® CS6 and converted into vector images created by Illustrator®. The combination with a silhouette vector improved image interpretation, without resulting in longer radiation exposure or acquisition times.

[Peritoneal carcinomatosis from ovarian cancer: role of 18F-FDG-PET/CT and CA125]. / La carcinosi peritoneale da carcinoma ovarico: utilità della 18F-FDG-PET/TC e del biomarker CA125.

The purpose of this study was to evaluate the contribution of 18F-FDG-PET/CT in highlighting the peritoneal involvement in patients with ovarian cancer, also in relation to the biomarker CA125. We retrospectively analyzed 64 female patients with histological diagnosis of ovarian cancer who underwent 18F-FDG-PET/CT and CA125 measurement. Sensitivity and specificity of 18F-FDG-PET/CT were both 90.63% (95% CI: 80-100%). Sensitivity and specificity of CA125 were 93.33% (95% CI: 80-100%) and 33.33% (95% CI: 25-64%), respectively. In patients with peritoneal carcinomatosis from ovarian cancer, it is recommended to perform 18F-FDG-PET/CT, in particular when elevated CA125 levels are detected.

[Role of CT in the preoperative diagnosis of a giant benign solitary fibrous tumor of the pleura]. / Ruolo della TC nella diagnosi preoperatoria del tumore solitario fibroso gigante della pleura.

The authors emphasize the role of CT in the preoperative diagnosis of a giant benign solitary fibrous tumor of the pleura. CT can provide evidence of complete resection of the lesion, showing a pedunculated stalk. Aspiration cytology is not a reliable diagnostic approach.

[Atypical appearance of pneumatosis intestinalis at multidetector CT]. / Aspetto atipico della pneumatosi intestinale in TC multidetettore.

Pneumatosis intestinalis may be caused by bowel ischemia and may display different patterns of appearance. We report a case of pneumatosis intestinalis with an atypical target pattern, detected by multidetector computed tomography (CT) in a 66-year-old male presenting with acute abdominal syndrome. Abdominal CT scan showed a double gas collection within the wall of a jejunal segment, with a characteristic target air distribution. The patient was surgically treated and successfully discharged from our hospital with the diagnosis of acute bowel ischemia. The target air sign can be an initial CT finding of the typical pneumatosis intestinalis and it can be useful in the early diagnosis of bowel ischemia.

The Role of Multiparametric Magnetic Resonance in Volumetric Modulated Arc Radiation Therapy Planning for Prostate Cancer Recurrence After Radical Prostatectomy: A Pilot Study.

BACKGROUND AND PURPOSE: Volumetric modulated arc radiotherapy (RT) has become pivotal in the treatment of prostate cancer recurrence (RPC) to optimize dose distribution and minimize toxicity, thanks to the high-precision delineation of prostate bed contours and organs at risk (OARs) under multiparametric magnetic resonance (mpMRI) guidance. We aimed to assess the role of pre-treatment mpMRI in ensuring target volume coverage and normal tissue sparing. MATERIAL AND METHODS: Patients with post-prostatectomy RPC eligible for salvage RT were prospectively recruited to this pilot study. Image registration between planning CT scan and T2w pre-treatment mpMRI was performed. Two sets of volumes were outlined, and DWI images/ADC maps were used to facilitate precise gross tumor volume (GTV) delineation on morphological MRI scans. Two rival plans (mpMRI-based or not) were drawn up. RESULTS: Ten patients with evidence of RPC after prostatectomy were eligible. Preliminary data showed lower mpMRI-based clinical target volumes than CT-based RT planning (p = 0.0003): median volume difference 17.5 cm3. There were no differences in the boost volume coverage nor the dose delivered to the femoral heads and penile bulb, but median rectal and bladder V70Gy was 4% less (p = 0.005 and p = 0.210, respectively) for mpMRI-based segmentation. CONCLUSIONS: mpMRI provides high-precision target delineation and improves the accuracy of RT planning for post-prostatectomy RPC, ensures better volume coverage with better OARs sparing and allows non-homogeneous dose distribution, with an aggressive dose escalation to the GTV. Randomized phase III trials and wider datasets are needed to fully assess the role of mpMRI in optimizing therapeutic strategies.

Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.

BACKGROUND: To evaluate the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis in comparison with other imaging modalities. METHODS: The authors performed a search of the Medline/ PubMed (National Library of Medicine, Bethesda, Maryland) for original research and review publications examining the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis. The search design utilized a single or combination of the following terms : (1) acute cholecystitis, (2) ultrasonography, (3) computed tomography, (4) magnetic resonance cholangiopancreatography and (5) cholescintigraphy. This review was restricted to human studies and to English-language literature. Four authors reviewed all the titles and subsequent the abstract of 198 articles that appeared appropriate. Other articles were recognized by reviewing the reference lists of significant papers. Finally, the full text of 31 papers was reviewed. RESULTS: Sonography is still used as the initial imaging technique for evaluating patients with suspected acute calculous cholecystitis because of its high sensitivity at the detection of GB stones, its real-time character, and its speed and portability. Cholescintigraphy still has the highest sensitivity and specificity in patients who are suspected of having acute cholecystitis. However, due to a combination of reasons including logistic drawbacks, broad imaging capability and clinician referral pattern the use of cholescintigraphy is limited in clinical practice. CT is particularly useful for evaluating the many complications of acute calculous cholecystitis. The lack of widespread availability of MRI and the relatively high cost prohibits its primary use in patients with acute calculous cholecystitis. CONCLUSIONS: US is currently considered the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis.